Our Summary

This research paper examines the outcomes of a treatment for anal fistulas, a kind of abnormal connection between the rectum and the skin near the anus, called the LIFT procedure. The researchers looked at medical records from people who had this procedure done between March 2012 and September 2016. They found that out of 53 patients, about 38% still had fistulas after the procedure, and were followed up with after about 4 months. The recurrence of the fistulas was either transsphincteric (inside the sphincter muscle) or intersphincteric (between the two sphincter muscles). The treatment for the persistent fistulas was usually a seton (a thread placed in the fistula to keep it open), followed by an advancement flap (a surgical technique to close the fistula) or a fistulotomy (a surgery to open the fistula). Half of the patients who had surgery after the LIFT procedure failed saw their fistula heal; about 32% are still being treated. In conclusion, after a failed LIFT procedure, half of the patients saw their fistula heal after having a seton placed followed by a fistulotomy or rectal advancement flap.

FAQs

  1. What is the LIFT procedure for transsphincteric anal fistula?
  2. What treatments are available for persistent transsphincteric fistulas after a failed LIFT procedure?
  3. What is the success rate of surgery after a failed LIFT procedure?

Doctor’s Tip

One helpful tip a doctor might tell a patient about anal fistula surgery is to be prepared for the possibility of the surgery not completely resolving the issue. In some cases, additional treatments such as seton placement, fistulotomy, or advancement flap may be needed to fully heal the fistula. It’s important to follow up with your doctor regularly and communicate any concerns or changes in symptoms.

Suitable For

Patients who are typically recommended anal fistula surgery are those with transsphincteric anal fistulas who have not responded to other conservative treatments such as antibiotics or drainage procedures. In cases where a LIFT procedure has failed, patients may undergo further surgical interventions such as seton placement, fistulotomy, or advancement flap surgery to treat the persistent or recurrent fistula. The success rate of surgery after a failed LIFT procedure is approximately 50%, with some patients still undergoing treatment for their fistula.

Timeline

Before anal fistula surgery:

  1. Patient experiences symptoms such as pain, swelling, discharge, and/or itching around the anus.
  2. Patient may undergo diagnostic tests such as physical examination, MRI, or fistulogram to determine the extent and location of the fistula.
  3. Patient and surgeon discuss treatment options, including LIFT procedure.
  4. Patient undergoes LIFT procedure to treat the transsphincteric anal fistula.

After anal fistula surgery:

  1. Patient may experience initial discomfort and pain at the surgical site.
  2. Follow-up appointments are scheduled to monitor healing and address any complications.
  3. In cases of persistent or recurrent fistula, further treatment options such as seton placement, fistulotomy, or advancement flap may be recommended.
  4. Patients who undergo surgery after failed LIFT have a 50% chance of healing with seton placement followed by fistulotomy or advancement flap.
  5. Patients may require ongoing treatment and monitoring for complete resolution of the fistula.

What to Ask Your Doctor

  1. What is the success rate of the LIFT procedure for treating transsphincteric anal fistulas?
  2. What are the potential risks and complications associated with anal fistula surgery, specifically the LIFT procedure?
  3. How long is the recovery period after anal fistula surgery?
  4. What are the alternative treatment options for anal fistulas if the LIFT procedure is not successful?
  5. What is the likelihood of recurrence of the anal fistula after the LIFT procedure?
  6. How will pain and discomfort be managed after the surgery?
  7. Will I need to make any changes to my diet or lifestyle after the surgery?
  8. How frequently will follow-up appointments be needed after the surgery?
  9. What are the signs and symptoms of a potential complication after anal fistula surgery that I should watch out for?
  10. Are there any long-term effects or implications of having anal fistula surgery?

Reference

Authors: Wright M, Thorson A, Blatchford G, Shashidharan M, Beaty J, Bertelson N, Aggrawal P, Taylor L, Ternent CA. Journal: Am J Surg. 2017 Dec;214(6):1210-1213. doi: 10.1016/j.amjsurg.2017.08.042. Epub 2017 Sep 18. PMID: 29146001