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A Prospective Study of Combined Sphincter Preserving Procedure (LIFT + VAAFT + FiLAC) in Complex Anal Fistula

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Abstract

Successful treatment of complex perianal fistula continues to be a challenging problem. Various new techniques have evolved such as ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula laser closure (FiLaC), fibrin glue, and fistula plug. However, the results of all these techniques are variable and far from being optimal. In this study, we have combined the LIFT procedure with VAAFT and FiLaC in the treatment of complex anal fistula. We hypothesize that the combined approach can improve the healing rate without causing any change in continence. Patients of complex anal fistula (high trans-sphincteric, supra-sphincteric, and horse-shoe fistula) were included in the study based on clinical examination and MRI. All the patients were operated using the combined approach by the same team of surgeons. Patients were followed for 1 year. The assessment of continence was done by Wexner scoring. The healing, recurrence, and continence status were noted. The study included forty five patients with complex anal fistula. Primary healing occurred in 91.11% patients and none of the patients reported any de-novo incontinence. The patients with minor pre-existing incontinence did not report any worsening of continence after the procedure. The preoperative and postoperative Wexner scores did not show any significant change. The average healing time was 43.53 days. This study concludes that the combined sphincter sparing approach (LIFT + VAAFT + FiLAC) is a safe and effective procedure for complex anal fistula. Combining the various techniques can improve the outcome without compromising the continence status of patient.

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Authors and Affiliations

  1. Department of Surgery, King George’s Medical University, Lucknow, India

    Arshad Ahmad, Abhishek Kumar, Abhinav Arun Sonkar, Pankaj Kumar & Sandeep Kumar Varma

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  1. Arshad Ahmad
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  2. Abhishek Kumar
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  3. Abhinav Arun Sonkar
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  4. Pankaj Kumar
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  5. Sandeep Kumar Varma
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Correspondence to Arshad Ahmad.

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Ahmad, A., Kumar, A., Sonkar, A.A. et al. A Prospective Study of Combined Sphincter Preserving Procedure (LIFT + VAAFT + FiLAC) in Complex Anal Fistula. Indian J Surg 84, 1211–1216 (2022). https://doi.org/10.1007/s12262-021-03222-1

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  • DOI: https://doi.org/10.1007/s12262-021-03222-1

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