Increasing experience of ligation of the intersphincteric fistula tract for patients with Crohn's disease: what have we learned?

Colorectal Dis. 2017 Aug;19(8):750-755. doi: 10.1111/codi.13668.


Aim: Ligation of the intersphincteric fistula tract (LIFT) has been proposed as a treatment of trans-sphincteric fistula in perianal Crohn's disease (CD). The aim of this study was to look at our experience of the LIFT procedure in CD patients on long-term follow-up. Specifically, we aimed to determine the fistula healing rate after the LIFT procedure after more than 12 months follow-up and to identify any prognostic factors.

Method: Retrospective study of patients with trans-sphincteric Crohn's fistula tracts treated with the LIFT procedure between January 2011 and October 2015. Complete fistula healing as well as clinical outcomes were analysed.

Results: Data were available for 23 patients. After a median follow-up of 23 months, LIFT site healing was 48%. Patients with healed LIFT had a median follow-up time of 10.5 months, while patients with failed LIFT had a median follow-up time of 31 months (P = 0.04). Median time to failure was 9 months for patients with follow-up > 1 year. Most patients failed within 1 year (9/12; 75%) of the procedure. In multi-site CD, the LIFT procedure was more likely to be successful in those with small bowel disease (P = 0.04) compared with colonic disease (P = 0.02). Other factors such as preoperative use of biological therapies, presence of a seton, previous repair attempts, fistula position, type or number of fistulas, multiple fistula tracts, smoking status and other associated perianal disease did not appear to influence LIFT healing rates.

Conclusion: The LIFT procedure offers reasonable long-term success in the treatment of perianal trans-sphincteric fistulas associated with CD. LIFT is more likely to fail in patients with concurrent colonic CD than in patients with small bowel CD.

Keywords: Crohn's; LIFT; fistula.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Anal Canal / surgery*
  • Colon / pathology
  • Crohn Disease / complications*
  • Crohn Disease / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Intestine, Small / pathology
  • Ligation / methods*
  • Male
  • Middle Aged
  • Rectal Fistula / surgery*
  • Recurrence
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome