title: The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results.
abstract: BACKGROUND
  The ligation of the intersphincteric fistula tract procedure, a sphincter-preserving technique, aims to obtain complete, durable healing, while preserving fecal continence in the treatment of transsphincteric anal fistulas.
  
  
  OBJECTIVE
  This was a systematic review to evaluate the outcomes of the originally described (classic) ligation of the intersphincteric fistula tract procedure and the identified technical variations of the procedure.
  
  
  METHODS
  PubMed, Web of Science, and the archive of Diseases of the Colon & Rectum were searched with the terms "ligation of intersphincteric fistula" and "ligation of intersphincteric fistula tract."
  
  
  METHODS
  Original, English-language studies reporting the primary healing rate for each technical variation of the ligation of the intersphincteric fistula tract procedure were included. Studies were excluded when the technique used was unclear or when primary healing rate was reported in a pooled manner including outcomes from multiple technical variations of the ligation of the intersphincteric fistula tract procedure.
  
  
  METHODS
  Outcomes associated with all of the technical variations of the ligation of the intersphincteric fistula tract procedure were investigated.
  
  
  METHODS
  The main outcome measured was primary healing rate. Secondary outcome measures included time to healing, changes in continence, and risk factors for failure.
  
  
  RESULTS
  In all, 26 studies met criteria for review, including 1 randomized controlled trial and 25 cohort/case series. Seven technical variations of the ligation of the intersphincteric fistula tract procedure were identified and classified according to the surgical technique. Primary healing rates ranged from 47% to 95%.
  
  
  CONCLUSIONS
  The levels of evidence available in the published works are relatively low, as indicated by the Oxford Center for Evidence-Based Medicine evidence levels.
  
  
  CONCLUSIONS
  The ligation of the intersphincteric fistula tract procedure is a promising treatment option for transsphincteric fistulas, with reasonable success rates and minimal impact on continence. The true efficacy of the procedure is unknown because of the number of technical variations and the pooled results reported in the literature.
authors.affiliation: Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: Anne-Marie E
authors.initials: AM
authors.lastname: Sirany
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Nygaard
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Morken
mesh_terms: D001003:Anal Canal / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000601:surgery; D019317:Evidence-Based Medicine; D006801:Humans; D008026:Ligation / Q000379:methods*; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome; D014945:Wound Healing