Prospective clinical study of modified LIFT combined with acellular anal fistula repair matrix packing in the treatment of high anal fistula_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HAN Xu , ZHAO Tuanjie , LIU Liancheng , HUANG Bin , REN Chuncheng , WANG Min , ZHANG Zhiliang , SU Yue ,  ZHANG Yuru

Department of Anus & Intestine Surgery, Beijing Anorectal Hospital (Beijing Erlonglu Hospital), Beijing 100120, P. R. China;

Corresponding author：

ZHANG Yuru, Email: zhyr_11@163.com

Keywords：

modified ligation of intersphincteric fistula tract; acellular anal fistula repair matrix; high anal fistula; minimal invasive; packing

DOI：

10.7507/1007-9424.202010100

Video：

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Objective To observe the effect of modified ligation of intersphincteric fistula tract (LIFT) combined with acellular anal fistula repair matrix packing in the treatment of high anal fistula, and to evaluate its clinical efficacy and safety.Methods All 86 patients who met the diagnostic criteria of high anal fistula in Beijing Anorectal Hospital from October 2018 to August 2019 were selected and randomly divided into observation group and control group. The observation group was treated with modified LIFT combined with acellular anal fistula repair matrix tamponade, while the control group was treated with traditional low incision and high thread drawing surgery. The curative effect, wound healing time, postoperative pain score, intraoperative blood loss, postoperative complications, hospitalization time, patient satisfaction and recurrence at 6 months after operation were compared between the two groups.Results The effective rate of the observation group was 92.9% (39/42), and that of the control group was 86.4% (38/44), there was no significant difference between the two groups (Z=−1.251, P=0.211). The healing time of the observation group and the control group were (24.8±8.5) days and (32.1±10.9) days, respectively, the difference was statistically significant (t=3.472, P<0.001). Compared with the control group, the observation group had less intraoperative blood loss, less postoperative pain and shorter hospital stay (P<0.05). There was no anal incontinence after operation in the two groups, and the incidence of postoperative complications such as bloody stool, anal border edema and urinary retention were lower in the observation group (11.9%) compared with the control group (31.8%), with a statistically significant difference (P<0.05). The treatment satisfaction of the observation group was 90.5%, and that of the control group was 81.8%. There was no significant difference between the two groups (Z=−1.284, P>0.05).Conclusion Modified LIFT combined with acellular anal fistula repair matrix in the treatment of high anal fistula has the advantages of small trauma, quick recovery and low incidence of complications.

Citation： HAN Xu, ZHAO Tuanjie, LIU Liancheng, HUANG Bin, REN Chuncheng, WANG Min, ZHANG Zhiliang, SU Yue, ZHANG Yuru. Prospective clinical study of modified LIFT combined with acellular anal fistula repair matrix packing in the treatment of high anal fistula. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(6): 751-756. doi: 10.7507/1007-9424.202010100 Copy

