Our Summary

This study examined the effectiveness of a surgical procedure called Ligation of the Inters-sphincteric Fistula Tract (LIFT) in treating anal fistulas in people with Crohn’s disease, a type of inflammatory bowel disease. Anal fistulas are abnormal connections between the anus and the skin, and can be difficult to treat in Crohn’s disease due to multiple complications.

The study involved 46 patients who underwent the LIFT procedure between March 2012 and September 2019. The researchers found that 65% of these patients experienced healing of the fistula, which is higher than the previously reported rate of 48%. However, they also found that 8 patients experienced a recurrence of the fistula within the sphincter muscle, and another 8 had a recurrence that crossed the sphincter muscle.

Interestingly, the researchers found that patients who were smoking at the time of the surgery were more likely to experience a failure of the LIFT procedure. Other factors such as age, sex, race, how long the patient had had the disease, where the disease was located, the type of fistula, history of inflammation in the rectum, use of biological drugs or a seton (a type of surgical thread), and previous attempts to repair the fistula did not seem to affect the success of the LIFT procedure.

There was also a trend (but not a statistically significant one) suggesting that patients with active inflammation in the rectum at the time of surgery were more likely to experience a failure of the LIFT procedure.

In conclusion, this study suggests that the LIFT procedure can be an effective treatment for anal fistulas in Crohn’s disease patients, but that smoking can negatively affect the success of the procedure.

FAQs

  1. What is the LIFT procedure and how effective is it in treating anal fistulas in Crohn’s disease patients?
  2. What factors were found to affect the success of the LIFT procedure in the study?
  3. In the study, what was the recurrence rate of fistulas after undergoing the LIFT procedure?

Doctor’s Tip

A doctor might advise a patient undergoing anal fistula surgery to quit smoking to improve the chances of successful healing. They may also recommend maintaining good hygiene in the area, following post-operative care instructions carefully, and attending follow-up appointments to monitor healing progress and address any concerns promptly. Additionally, the doctor may discuss the importance of managing Crohn’s disease effectively to reduce the risk of fistula recurrence.

Suitable For

Patients with anal fistulas, particularly those with Crohn’s disease, may be recommended for anal fistula surgery such as the LIFT procedure if conservative treatments have been unsuccessful in resolving the issue. Factors such as smoking status and active inflammation in the rectum may impact the success of the surgery, so these factors should be taken into consideration when recommending surgery for anal fistulas in Crohn’s disease patients.

Timeline

Before anal fistula surgery:

  • Patient experiences symptoms such as pain, swelling, discharge, and discomfort in the anal area.
  • Patient may undergo diagnostic tests such as physical examination, MRI, or ultrasound to confirm the presence of an anal fistula.
  • Patient may try conservative treatments such as antibiotics, sitz baths, and dietary changes to manage symptoms.

After anal fistula surgery:

  • Patient undergoes the LIFT procedure to treat the anal fistula.
  • Patient may experience some pain and discomfort in the days following surgery.
  • Patient is advised to follow post-operative care instructions such as taking pain medication, keeping the area clean, and avoiding strenuous activity.
  • Patient attends follow-up appointments to monitor healing and address any complications.
  • Patient may experience recurrence of the fistula in some cases, especially if they are smokers.

Overall, the timeline for a patient before and after anal fistula surgery involves diagnosing the condition, undergoing the surgical procedure, and managing post-operative care to promote healing and prevent complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery, particularly if they have Crohn’s disease, include:

  1. What is the success rate of the LIFT procedure in treating anal fistulas in patients with Crohn’s disease?
  2. Are there any specific factors, such as smoking or active inflammation in the rectum, that could affect the success of the surgery?
  3. What are the potential risks and complications associated with the LIFT procedure in patients with Crohn’s disease?
  4. How long is the recovery period after the surgery, and what can I expect in terms of post-operative care?
  5. Will I need any additional treatments or follow-up appointments after the surgery?
  6. Are there any lifestyle changes or modifications I should make to improve the outcome of the surgery?
  7. What are the alternative treatment options available for anal fistulas in patients with Crohn’s disease, and how do they compare to the LIFT procedure?
  8. Can you provide me with information about your experience and success rate with performing the LIFT procedure in patients with Crohn’s disease?

Reference

Authors: Wood T, Truong A, Mujukian A, Zaghiyan K, Fleshner P. Journal: Tech Coloproctol. 2022 Mar;26(3):205-212. doi: 10.1007/s10151-022-02582-4. Epub 2022 Feb 1. PMID: 35103901