title: Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery?
abstract: BACKGROUND
  The ligation of the intersphincteric fistula tract procedure has been reported to have high cure rates, with minimal impairment of continence.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the success rates and functional outcome after the ligation of the intersphincteric fistula tract procedure.
  
  
  METHODS
  This study was performed as a retrospective review.
  
  
  METHODS
  The study was conducted at the Division of Colon and Rectal Surgery, University of Minnesota and at affiliated hospitals in Minneapolis and St. Paul, Minnesota, between March 2007 and September 2011.
  
  
  METHODS
  Ninety-three patients with transsphincteric cryptoglandular anal fistula were included.
  
  
  METHODS
  Ligation of the intersphincteric fistula tract procedure was performed.
  
  
  METHODS
  Failure was defined as persistent or recurrent drainage, air leakage from a patent external opening, or intersphincteric incision or reoperation for recurrent fistula. Success was defined as healing of the external fistula opening and intersphincteric incision. Patients were followed up with a questionnaire to assess the recurrence rate and the Wexner incontinence score.
  
  
  RESULTS
  The median follow-up time for was 19 months (range, 4-55). Thirty patients (32%) had a history of previous surgery for their fistula. The success rate of fistula healing was 40% after the first ligation of the intersphincteric fistula tract procedure. When including patients with repeat ligation of the intersphincteric fistula tract and subsequent intersphincteric fistulotomy after ligation of the intersphincteric fistula tract repair, the success rates were 47% and 57%. Patients with successful fistula closure reported a mean Cleveland Clinic Florida Fecal Incontinence score of 1.0 (SD 2.3). No predictor for successful fistula closure was found.
  
  
  CONCLUSIONS
  Retrospective design, limited accuracy of diagnosing fistula failure, and lack of baseline continence were limitations of this study.
  
  
  CONCLUSIONS
  The present study indicates that the ligation of the intersphincteric fistula tract procedure for transsphincteric fistulas has a significant risk for failure but good functional outcome in patients with no recurrence.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. ulrik-wallin@uiowa.edu
authors.forename: Ulrik G
authors.initials: UG
authors.lastname: Wallin
authors.forename: Anders F
authors.initials: AF
authors.lastname: Mellgren
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: Stanley M
authors.initials: SM
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000150:complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D055815:Young Adult