72067 - LIFT superior to fistula plug or flap in simple anal fistula treatment – a single-center retrospective cohort study

Introduction Anal fistula surgery is common but despite a wide range of procedures, healing rates are disappointing. The ligation of intersphincteric fistula tract (LIFT) technique was first introduced in 2007 and has gained widespread use since. The results of LIFT have been similar to other surgical options in terms of risk of recurrence but associated with better preserved continence in meta-analyses of previous studies. Method A retrospective single-center cohort study was conducted collecting data from all patients undergoing definitive surgery for perianal fistulation between 2011 and 2022. The study particularly focused on the introduction of LIFT at the unit in 2018. Information was collected from medical records. All patients were followed-up with visits including physical examination. Result In 836 anal fistulation interventions, 70 patients who had undergone a first definitive surgery with curative intent were included. There was no difference in the percentage undergoing simple fistulotomy over time (p=0.57). LIFT virtually replaced the plug and flap methods from 2018 onwards (Figure 1). During follow-up, 51 patients had a non-healed fistula or relapse, 98% of them occurred within 9 months from surgery. Relapse within 9 months occurred in 52% in the LIFT group, 84% after plug and 75% after flap procedure (p=0.024 for LIFT vs. plug/flap). No significant difference between the surgical treatment groups was found regarding IBD, diabetes, preoperative MR, or immunosuppression. No severe complications or incontinence was reported for any of the patients. Discussion In this retrospective cohort study, LIFT was superior to other methods in preventing early relapse.