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Introduction

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?

The anus forms an integral and final part of your digestive system that helps in the elimination of waste from the body. Multiple glands in the anal region secrete fluid and enable easy passage of stools. However, these glands can get clogged and lead to an infection. Most often, these infections are caused due to bacteria that build up in the tissues and pockets around the glands and lead to fluid and tissue accumulation; this stage is called the anal abscess.

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?

The signs and symptoms of an anal fistula that most people experience include:

  • ● 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?

Based on your signs, symptoms, and physical and medical examination, a colorectal specialist can diagnose an anal fistula. However, while some anal fistulas may be easy to spot, others can be tricky as they drain and close by themselves, only to recur. In these cases, the specialist may require you to undergo one or more of the following tests:

  • ● Ultrasound or MRI
  • ● A colonoscopy or anoscopy

How is Anal Fistula Using the LIFT Technique Treated?

There are different treatment modalities used for treating anal fistulas such as fistulotomy, fistulectomy, seton procedures—an advanced flap procedure, endoscopic ablation, laser surgery, and a LIFT procedure. While these are invasive options to treat an anal fistula, the non-invasive options include the use of fibrin glue and a bioprosthetic plug. The treatment chosen for a patient depends upon the size, extent, location, and complexity of the anal fistula.

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?

The LIFT procedure has been used in treating anal fistulas for many years now and has shown a high success rate. Due to the placement of sutures and complete drainage of the fistulas, wound healing is relatively easy and quick. A LIFT surgery is usually preferred in cases of recurrent anal fistulas where previous treatments did not work.

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?

All surgeries have some amount of risk associated with them. A LIFT surgery is becoming increasingly popular because it eliminates risks such as incontinence seen with other fistula treating procedures. Some risks associated with a LIFT surgery include:

  • ● 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

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FAQ's

When is a LIFT Procedure Recommended?

A LIFT surgery is performed in cases where the patient has a single, straight, single fistula with no branching and does not have any associated scarring. This is also the preferred treatment of choice when the patient has undergone a few fistula treatments earlier.

Can a Fistula Get Cured by Itself?

A fistula needs surgical intervention and cannot heal by itself.

What is the Advantage of a LIFT Technique Over Other Surgical Methods?

Some advantages of a LIFT technique over others are that it is a safe, high success rate, shorter healing time, and a lesser rate of recurrence.

How Long Does Healing After a LIFT Surgery Take?

Healing after a LIFT surgery can take up to six weeks or longer. The first two weeks after surgery are important and the patient is advised to rest, avoid strenuous activities, and take good care of their healing wound.

Will I Need a Hospital Stay After a LIFT Surgery?

A LIFT surgery is performed under general anesthesia and requires hospital admission. After a LIFT surgery, the patient may require three to five days of hospital stay before they can go home.

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