Garg P. Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space. World J Gastrointest Surg 2022; 14(5): 374-382 [PMID: 35734614 DOI: 10.4240/wjgs.v14.i5.374]
Corresponding Author of This Article
Pankaj Garg, MS, CEO, Chief Colorectal Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, 1043, Sector 15, Panchkula 134113, India. drgargpankaj@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. May 27, 2022; 14(5): 374-382 Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.374
Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space
Pankaj Garg
Pankaj Garg, Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, India
Pankaj Garg, Department of Colorectal Surgery, Indus International Hospital, Mohali 140507, India
Author contributions: Garg P conceived and designed the study, collected and analyzed the data, revised the data, granted final approval and submitted the manuscript (guarantor of the review).
Conflict-of-interest statement: There is no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Garg, MS, CEO, Chief Colorectal Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, 1043, Sector 15, Panchkula 134113, India. drgargpankaj@gmail.com
Received: December 29, 2021 Peer-review started: December 29, 2021 First decision: January 27, 2022 Revised: January 29, 2022 Accepted: April 27, 2022 Article in press: April 27, 2022 Published online: May 27, 2022
Abstract
Complex anal fistulas are difficult to treat. The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement. Due to this, several sphincter-sparing procedures have been developed in the last two decades. Though moderately successful in simple fistulas (50%-75% healing rate), the healing rates in complex fistulas for most of these procedures has been dismal. Only two procedures, ligation of intersphincteric fistula tract and transanal opening of intersphincteric space have been shown to have good success rates in complex fistulas (60%-95%). Both of these procedures preserve continence while achieving high success rates. In this opinion review, I shall outline the history, compare the pros and cons, indications and contraindications and future application of both these procedures for the management of complex anal fistulas.
Core Tip: Ligation of intersphincteric fistula tract (LIFT) and transanal opening of intersphincteric space (TROPIS) are two of the more recent innovative procedures introduced in the last decade. Both of these procedures have been shown to be quite effective in complex anal fistulas. As both procedures are primarily sphincter-sparing, they do not lead to deterioration in continence. The advantages and disadvantages, indications and contraindications of LIFT and TROPIS have been discussed in this opinion viewpoint as well as the role both these procedures are likely to play in the future.
