COMPARATIVE STUDY OF OUTCOMES OF CORING, DUAL SETON AND LIGATION OF INTERSPHINCTERIC FISTULA TRACT (LIFT) PROCEDURE IN MANAGEMENT OF HIGH FISTULA-IN-ANO

Dr Dinesh Prasad, Dr Ashlesh Bhavsar, Dr Abhishek Kumar, Dr Darshit Kalaria

Abstract


INTRODUCTION: A fistula-in-ano is an abnormal tract or cavity establishing a communication between rectum or anal canal and the perianal area. Surgery is the treatment of choice with the goals of draining infection, eradicating the fistulous tract and avoiding persistent or recurrent disease while preserving anal sphincter function. Various surgical options available include fistulotomy / fistulectomy with seton wire placement, advanced flaps, fistula plugs, fibrin glue and more recently newer techniques such as Ligation of the intersphincteric fistula tract (LIFT), Video-assisted anal fistula treatment (VAAFT) and FILAC technique (Fistula–Tract Laser Closure).The present study was conducted to assess and compare the outcome of LIFT procedure, Dual Seton placement and Coring out in complex fistula-in-ano.

MATERIALS AND METHOD: In our study, we have evaluated the record of the 50 cases operated for high and complex fistula between June 2017 to June 2019 .Out of 50cases, 5 cases has undergone for coring out of fistula tract with closure of internal opening,20 cases were operated for LIFT procedure, and 25 cases were treated  by  DUAL seton. All cases were done under spinal anesthesia. All cases were done in the Lithotomy position. Basic stapes in all the 3 above procedures included diluted hydrogen peroxide and Methylene Blue dye injection through the external opening to determine the patency of the tract. H2O2 was mixed along with Methylene Blue before injection to increase the chance of identifying internal opening.In present study we compare the various aspects in the treatment of complex fistula in ano using various modalities such as coring, DUAL Setons and lift procedure.

RESULTS: In our study healing rate in LIFT procedure is 90% and incontinence rate is 0%, anal stricture rate is 0%.and Recurrence is 10% and for seton placement the recurrence rate is nil compared to 60% recurrence in coring.

CONCLUSIONS: In our study of patients having complex fistula-in-ano, out of the three procedures Dual seton have least recurrence rates(0%) at the cost of prolonged morbidity, LIFT procedure has  low recurrence rate(10%) much better than the Coring which has a very high recurrence rate (60%) with similar morbidity.


Keywords


Fistula -in-ano Ligation of the intersphincteric fistula tract (LIFT) Dual Seton Coring

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References


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