The anal or perianal fistula is a very common disease. This fistula is a tunnel-like structure that forms from inside the anus into the surrounding skin. Anal fistulas occur because of infection and require medical intervention. One such procedure that is routinely performed and has a high success rate in treating anal fistulas is the ligation of intersphincteric fistula tract or ligation of intersphincteric fistula tract or a LIFT procedure.
Description of a LIFT Procedure
The LIFT technique was first described by Rojanasakul et al. in 2007. This procedure aimed to drain the fistula between the internal and external sphincter muscles without causing postoperative incontinence that is common with other procedures. This is done by a simple skin incision, followed by separation of the two sphincter muscle groups, and tying off (or ligating) the fistula ends. The wound is then closed with an absorbable suture to facilitate quicker healing.
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What are the Cases That Require A LIFT Procedure?
When the anal abscess is not treated in time, it expells the infectious content inside it. In this pursuit, it tunnels its way until it creates an opening in the skin. At this stage, the structure is called an anal fistula and usually connects the infected anal glands to this opening in the skin.
Apart from clogged glands, other causes of an anal fistula are:
- ● Crohn’s disease
- ● Trauma
- ● Sexually transmitted diseases
- ● Radiation for cancer treatment
- ● Tuberculosis
- ● Ulcerative colitis
- ● Diverticulitis
- ● Cancer
What are the Symptoms of an Anal Fistula?
- ● Pain around the anal region
- ● Swelling and redness in and around the anus
- ● Foul-smelling anal discharge
- ● Bleeding from the abscess
- ● Increased pain during abscess drainage
- ● Irritation of the skin around the anus where the abscess drains
- ● Generalized malaise and fatigue
- ● Fever with chills
- ● Painful urination and bowel movements
If you are experiencing one or more of the above-mentioned symptoms, please visit your doctor immediately.
How is Anal Fistula Diagnosed?
- ● Ultrasound or MRI
- ● A colonoscopy or anoscopy
How is Anal Fistula Using the LIFT Technique Treated?
The LIFT procedure is particularly used to treat fistulas that pass through the anal sphincters, and doing any of the other procedures can damage the sphincter leading to loss of continence. This technique is a modified approach that aims to securely close the internal opening using an intersphincteric approach. An ideal case for a LIFT surgery is a patient having a simple, straight, single fistula with no associated inflammation, side branches, or scarring.
During a LIFT procedure, the surgeon makes a cut in the skin right above the fistula and gains access to the anal sphincter muscles. These muscles are moved apart, the fistula is then completely cut open to flatten it, drained, cleaned, and sealed at both ends. Any infected tissue is scraped out as well. Sutures are placed to close the defect in the external sphincter muscle.
What are the Result of LIFT Procedure?
A LIFT surgery has many advantages—preservation of anal sphincters, minimal tissue injury, and shorter healing time. Post a LIFT procedure, the surgical team will instruct you about the Dos and Don’ts to enable comfortable recovery and healing.
After a LIFT procedure is completed, the patient is administered IV antibiotics for a day or two and requires a hospital stay of at least three to five days. It can take up to six weeks for your wound to heal, and you must follow a few common post-surgical instructions, which include:
- ● Changing the dressing regularly or as instructed by the surgeon
- ● Avoiding heavy lifting, exercising, or strenuous activity for the next few weeks
- ● Keeping the wound clean and refraining from rubbing on the surgical site
- ● Eating a high-fiber diet to allow bulking up of stools and easy elimination
- ● Taking sitz baths is helpful in wound healing and alleviating symptoms
- ● Avoiding sexual intercourse until the wound healing is complete
What are the Risks Associated with LIFT Surgery?
- ● Recurrence of a fistula that may require a fistulotomy or seton procedure
- ● Infection of the wound site
- ● Excessive bleeding from the site
- ● Purulent discharge from the wound during healing