Broadly,complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing,prevent recurrences and maintain continence. The risk of i...Broadly,complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing,prevent recurrences and maintain continence. The risk of incontinence associated with treatment ranges from10% to 57%. The objective of this manuscript is to review the current literature to date on the ligation of the intersphincteric fistula tract procedure(LIFT procedure) as a treatment option in these types of fistula.A search was conducted in Medline,PUBMED,EMBASE and ISI Web of Knowledge,and studies published from January 2009 to May 2013 were included. The primary outcomes were fistula healing rates,mean healing time and patient satisfaction with this surgical technique.Eighteen studies were included in this review. The total number of patients included was 592(65% male).The median age reported was 42.8 years. The most common type of fistula included was transsphincteric(73.3% of cases). The mean healing rate reported was74.6%. The risk factors for failure discovered were obesity,smoking,multiple previous surgeries and the length of the fistula tract. The mean healing time was5.5 wk,and the mean follow-up period was 42.3 wk.The patient satisfaction rates ranged from 72% to 100%. No de novo incontinence developed secondary to the LIFT procedure. There is not enough evidence that variants in the surgical technique achieve better outcomes(Bio-LIFT,LIFT-Plug,LIFT-Plus). This review indicates that the LIFT procedure is primarily effective for transsphincteric fistulas with an overall fistula closure of 74.6% and has a low impact on fecal continence. This procedure produces better outcomes at the first surgical attempt.展开更多
Complex anal fistulas are difficult to treat.The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement.Due to this,several sphincter-sp...Complex anal fistulas are difficult to treat.The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement.Due to this,several sphincter-sparing procedures have been developed in the last two decades.Though moderately successful in simple fistulas(50%-75%healing rate),the healing rates in complex fistulas for most of these procedures has been dismal.Only two procedures,ligation of intersphincteric fistula tract and transanal opening of intersphincteric space have been shown to have good success rates in complex fistulas(60%-95%).Both of these procedures preserve continence while achieving high success rates.In this opinion review,I shall outline the history,compare the pros and cons,indications and contraindications and future application of both these procedures for the management of complex anal fistulas.展开更多
Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of conti...Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.展开更多
目的探讨经括约肌间瘘管结扎(ligation of intersphincteric fistula tract,LIFT)术治疗低位单纯性肛瘘的临床疗效。方法选取2020年2月至2023年2月连云港市东海县中医院收治的低位单纯性肛瘘患者46例。采用随机数字表法分为对照组和观察...目的探讨经括约肌间瘘管结扎(ligation of intersphincteric fistula tract,LIFT)术治疗低位单纯性肛瘘的临床疗效。方法选取2020年2月至2023年2月连云港市东海县中医院收治的低位单纯性肛瘘患者46例。采用随机数字表法分为对照组和观察组,各23例。对照组采用传统肛瘘切开术,观察组采用LIFT术,比较两组患者的临床疗效及术后恢复情况。结果两组患者总有效率无显著差异(P=0.310)。观察组患者创面愈合时间、住院时长均短于对照组,视觉模拟评分法评分低于对照组,差异均有显著性(P<0.05)。两组患者术前肛门失禁Wexner评分无显著差异,术后1个月、术后3个月,观察组患者肛门失禁Wexner评分均较对照组低,差异有显著性(P<0.05)。结论LIFT术治疗低位单纯性肛瘘,能够在一定程度上减轻患者痛苦,保留患者括约肌功能,患者恢复更快。展开更多
Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears th...Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.展开更多
