Emergency Ligation of Intersphincteric Fistula for Anal Fistula

| Posted in: Science

Journal name: The Malaysian Journal of Medical Sciences
Original article title: Ligation of the Intersphincteric Fistula Tract as an Emergency Treatment for Cryptoglandular Anal Fistula
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:

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Author:

Diana Melissa Dualim, Michael Pak-Kai Wong, Siti Mayuha Rusli, Abdel Latif Khalifa Elnaim Ali, Ismail Sagap


The Malaysian Journal of Medical Sciences:

(A peer-reviewed, open-access journal)

Full text available for: Ligation of the Intersphincteric Fistula Tract as an Emergency Treatment for Cryptoglandular Anal Fistula

Year: 2024 | Doi: 10.21315/mjms2024.31.1.5

Copyright (license): CC BY 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

Ligation of the intersphincteric fistula tract (LIFT) is a promising surgical technique for treating anal fistulas of cryptoglandular origin, aiming to preserve sphincter function. This prospective observational study investigates the outcomes following LIFT procedures in both emergency (EM-LIFT) and elective (EL-LIFT) settings. The study assesses postoperative parameters such as healing rates, recurrence rates, complications, and hospital stays, thereby providing insights into the feasibility of performing LIFT under acute conditions.

Healing and Recurrence Rates

One of the significant findings of this study is the comparable healing rates for both the EM-LIFT and EL-LIFT groups, with rates of 90.9% and 100%, respectively, both achieving a median healing time of 2 months. Recurrence was observed in two patients from the EM-LIFT group and three in the EL-LIFT group, with a median recurrence time of 5 months in both. The study highlights that while EM-LIFT is effective in terms of healing, the rates of recurrence are in line with previous studies, suggesting that LIFT can be safely executed as an emergency procedure without compromising the outcomes.

Conclusion

The results of this study demonstrate that performing LIFT as an emergency intervention for active anal fistulas is both feasible and safe, yielding outcomes comparable to those seen in elective surgeries. As such, EM-LIFT should be considered a viable option for managing cryptoglandular-type anal fistulas with local sepsis, potentially circumventing the traditional two-stage procedure that involves initial drainage followed by a delayed definitive repair. This highlights an important step forward in the surgical management of anal fistulas, warranting further studies to validate long-term outcomes and recurrence rates across larger populations.

FAQ section (important questions/answers):

What is the purpose of the LIFT procedure?

The LIFT procedure is designed to treat anal fistulas of cryptoglandular origin, preserving the anal sphincter while promoting healing, reducing recurrence rates, and minimizing postoperative complications.

What were the outcomes compared in the EM-LIFT and EL-LIFT?

Outcomes compared included healing rates, healing times, recurrence rates, postoperative complications, and length of hospital stay between the emergency and elective settings for the LIFT procedure.

What were the findings regarding healing rates for both groups?

The EM-LIFT group had a healing rate of 90.9%, while the EL-LIFT group had a 100% healing rate, with similar median healing times of 2 months for both.

What complications were observed after the LIFT procedures?

Postoperative complications included minor pain and subcutaneous infections, but no cases of fecal incontinence were reported, indicating a favorable safety profile for both EM-LIFT and EL-LIFT groups.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Emergency Ligation of Intersphincteric Fistula for Anal Fistula”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Study (Studying):
In the medical context, a study refers to a systematic investigation conducted to evaluate a specific hypothesis or question regarding a medical procedure or treatment. The study highlights postoperative outcomes of ligation of intersphincteric fistula tract (LIFT) for anal fistulas, contributing to the body of knowledge regarding emergency versus elective surgical interventions.

2) Table:
Tables are organized representations of data, detailing the results of a study in a structured format. They allow for quick comparisons of variables, such as demographics and treatment outcomes in this research, making it easier for practitioners to digest complex information and identify patterns that influence clinical decisions.

3) Pain:
Pain is a common symptom associated with medical conditions, especially postoperative experiences. In the context of anal fistula surgeries, evaluating pain levels helps ascertain patient recovery and satisfaction. The study monitors postoperative pain to assess the effectiveness of the LIFT procedure while ensuring adequate pain management strategies are employed.

4) Incision:
An incision refers to a surgical cut made to access internal structures during an operation. The technique used in LIFT involves precise incisions to access the intersphincteric space, enabling effective treatment of anal fistulas while minimizing trauma to surrounding tissues, thereby aiding in the preservation of anal sphincter function.

5) Antibiotic (Antibacterial):
Antibiotics are medications used to treat bacterial infections. In the context of surgical procedures like LIFT, prophylactic antibiotics are administered to prevent postoperative infections. The study emphasizes the importance of antibiotic administration in improving surgical outcomes, reducing complication rates, and maintaining patient safety following anal fistula repair.

6) Repair:
Repair in a medical context refers to the restoration of function or integrity to an injured or diseased body part. In this study, the focus is on the surgical repair of anal fistulas using the LIFT technique, which aims to close the fistula effectively while preserving anal sphincter function, facilitating successful recovery.

7) Rules:
Rules in medical research may refer to guidelines or protocols that dictate how a study is designed and conducted. Strict adherence to research rules ensures validity and reliability of results, influencing how procedures like LIFT are implemented, thereby guiding clinical practice and promoting evidence-based healthcare decision-making.

8) Discussion:
The discussion section of a study interprets the findings, comparing results with existing literature. It contextualizes the outcomes of the LIFT procedure for anal fistulas, addressing implications for future practice, limitations of the research, and recommendations for further studies. This helps in bridging the gap between research and clinical practice.