1.	Owen HA, Buchanan GN, Schizas A, et al. Quality of life with anal fistula. Ann R Coll Surg Engl, 2016, 98(5): 334-338.
2.	中国医师协会肛肠医师分会临床指南工作委员会. 肛瘘诊治中国专家共识(2020版). 中华胃肠外科杂志, 2020, 23(12): 1123-1130.
3.	赵云, 肖维, 高哲. 改良 LIFT 治疗复杂性肛瘘的临床疗效研究. 中国现代医学杂志, 2018, 28(2): 78-81.
4.	Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol, 2015, 21(1): 12-20.
5.	黄斌, 张玉茹, 刘连成, 等. 视频辅助治疗高位肛瘘58例报道. 中国中西医结合外科杂志, 2020, 26(2): 163-165.
6.	Oldfield F, Gilbert T, Skaife P. Is modern management of fistula-in-ano acceptable? Br J Hosp Med (Lond), 2016, 77(7): 388-393.
7.	Kouchi K, Takenouchi A, Matsuoka A, et al. Efficacy of an anal fistula plug for fistulas-in-ano in children. J Pediatr Surg, 2017, 52(8): 1280-1282.
8.	Xu Y, Tang W. Comparison of an anal fistula plug and mucosa advancement flap for complex anal fistulas: a meta-analysis. ANZ J Surg, 2016, 86(12): 978-982.
9.	Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol, 2011, 15(4): 445-449.
10.	Marref I, Spindler L, Aubert M, et al. The optimal indication for FiLaC® is high trans-sphincteric fistula-in-ano:a prospective cohort of 69 consecutive patients. Tech Coloproctol, 2019, 23(9): 893-897.
11.	Lauretta A, Falco N, Stocco E, et al. Anal fistula laser closure: the length of fistula is the Achilles’heel. Tech Coloproctol, 2018, 22(12): 933-939.
12.	Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol, 2011, 15(4): 417-422.
13.	Adegbola SO, Sahnan K, Pellino G, et al. Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol, 2017, 21(10): 775-782.
14.	Zarin M, Khan MI, Ahmad M, et al. VAAFT: video assisted anal fistula treatment; bringing revolution in fistula treatment. Pak J Med Sci, 2015, 31(5): 1233-1235.
15.	张祎, 宫爱民. 经括约肌间瘘管结扎术治疗前位肛瘘疗效观察. 大连医科大学学报, 2018, 40(3): 234-237, 246.
16.	Yassin NA, Hammond TM, Lunniss PJ, et al. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Disease, 2013, 15(5): 527-535.
17.	王帅军. 经括约肌间瘘管结扎术治疗低位单纯性肛瘘疗效观察. 实用中西医结合临床, 2020, 20(10): 24-25.
18.	蒋进广, 王猛, 陈娟, 等. 经括约肌间瘘管结扎术治疗经括约肌肛瘘的临床研究. 中国肛肠病杂志, 2016, 36(4): 20-22.
19.	陈红锦, 谷云飞, 孙桂东, 等. 经括约肌间瘘管结扎术治疗复杂性肛瘘. 中华胃肠外科杂志, 2014, 17(12): 1190-1193.
20.	刘扬, 路明. 经括约肌间瘘管结扎术治疗高位单纯性肛瘘的前瞻性临床对比研究. 中国普外基础与临床杂志, 2020, 27(2): 143-146.
21.	Vogel JD, Johnson EK, Morris AM, et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum, 2016, 59(12): 1117-1133.
22.	Hong KD, Kang S, Kalaskar S, et al. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula:systematic review and meta-analysis. Tech Coloproctol, 2014, 18(8): 685-691.
23.	Tan KK, Tan IJ, Lim FS, et a1. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum, 2011, 54(11): 1368-1372.
24.	李冬生. 改良LIFT术和常规LIFT术治疗单纯性经括约肌型肛瘘的比较分析. 国际医药卫生导报, 2015, 21(15): 2177-2180.
25.	王振军. 肛瘘治疗新手术: LIFT-Plug术. 中国临床医生, 2011, 39(8): 8-9.
26.	赵丹丹, 李春雨. LIFT-Pplug术式治疗经括约肌型肛瘘的疗效及安全性. 中国现代普通外科进展, 2017, 20(5): 386-388.
27.	吴博, 王竞, 凌光烈. 改良经扩约肌间瘘管结扎术-Plug术治疗低位肛瘘疗效分析. 山西医药杂志, 2013, 42(7): 434-436.

