PMID- 33222365
OWN - NLM
STAT- MEDLINE
DCOM- 20210820
LR  - 20210820
IS  - 1463-1318 (Electronic)
IS  - 1462-8910 (Linking)
VI  - 23
IP  - 4
DP  - 2021 Apr
TI  - High failure rates following ligation of the intersphincteric fistula tract for 
      transsphincteric anal fistulas: are preoperative MRI measurements of the fistula 
      tract predictive of outcome?
PG  - 932-936
LID - 10.1111/codi.15452 [doi]
AB  - AIM: Treatment of transsphincteric fistulas (TSFs) with fistulotomy after an 
      indwelling seton is tempered by risks of incontinence and litigation. Thus, 
      ligation of the TSF tract has been popularized as an alternative option. We 
      previously reported on 107 patients who underwent ligation of the 
      intersphincteric fistula tract (LIFT), with a 46% failure rate. Posterior fistula 
      was the only predictor of recurrence. The aim of the present work was to 
      investigate whether the length, width or depth of the fistula measured on 
      preoperative MRI was correlated with recurrence. METHOD: Following institutional 
      review board approval, a retrospective analysis of our prospective Complex Anal 
      Fistula Database from 1 January 2011 to 31 August 2019 was performed. Patients 
      with TSF who underwent preoperative MRI and LIFT were included. Fistula location 
      was classified as anterior, posterior or lateral. MRI measurements of fistula 
      length, width and depth (in the intersphincteric groove) were performed. The type 
      and rate of postoperative recurrence were analysed. RESULTS: 173 patients 
      underwent MRI for an anal fistula; of these 40 underwent LIFT and 22/40 (55%) had 
      preoperative MRI. There was no difference in the length, width or depth of 
      anterior (n = 9), posterior (n = 7) or lateral (n = 6) fistula tracts. The 
      overall recurrence rate was 9/22 (41%). Posterior TSFs had the highest recurrence 
      rate (5/7, 71%). CONCLUSION: The mean length, width, and depth of the fistula 
      tract, measured at the preoperative site of LIFT in the intersphincteric groove, 
      did not correlate with recurrence regardless of fistula location.
CI  - (c) 2020 The Association of Coloproctology of Great Britain and Ireland.
FAU - Sarmiento-Cobos, Mauricio
AU  - Sarmiento-Cobos M
AD  - Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
FAU - Rosen, Lester
AU  - Rosen L
AD  - Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
FAU - Wasser, Elliot
AU  - Wasser E
AD  - Department of Radiology, Cleveland Clinic Florida, Weston, Florida, USA.
FAU - Yang, Feng
AU  - Yang F
AD  - Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
FAU - Wexner, Steven D
AU  - Wexner SD
AD  - Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
LA  - eng
PT  - Journal Article
DEP - 20201204
PL  - England
TA  - Colorectal Dis
JT  - Colorectal disease : the official journal of the Association of Coloproctology of 
      Great Britain and Ireland
JID - 100883611
SB  - IM
MH  - Anal Canal/diagnostic imaging/surgery
MH  - Humans
MH  - Ligation
MH  - Magnetic Resonance Imaging
MH  - Prospective Studies
MH  - *Rectal Fistula/diagnostic imaging/etiology/surgery
MH  - Recurrence
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - LIFT
OT  - MRI
OT  - recurrence
OT  - transsphincteric fistula
EDAT- 2020/11/23 06:00
MHDA- 2021/08/21 06:00
CRDT- 2020/11/22 20:48
PHST- 2020/10/29 00:00 [revised]
PHST- 2020/09/23 00:00 [received]
PHST- 2020/11/01 00:00 [accepted]
PHST- 2020/11/23 06:00 [pubmed]
PHST- 2021/08/21 06:00 [medline]
PHST- 2020/11/22 20:48 [entrez]
AID - 10.1111/codi.15452 [doi]
PST - ppublish
SO  - Colorectal Dis. 2021 Apr;23(4):932-936. doi: 10.1111/codi.15452. Epub 2020 Dec 4.