Abstract: Objective:To explore the clinical effect of ligation of the intersphicteric fistula tract (LIFT) in the treatment of transsphincteric fistula.
Methods: The prospective study was conducted. The clinical data of 132 patients with transsphincteric fistula who were respectively admitted to the First Affiliated Hospital of Nanjing University of Chinese Medicine (51 patients), Suzhou Hospital of Chinese Medicine (38 patients), the Third Affiliated Hospital of Nanjing University of Chinese Medicine (30 patients) and Xuzhou Central Hospital (13 patients) between January 2011 and July 2015 were collected. All the patients were allocated into the treatment group (undergoing LIFT) and control group (undergoing fistulotomy or incisionthreaddrawing procedure) according to random number table. Observation indices: (1) operation time, (2) anal pain scores at postoperative day 1, 3, 7 and 14, (3) wound healing time, (4) anal incontinence scores before operation, at discharge and at postoperative month 3, 6 and 12, (5) total cure rate. Total cure rate=onestage cure rate+local incision failure rate (healing through local dressing change). The patients were followed up using outpatient examination, questionnaires and telephone interview up to December 2015. The outpatient examination was conducted at postoperative month 1, and questionnaires and telephone interview were performed to detect wound healing, anal control ability and healing situation at postoperative month 3, 6, 12 and 24. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using the nonparametric test. Repeated measures data were analyzed by the repeated measures ANOVA, and count data were analyzed using chisquare test.
Results:All the 132 patients who were screened for eligibility were randomly divided into the treatment group (67 patients) and control group (65 patients), without the occurrence of preoperative anal incontinence. Sixtyseven patients in the treatment group underwent LIFT, 45 and 20 patients in the control group respectively underwent fistulotomy and incisionthreaddrawing procedure. (1) Operation time in the treatment group and control group was (52±16)minutes and (49±17)minutes, with no statistically significant difference (t=-1.3, P>0.05). (2) Anal pain scores at postoperative day 1, 3, 7 and 14 were 1 (range, 0-3), 4 (range, 1-6), 2 (range, 0-5), 1 (range, 0-4) in the treatment group and 1 (range, 0-3), 4 (range, 1-7), 4 (range, 1-7), 2 (range, 0-6) in the control group, respectively, showing a statistically significant difference in the change trend of pain between the 2 groups (F=174.5, P<0.05)and at postoperative day 7 and 14 between 2 groups(Z=-6.1,-3.3, P<0.05), and showing no statistically significant difference at postoperative day 1 and 3 between 2 groups (Z=-0.3,-1.7, P>0.05). (3) Wound healing time in the treatment group and control group respectively was 29 days(range, 19-55 days)and 38 days(range, 19- 85 days), with a statistically significant difference between 2 groups (Z=-4.6, P<0.05). (4) Anal incontinence scores at discharge and at postoperative month 3, 6 and 12 respectively were 0 (range, 0-2), 0 (range, 0-2), 0 (range, 0-2), 0 (range, 0-2) in the treatment group and 0 (range, 0-4), 0 (range, 0-7), 0 (range, 0-5), 0 (range, 0-4) in the control group, respectively, showing a statistically significant difference in the change trend of anal incontinence scores between the 2 groups (F=10.8, P<0.05) and at postoperative month 12 between the 2 groups (Z=-2.2, P<0.05), and showing no statistically significant difference at discharge and at postoperative month 3 and 6 between the 2 groups (Z=-1.8,-1.6,-1.4, P>0.05). (5) Among 67 patients in the treatment group, 50 were cured through onestage operation, 8 with sphincteric incision infection (or dehiscence) were cured through dressing change, 9 with recurrence were cured using reoperations, and total cure rate was 86.6%(58/67). Among 65 patients in the control group, 61 were cured through onestage operation,4 with recurrence were cured through reoperations, and total cure rate was 93.8%(61/65). There was no statistically significant difference in the total cure rate between the 2 groups (χ²=1.2, P>0.05). All the 132 patients were followed up for 5-59 months with a median time of 24 months.
Conclusion:LIFT in the treatment of transsphincteric fistula has the advantages of sphincterpreserving, postoperative mild pain, shorter wound healing time and better anal control ability.