9) Disease:
Disease refers to a pathological condition affecting bodily functions. The study focuses on anal fistulas, which arise from chronic infections and can significantly impact patients' quality of life. Understanding associated diseases helps in formulating effective treatments and comprehensively managing patients suffering from conditions related to anal pathology.

10) India:
India may refer to the geographical location of the study, highlighting the importance of local healthcare practices in managing anal fistulas. The findings contribute to the global discussion on surgical techniques such as LIFT in various populations, enhancing understanding of cultural and regional differences in treatment efficacy and outcomes.

11) Kumar:
Kumar is likely a reference to a specific author or contributor to the study. Recognizing authors adds credibility to research findings, as their expertise and background influence the rigor of the research undertaken. It highlights collaboration among healthcare professionals in advancing surgical methods for treating complex conditions.

12) Kaji:
Kaji may refer to another contributing author involved in the research. Author attribution is significant in academic literature for accountability and transparency. It connects the presented research with qualified individuals, showcasing their contributions to enhancing surgical techniques or treatment protocols for anal fistulas or similar health issues.

13) Male:
Male, in this context, refers to the gender distribution of study participants. Understanding gender demographics can provide insights into conditions, treatments, and outcomes, as certain health issues may have differing prevalence or manifestations in men compared to women. This information helps clinicians tailor treatment strategies effectively.

14) Tuberculosis:
Tuberculosis is a contagious bacterial infection that can complicate surgical outcomes. The study excludes patients with active tuberculosis to avoid confounding factors that could affect healing and recovery post-operation on anal fistulas. This meticulous selection ensures the reliability and applicability of the study findings in the target population.

15) Inflammation:
Inflammation is a critical response of the body to injury or infection, often leading to symptoms that can affect surgeries, such as swelling and pain. In the context of anal fistulas, understanding inflammatory processes is essential for devising effective surgical interventions like LIFT, aiming for optimal healing outcomes with minimal complications.

16) Calculation:
Calculation pertains to the statistical analysis performed in the study to interpret data effectively. This includes determining sample sizes, comparing outcomes, and assessing healing rates. Sound calculations are fundamental in research, ensuring that results are statistically valid and can influence clinical practices in treating anal fistulas.

17) Learning:
Learning refers to the acquisition of knowledge derived from research findings. The study on LIFT procedures contributes valuable insights that enhance understanding among healthcare professionals regarding emergency versus elective surgery for anal fistulas, facilitating better patient care and informed decision-making in clinical environments.

18) Quality:
Quality in medical research denotes the standard of care and outcomes achieved through surgical interventions. This study measures quality by examining healing rates and complications associated with the LIFT procedure. High-quality outcomes are critical for preserving patient well-being and ensuring effective health care delivery post-surgery.

19) Account:
Account in a research context may refer to documenting and reporting findings accurately. Transparent accounts of surgical outcomes associated with LIFT allow other practitioners to gauge effectiveness, informing future practices and improving the standard of patient care related to anal fistula management.

20) Raval:
Raval could reference an author or contributor associated with the study. Acknowledging all contributors signifies the collaborative effort in research, emphasizing the importance of interdisciplinary approaches in understanding and managing conditions like anal fistulas through comprehensive surgical research and development.

21) Field:
Field typically refers to a specialized area within medicine. In this study, the focus is on colorectal surgery, particularly the management of anal fistulas. Research in any medical field is crucial for advancing knowledge, techniques, and patient care standards to optimize treatment outcomes for specific conditions.

22) Visit:
Visit refers to patient follow-up appointments to monitor recovery post-surgery. Regular visits are integral in assessing healing rates, complications, and overall patient satisfaction with procedures like LIFT, ensuring ongoing support and guidance for patients in their recovery journey after anal fistula treatment.

23) Post:
Post refers to the period following the surgical procedure. In medical studies, assessing postoperative outcomes such as healing, complications, and patient recovery is essential. The research aims to evaluate the effects of the LIFT procedure on patients post-operation, contributing to the understanding of efficacy and safety.

24) Life:
Life in a healthcare context involves considering the impact of diseases and treatments on patients’ overall well-being. Surgical interventions like LIFT affect not just physical health but quality of life. This study's findings aim to enhance patient experiences and outcomes, ultimately improving the standard of living for those affected.

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Discover the significance of concepts within the article: ‘Emergency Ligation of Intersphincteric Fistula for Anal Fistula’. Further sources in the context of Science might help you critically compare this page with similair documents:

Surgical intervention, Surgical treatment, Anal fistula, Emergency treatment, Wound healing, Conflict of interest, Sample size, Antibiotic treatment, Statistically Significant, Follow Up Period, Anal fissure, Small sample size, Long-term follow-up, Demographic distribution, Recurrence Rate, Conventional treatment, Conservative treatment, Fistulotomy, Selection bias, Acute phase, Anal sphincter, Perianal skin, Study period, Fibrin glue, Statistical comparison, Postoperative complication, Sphincter function, Healing time, Hospital stay, Sepsis, Faecal incontinence, Intersphincteric fistula, Non healing wound, External opening, Internal opening, Purulent discharge, Complex Fistula, Tertiary care centre, Study approval, Length of Hospital Stay, Surgical wound, Patient information sheet, Peri-operative care, Emergency procedure, Operative Time, Healing rate, Anal continence, Randomised controlled trial, Difficulty index, Sphincter preserving procedure, Endorectal advancement flap, Anal fistula plug, Postoperative outcome, Study outcome, LIFT Procedure, Estimated sample size, Surgeon, Long-term outcome, Elective procedure, Complex anal fistula.

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