1. Owen HA, Buchanan GN, Schizas A, et al. Quality of life with anal fistula. Ann R Coll Surg Engl, 2016, 98(5): 334-338.
2. 中国医师协会肛肠医师分会临床指南工作委员会. 肛瘘诊治中国专家共识(2020版). 中华胃肠外科杂志, 2020, 23(12): 1123-1130.
3. 赵云, 肖维, 高哲. 改良 LIFT 治疗复杂性肛瘘的临床疗效研究. 中国现代医学杂志, 2018, 28(2): 78-81.
4. Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol, 2015, 21(1): 12-20.
5. 黄斌, 张玉茹, 刘连成, 等. 视频辅助治疗高位肛瘘58例报道. 中国中西医结合外科杂志, 2020, 26(2): 163-165.
6. Oldfield F, Gilbert T, Skaife P. Is modern management of fistula-in-ano acceptable? Br J Hosp Med (Lond), 2016, 77(7): 388-393.
7. Kouchi K, Takenouchi A, Matsuoka A, et al. Efficacy of an anal fistula plug for fistulas-in-ano in children. J Pediatr Surg, 2017, 52(8): 1280-1282.
8. Xu Y, Tang W. Comparison of an anal fistula plug and mucosa advancement flap for complex anal fistulas: a meta-analysis. ANZ J Surg, 2016, 86(12): 978-982.
9. Wilhelm A. A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe. Tech Coloproctol, 2011, 15(4): 445-449.
10. Marref I, Spindler L, Aubert M, et al. The optimal indication for FiLaC® is high trans-sphincteric fistula-in-ano:a prospective cohort of 69 consecutive patients. Tech Coloproctol, 2019, 23(9): 893-897.
11. Lauretta A, Falco N, Stocco E, et al. Anal fistula laser closure: the length of fistula is the Achilles’heel. Tech Coloproctol, 2018, 22(12): 933-939.
12. Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol, 2011, 15(4): 417-422.
13. Adegbola SO, Sahnan K, Pellino G, et al. Short-term efficacy and safety of three novel sphincter-sparing techniques for anal fistulae: a systematic review. Tech Coloproctol, 2017, 21(10): 775-782.
14. Zarin M, Khan MI, Ahmad M, et al. VAAFT: video assisted anal fistula treatment; bringing revolution in fistula treatment. Pak J Med Sci, 2015, 31(5): 1233-1235.
15. 张祎, 宫爱民. 经括约肌间瘘管结扎术治疗前位肛瘘疗效观察. 大连医科大学学报, 2018, 40(3): 234-237, 246.
16. Yassin NA, Hammond TM, Lunniss PJ, et al. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Disease, 2013, 15(5): 527-535.
17. 王帅军. 经括约肌间瘘管结扎术治疗低位单纯性肛瘘疗效观察. 实用中西医结合临床, 2020, 20(10): 24-25.
18. 蒋进广, 王猛, 陈娟, 等. 经括约肌间瘘管结扎术治疗经括约肌肛瘘的临床研究. 中国肛肠病杂志, 2016, 36(4): 20-22.
19. 陈红锦, 谷云飞, 孙桂东, 等. 经括约肌间瘘管结扎术治疗复杂性肛瘘. 中华胃肠外科杂志, 2014, 17(12): 1190-1193.
20. 刘扬, 路明. 经括约肌间瘘管结扎术治疗高位单纯性肛瘘的前瞻性临床对比研究. 中国普外基础与临床杂志, 2020, 27(2): 143-146.
21. Vogel JD, Johnson EK, Morris AM, et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula. Dis Colon Rectum, 2016, 59(12): 1117-1133.
22. Hong KD, Kang S, Kalaskar S, et al. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula:systematic review and meta-analysis. Tech Coloproctol, 2014, 18(8): 685-691.
23. Tan KK, Tan IJ, Lim FS, et a1. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum, 2011, 54(11): 1368-1372.
24. 李冬生. 改良LIFT术和常规LIFT术治疗单纯性经括约肌型肛瘘的比较分析. 国际医药卫生导报, 2015, 21(15): 2177-2180.
25. 王振军. 肛瘘治疗新手术: LIFT-Plug术. 中国临床医生, 2011, 39(8): 8-9.
26. 赵丹丹, 李春雨. LIFT-Pplug术式治疗经括约肌型肛瘘的疗效及安全性. 中国现代普通外科进展, 2017, 20(5): 386-388.
27. 吴博, 王竞, 凌光烈. 改良经扩约肌间瘘管结扎术-Plug术治疗低位肛瘘疗效分析. 山西医药杂志, 2013, 42(7): 434-436.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prospective clinical study of modified LIFT combined with acellular anal fistula repair matrix packing in the treatment of high anal fistula

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