Ligation of Intersphincteric Fistula Tract for Perianal Fistula: Long-Term Results, Functional Outcomes, and Predictors of Failure

Ligation of intersphincteric fistula tract is a sphincter-preserving procedure for anal fistula. Most studies evaluating the operation are small with a limited follow-up. To evaluate the long-term success rate and functional outcomes following ligation of intersphincteric fistula tract. Retrospective cohort study. The study was conducted at a tertiary referral center for coloproctology. One hundred and thirty-nine participants with cryptoglandular or Crohn's perianal fistula were included. Ligation of intersphincteric fistula tract. The primary endpoint was clinical healing without recurrence following ligation of intersphincteric fistula tract. Clinical healing was defined as healing of the external fistula opening and intersphincteric incision. Secondary endpoints were long-term healing at last follow-up and functional outcomes measured using the St. Marks Incontinence score. Predictors of non-healing were also evaluated. One hundred thirty-nine patients were included with a median follow-up of 28 months (range, 20-59). Ten had Crohn's disease and 52 had complex fistulas. Sixty-nine (50%) patients experienced healing without recurrence, 4 healed but recurred, and 66 participants failed to heal after the primary procedure. Patients without initial healing were managed with additional surgical procedures (median 2), most of them minor such as curettage of a remaining external sinus. At the end of the follow-up period, 126 (91%) of patients had a closed fistula. No statistically significant predictors of non-healing were identified. The majority of the participants with persistent healing following the primary operation had a postoperative total St. Mark's incontinence score below 5. The retrospective design introduces the possibility of residual confounding and selection bias. The initial healing rate after LIFT was moderate, but following additional mainly minor procedures, the final healing rate of 91% was achieved. Recurrence following initial healing was rare. Evaluation of anal function indicated a good continence. See Video Abstract.