Short-Term Outcomes of Eldemerdash Modification of LIFT (Ligation of Inter-sphincteric Fistula Track) Technique for High Trans-Sphincteric Fistula, A prospective Pilot Study of A promising Novel Technique | ||
| The Egyptian Journal of Surgery | ||
| Volume 44, Issue 3, July 2025, Pages 966-975 PDF (691.44 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2025.349559.1336 | ||
| Authors | ||
| Mohamed Gamal Qassem* 1; Ahmed Elsharkawy2; Mohamed A. Abdel Hamid1; Ahmed S. M. Omar1 | ||
| 1Department of General and GIT Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||
| 2Emergency Physician, Mouwasat Hospital Dammam, KSA | ||
| Abstract | ||
| Background: Although ligation of intersphincteric fistula tract (LIFT) technique has been widely accepted as a sphinctersparing technique, fistula recurrence is still high up to 43–60%. We developed a novel technique, Eldemerdash modification LIFT (LIFT-EM), which is based on adding internal fistulotomy, aiming to eradicate the causative cryptoglandular infection and trying to minimize recurrence rates. Patients and Methods: This is a prospective pilot study on 18 patients with high trans-sphincteric fistula diagnosed with preoperative MRI fistulogram. All patients underwent LIFT-EM. Follow-up intervals were 1 day, 1 week, 3, and 6 months. Cleveland Clinic Florida Fecal Incontinence questionnaire was requested from all participants both pre and postoperatively. Postoperative outcomes were assessed in terms of recurrence, change incontinence status perioperative complications. Results: The mean age of study cases was 36.4±6.0 years, ranging between 27 to 45 years. The mean BMI was 35.3±9.5 with males representing all cases. Recurrence/persistence was recorded in only one (5.6%) patient. Pre and postoperative Cleveland Clinic Florida Fecal Incontinence scores were similar. Study variables did not significantly impact recurrence/ persistence. There was a higher mean VAS score at 24h and 1 week in posterior fistula cases, P 0.001. There was a higher mean duration of hospital stay among ASA grade 2 cases (P 0.001). Inversely, patients with previous anorectal abscess had significantly shorter hospital stay (P 0.018). Conclusion: In properly selected cases, LIFT-EM could be a safe and effective sphincter-sparing technique in treating high trans-sphincteric fistula with low recurrence rates. Randomized clinical trials with larger sample and longer followup periods comparing LIFT modifications are encouraged to consolidate our findings. | ||
| Keywords | ||
| Eldemerdash modification; high trans-sphincteric fistula; ligation of intersphincteric fistula track; recurrenc | ||
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