Does a Combination of ‘Ligation of Intersphincteric Fistula Tract’ with ‘video Assisted Fistula Tract Surgery’ Offer a Minimally Invasive Cure for Fistula in an O?

Dinesh Shah, Sanjay Dhandharia, MD, Brij B Agarwal, MD

Piles Clinic Jaipur,Shri sai krupa hospital,Bilaspur Dr. Agarwal’s Clinic, New Delhi, India.

INTRODUCTION
This study was undertaken to evaluate the efficacy of a combined surgical procedure i.e.ligation of intersphincteric fistula tract (LIFT) with video assisted fistula tract surgery (VAFT)] as a minimally invasive procedure for fistula in ano.

METHODS AND PROCEDURES
A prospective case series (January 2011-February 2012) of consenting candidates of fistula in ano, having simple straight tracts, with well defined exclusion criteria. The patients were evaluated with a standard clinical and preoperative diagnostic protocol. They were operated on a day care basis following a standardized perioperative protocol. The fistula tract ablation was done by VAFT till the tract was felt entering into the ano-rectal wall. The transmural portion was managed with the principle of LIFT. The patients were followed on Day 3 (D3), Day 7 (D7), Week 3 (W3), Month 3 (M3) and Month 6 (M6) for postoperative pain (POP), discharge, need for dressings, convalescence, return to work and recurrence. The data were entered into an excel sheath and analyzed.

RESULTS
A total of 62 patients (59 males and 3 females) with mean age of 32 (range 20-80) were operated. There was no technical difficulty, conversion to conventional procedure, failure to discharge from day care or need for re-hospitalization. All the patients were able to resume their normal routine from D3 onwards. There were no postoperative dressing requirements. Mean POP on a 100 point visual analogue scale showed a progressive reduction (D3-56, D7-40, W3-18, M3-15 and M6-5). There was no recurrence at M3 follow up. However at M6 follow up 9 recurrences (all males) were seen.

CONCLUSION
Combined procedure of VAFT+LIFT offers the advantages of minimally invasive surgery in treatment of simple straight fistula in ano. This needs to be evaluated in complex fistulae.

Session: Poster Presentation

Program Number: P041