目的探讨经直肠推移瓣术(endorectal advancement flap,ERAF)联合括约肌间瘘结扎术(ligation of the intersphincteric fistula tract,LIFT)治疗高位单纯型肛瘘的临床疗效。方法选取2022年3—9月北京市肛肠医院(北京市二龙路医院)高位...目的探讨经直肠推移瓣术(endorectal advancement flap,ERAF)联合括约肌间瘘结扎术(ligation of the intersphincteric fistula tract,LIFT)治疗高位单纯型肛瘘的临床疗效。方法选取2022年3—9月北京市肛肠医院(北京市二龙路医院)高位单纯型肛瘘住院患者84例,按照随机数字表法分为观察组和对照组,每组42例。观察组采用ERAF联合LIFT,对照组采用传统切除挂线术。比较治疗后两组视觉模拟评分(visual analogue scale,VAS)、临床疗效及并发症情况。结果84例患者中,男58例、女26例,年龄27~59岁,平均(32.6±6.8)岁。观察组术后第1天、第3天、第7天的VAS低于对照组[(5.24±1.08)分比(7.19±1.35)分,(4.76±1.11)分比(6.21±1.09)分,(2.34±0.54)分比(2.98±0.61)分],出血量、住院时间及伤口愈合时间低于对照组[(7.83±1.62)ml比(12.66±2.46)ml,(3.75±1.66)d比(4.55±1.71)d,(28.15±8.65)d比(39.12±10.23)d],术后2个月Wexner评分及肛管收缩压低于对照组[(3.28±0.63)分比(4.46±0.75)分,(178.49±8.82)mmHg比(186.22±10.29)mmHg,1 mmHg=0.133 kPa],肛管静息压高于对照组[(45.88±2.87)mmHg比(43.85±1.74)mmHg],并发症发生率低于对照组(11.90%比33.33%),差异均有统计学意义(P<0.05);两组手术时间的比较,差异无统计学意义(P>0.05)。结论相较于传统肛瘘切除挂线术,ERAF联合LIFT具有患者出血量少、痛苦小、病程短、恢复快等优点,值得临床推广。展开更多
目的评价经括约肌间瘘管结扎术(ligation of the intersphincteric fistula tract,LIFT)联合直肠推移瓣术(endorectal advancement flap,ERAF)治疗高位复杂性肛瘘的临床疗效。方法2016年8月~2021年12月我院收治的高位复杂性肛瘘病人40例...目的评价经括约肌间瘘管结扎术(ligation of the intersphincteric fistula tract,LIFT)联合直肠推移瓣术(endorectal advancement flap,ERAF)治疗高位复杂性肛瘘的临床疗效。方法2016年8月~2021年12月我院收治的高位复杂性肛瘘病人40例,根据抽签法随机分成试验组和对照组,每组各20例。试验组采用LITF+ERAF,对照组采用LIFT,随访6~12个月,比较其临床疗效,比较创面愈合时间、治愈率、术后第1天疼痛程度、肛门功能和复发率。结果两组术后第1天疼痛程度、创面愈合时间、治愈率比较差异无统计学意义(P>0.05)。两组术前、创面愈合后、术后6个月的Wexner肛门失禁评分、肛管静息压和肛管最大收缩压比较差异无统计学意义(P>0.05);两组创面愈合后、术后6个月的肛管静息压和肛管最大收缩压分别与其自身术前比较,差异有统计学意义(P<0.05)。随访6~12个月,试验组无复发,对照组复发3例,差异有统计学意义(P<0.05)。结论LITF联合ERAF疗效好、痛苦小、病程短、术后复发率低、肛门功能影响小。展开更多
目的研究单纯性经括约肌型肛瘘的手术改良方案,并探讨其应用价值,以指导临床疾病的治疗。方法选取2013年1月~2015年1月于我院接受治疗的单纯性经括约肌型肛瘘患者56例,随机均分为两组：对照组行经括约肌间瘘管结扎术（ligation of the i...目的研究单纯性经括约肌型肛瘘的手术改良方案,并探讨其应用价值,以指导临床疾病的治疗。方法选取2013年1月~2015年1月于我院接受治疗的单纯性经括约肌型肛瘘患者56例,随机均分为两组：对照组行经括约肌间瘘管结扎术（ligation of the intersphinctericfistula tract,LIFT术）,观察组行改良LIFT术治疗。比较两组手术时间、术后疼痛评分、术后住院时间、肛瘘治愈率,随访统计手术前及手术后3个月时患者肛管静息压及最大收缩压变化。结果观察组治愈率明显高于对照组,差异有统计学意义（P〈0.05）;两组手术时间、术后疼痛评分、术后住院时间、手术前及手术3个月后肛管静息压及最大收缩压接近,差异无统计学意义（P〉0.05）。结论改良LIFT术能在保证手术效果及肛门功能的基础上,显著提升单纯性经括约肌型肛瘘的治愈率,值得推广。展开更多
文摘Broadly,complex fistulas are those that are not low transsphincteric or intersphincteric. The objectives of surgical management are to achieve fistula healing,prevent recurrences and maintain continence. The risk of incontinence associated with treatment ranges from10% to 57%. The objective of this manuscript is to review the current literature to date on the ligation of the intersphincteric fistula tract procedure(LIFT procedure) as a treatment option in these types of fistula.A search was conducted in Medline,PUBMED,EMBASE and ISI Web of Knowledge,and studies published from January 2009 to May 2013 were included. The primary outcomes were fistula healing rates,mean healing time and patient satisfaction with this surgical technique.Eighteen studies were included in this review. The total number of patients included was 592(65% male).The median age reported was 42.8 years. The most common type of fistula included was transsphincteric(73.3% of cases). The mean healing rate reported was74.6%. The risk factors for failure discovered were obesity,smoking,multiple previous surgeries and the length of the fistula tract. The mean healing time was5.5 wk,and the mean follow-up period was 42.3 wk.The patient satisfaction rates ranged from 72% to 100%. No de novo incontinence developed secondary to the LIFT procedure. There is not enough evidence that variants in the surgical technique achieve better outcomes(Bio-LIFT,LIFT-Plug,LIFT-Plus). This review indicates that the LIFT procedure is primarily effective for transsphincteric fistulas with an overall fistula closure of 74.6% and has a low impact on fecal continence. This procedure produces better outcomes at the first surgical attempt.
