title: Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage.
abstract: BACKGROUND
  The ligation of intersphincteric fistula tract (LIFT) is a relatively new surgical technique for treating complex anorectal fistulas.
  
  
  METHODS
  LIFT was compared with anorectal advancement flap management (ARAF) of complex anorectal fistulas requiring previous seton drainage. Crohn's patients were excluded. Patients with no confirmed recurrent sepsis after 6 months were randomized to day surgery performance of LIFT (25; 17 male) or ARAF (14; 10 male) with removal of the seton. Outcome measures included recurrences, surgical time, complications, hospital readmissions, and fecal incontinence.
  
  
  RESULTS
  LIFT was 32.5 minutes shorter than ARAF (P < .001). Complications were similar, with no hospital readmissions. Return to normal activities was 1 week for LIFT patients, 2 weeks for ARAF patients (P = .016). At 19 months there were 3 recurrences (2 in the LIFT group). One ARAF patient had minor incontinence.
  
  
  CONCLUSIONS
  The LIFT procedure was simple, safe, shorter, and patients returned to work earlier. All patients had preliminary seton drainage, possibly contributing to the low recurrence rates.
authors.affiliation: Department of Surgery School of Medicine, Townsville and the Australian Institute of Tropical Medicine, North Queensland Centre for Cancer Research, James Cook University, Townsville, Queensland, Australia.
authors.forename: Chrispen
authors.initials: C
authors.lastname: Mushaya
authors.forename: Lynne
authors.initials: L
authors.lastname: Bartlett
authors.forename: Bettina
authors.initials: B
authors.lastname: Schulze
authors.forename: Yik-Hong
authors.initials: YH
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004322:Drainage / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D012003:Rectal Fistula / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing