BJS Open, https://doi.org/10.1093/bjsopen/zrae055, published 06 June 2024
To the Editor
We read the article by van Oostendorp on Ligation of intersphincteric fistula tract (LIFT).1 The study was interesting but concerning, given the low fistula healing rate (28%) and surprisingly high incontinence rates after LIFT.
LIFT has been commonly performed for low and high trans-sphincteric fistulas, with success rates ranging from 21 to 94% and incontinence rates ranging from 0 to 20% in several RCTs. Factors such as previous fistula surgery and high trans-sphincteric fistulas affect the success rate of LIFT. In addition to the median recurrence-free survival time of 4.6 months, the low healing rates reported in the study by van Oostendorp might be misleading for readers, considering the relatively small population size and the large proportion of patients who had previous attempts to close their fistula (92%). Moreover, van Oostendorp reported higher healing rates for high trans-sphincteric fistulas (36%) than for low fistulas (20%), raising the question of whether the LIFT technique was standardized across both centres.
The number of continent patients significantly decreased from 84% preoperatively to 74% after longer follow-up, which is a source of concern despite 81% of patients being continent immediately after the procedure. Many of the patients in the study cohort underwent various procedures, including fistulotomy and laser fistulectomy, which calls into question the direct and clear relationship between incontinence and LIFT. Long-term continence could not be evaluated in 37% of patients.
The retrospective nature of the study with incomplete data and the features of the particular cohort makes it difficult to draw certain conclusions, but we agree with the authors that LIFT should be approached cautiously, and that better data are needed, and should be collected.
References
van Oostendorp JY, Verkade C, Han-Geurts IJM, van der Mijnsbrugge GJH, Wasowicz-Kemps DK, Zimmerman DDE. Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence. BJS Open 2024;8:zrae055
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