title: Sphincter-sparing techniques for fistulas-in-ano.
abstract: Anal fistulas require surgical treatment to cure the fistula. Fistulotomy is the treatment of choice because of its high success rate, but it also carries a risk of postoperative incontinence. Different methods have been proposed to overcome the need for dividing part or all of the sphincter, so-called "sphincter saving techniques" (SST), such as flap advancement, intrafistular injection of glue, or the insertion of a bio-prosthesis (collagen plug). However, the success rate of SSTs is lower than that of fistulotomy. Ligation of the Intersphincteric Fistula Tract (LIFT) is one of the most recent SSTs. It aims to ligate and transect the fistula by an approach through the intersphincteric space. The methodological quality of most published studies has been only average, but several studies have reported attractive success rates of 70 to 95% without postoperative incontinence. Other techniques such as endo-anal clip or injection of autologous stem cells are still anecdotal.
authors.affiliation: Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France. Electronic address: epommaret@yahoo.fr.
authors.forename: E
authors.initials: E
authors.lastname: Pommaret
authors.affiliation: Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Benfredj
authors.affiliation: Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Soudan
authors.affiliation: Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: de Parades
mesh_terms: D001003:Anal Canal; D019317:Evidence-Based Medicine; D005242:Fecal Incontinence / Q000209:etiology; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage; D006801:Humans; D008026:Ligation / Q000379:methods; D059351:Organ Sparing Treatments / Q000379:methods; D011788:Quality of Life; D012003:Rectal Fistula / Q000145:classification / Q000601:surgery* / Q000628:therapy; D013524:Surgical Flaps; D014014:Tissue Adhesives / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives
keywords: Advancement flap; Anal fistula; Autologous stem cells; Clip; Fibrin glue; Incontinence; Plug; Sphincter saving