文摘Complex anal fistulas are difficult to treat.The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement.Due to this,several sphincter-sparing procedures have been developed in the last two decades.Though moderately successful in simple fistulas(50%-75%healing rate),the healing rates in complex fistulas for most of these procedures has been dismal.Only two procedures,ligation of intersphincteric fistula tract and transanal opening of intersphincteric space have been shown to have good success rates in complex fistulas(60%-95%).Both of these procedures preserve continence while achieving high success rates.In this opinion review,I shall outline the history,compare the pros and cons,indications and contraindications and future application of both these procedures for the management of complex anal fistulas.
文摘Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.
文摘目的探讨经括约肌间瘘管结扎(ligation of intersphincteric fistula tract,LIFT)术治疗低位单纯性肛瘘的临床疗效。方法选取2020年2月至2023年2月连云港市东海县中医院收治的低位单纯性肛瘘患者46例。采用随机数字表法分为对照组和观察组,各23例。对照组采用传统肛瘘切开术,观察组采用LIFT术,比较两组患者的临床疗效及术后恢复情况。结果两组患者总有效率无显著差异(P=0.310)。观察组患者创面愈合时间、住院时长均短于对照组,视觉模拟评分法评分低于对照组,差异均有显著性(P<0.05)。两组患者术前肛门失禁Wexner评分无显著差异,术后1个月、术后3个月,观察组患者肛门失禁Wexner评分均较对照组低,差异有显著性(P<0.05)。结论LIFT术治疗低位单纯性肛瘘,能够在一定程度上减轻患者痛苦,保留患者括约肌功能,患者恢复更快。
文摘Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.
文摘目的评价经括约肌间瘘管结扎术(ligation of the intersphincteric fistula tract,LIFT)联合直肠推移瓣术(endorectal advancement flap,ERAF)治疗高位复杂性肛瘘的临床疗效。方法2016年8月~2021年12月我院收治的高位复杂性肛瘘病人40例,根据抽签法随机分成试验组和对照组,每组各20例。试验组采用LITF+ERAF,对照组采用LIFT,随访6~12个月,比较其临床疗效,比较创面愈合时间、治愈率、术后第1天疼痛程度、肛门功能和复发率。结果两组术后第1天疼痛程度、创面愈合时间、治愈率比较差异无统计学意义(P>0.05)。两组术前、创面愈合后、术后6个月的Wexner肛门失禁评分、肛管静息压和肛管最大收缩压比较差异无统计学意义(P>0.05);两组创面愈合后、术后6个月的肛管静息压和肛管最大收缩压分别与其自身术前比较,差异有统计学意义(P<0.05)。随访6~12个月,试验组无复发,对照组复发3例,差异有统计学意义(P<0.05)。结论LITF联合ERAF疗效好、痛苦小、病程短、术后复发率低、肛门功能影响小。
文摘目的研究单纯性经括约肌型肛瘘的手术改良方案,并探讨其应用价值,以指导临床疾病的治疗。方法选取2013年1月~2015年1月于我院接受治疗的单纯性经括约肌型肛瘘患者56例,随机均分为两组：对照组行经括约肌间瘘管结扎术（ligation of the intersphinctericfistula tract,LIFT术）,观察组行改良LIFT术治疗。比较两组手术时间、术后疼痛评分、术后住院时间、肛瘘治愈率,随访统计手术前及手术后3个月时患者肛管静息压及最大收缩压变化。结果观察组治愈率明显高于对照组,差异有统计学意义（P〈0.05）;两组手术时间、术后疼痛评分、术后住院时间、手术前及手术3个月后肛管静息压及最大收缩压接近,差异无统计学意义（P〉0.05）。结论改良LIFT术能在保证手术效果及肛门功能的基础上,显著提升单纯性经括约肌型肛瘘的治愈率,值得推广。
