Ligation of intersphincteric fistula tract:  early results of a pilot study.
BACKGROUND
Transsphincteric fistulotomy is associated with a variable degree of fecal incontinence that is directly related to the thickness of the sphincter mechanism overlying the fistula. Staged fistulotomy with seton or the use of cutting seton designed to reduce the proportionate incontinence rates have failed to do so. This has resulted in attempts to find novel sphincter-sparing techniques in the past 2 decades including draining seton, fibrin sealant, anal fistula plug, dermal advancement, and endorectal advancement flaps. These operations have a variable success rates of 30% to 80% reported in the literature.


OBJECTIVE
In 2007, Rojanasakul from Thailand demonstrated a novel technique, ligation of intersphincteric fistula tract, and reported a 94% success rate in a small series. Since then, a few other small cohorts of patients have been reported in the literature with success rates varying from 57% to 82%. An institutional review board-approved study was proposed to measure our results and compare them with the published data.


METHODS
This study was undertaken to evaluate the success of ligation of intersphincteric fistula tract procedures in a group of unselected transsphincteric fistulas deemed unsuitable for lay-open fistulotomy.


METHODS
The procedure was performed in 3 different settings: a public institution, a major university hospital, and a large private hospital.


METHODS
A total of 40 patients underwent 41 ligation of intersphincteric fistula tract procedures performed by 6 Board-certified colon and rectal surgeons.


RESULTS
In a mean follow-up of 18 weeks, 74% of the patients achieved healing. In patients who underwent ligation of intersphincteric fistula tract as their primary procedure, the healing rate was 90%. The limitation of this study is its "case series" nature and the short mean follow-up period of 18 weeks.


CONCLUSIONS
Ligation of intersphincteric fistula tract has had excellent success in transsphincteric fistulas in multiple small series. A larger number of patients and longer follow-up period are needed to validate the early favorable results.
Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA. abcarian@uic.edu
Ariane M
AM
Abcarian
Joaquin J
JJ
Estrada
John
J
Park
Cybil
C
Corning
Vivek
V
Chaudhry
Jose
J
Cintron
Leela
L
Prasad
Herand
H
Abcarian
D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000379:methods; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D012003:Rectal Fistula / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult