Abstract

OUTCOMES OF LIFT VERSUS SETON IN COMPLEX FISTULA-IN-ANO- A COMPARATIVE STUDY

Author(s): Varun Gupta, Atul Sharma, Sanjeev Kumar Singla, Jaspal Singh, Manvi Gupta, Richa Budhiraja

BACKGROUND
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 and Seton wire placement in complex fistula-in-ano.
MATERIALS AND METHODS
A prospective, randomized trial was carried out, in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana where 20 patients diagnosed to have complex fistula in ano were included. These were equally divided into two groups (10 patients each) group A undergoing LIFT procedure and Group B receiving Seton wire placement. The results were analysed and compared for healing time, post-op pain, anal incontinence at 1 week, 1 month and 3 months. Recurrence was compared at 1 month and 3 months.
RESULTS
Significant difference in healing time was noted in two groups with 5.3 weeks in LIFT group and 8.7 weeks in Seton wire group. Post-operatively, there was comparatively lesser pain at 1 week and 3 weeks in patients who had undergone LIFT procedure (2.6 &0.5 respectively) than Seton wire (3.9 & 1.0 respectively). Faecal incontinence was not seen in any of the patients in two groups. There was increased recurrence at 3 months in LIFT group (30%) as compared to Seton wire (10%).
CONCLUSION
In patients having complex fistula-in-ano, LIFT procedure provides better outcome than Seton wire placement in terms of decreased healing time and post-op pain. Although, the chances of recurrence are less with seton wire placement but multiple sittings are required for wire tightening.