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The ligation of inter-sphincteric fistula tract (LIFT®) technique is used to fix fistula-in-ano, or anal fistula, and is considered to be a simplified approach to surgery. It is considered a low-risk, viable alternative to other procedures that involve sealing the fistula with tissue or a plug. This technique was developed by a Arun Rojanasakul, a Thai surgeon based at Chulalongkorn University in Bangkok, Thailand.
A fistula is an abnormal tract or opening formed in tissue. In the case of an anal fistula, there is an opening in the anal canal. This canal, or tract, goes through the muscle surrounding the anus, known as the sphincter muscles, to the skin of the buttocks. If the opening or tract gets infected, a fistula is formed.
The LIFT® technique begins by making an incision in the opening of the fistula in the anal canal to determine where it is in the intersphincteric tract, the area between the sphincter muscles. Another opening is made through the external opening of the fistula on the buttocks. A tube is inserted through the external opening to identify the tract and to clean the area out. Infected tissue, called cryptoglandular tissue, is then removed. The openings are then sealed to prevent further infection and re-occurrence of a fistula.
There is some danger in the LIFT® technique due to its proximity to both the external and internal sphincter muscles. These muscles are what seals the anus and prevent anything from entering or leaving. Previous surgeries that utilized similar procedures as the LIFT® technique were unsuccessful when the internal sphincter was harmed and the anal mucosa was penetrated. These procedures often failed because sutures broke or blood supply to the area was permanently damaged.
If the sphincter is damaged through surgery, the patient can possibly become incontinent. Due to the damage, the sphincter cannot fully close, and fluid and feces can drain out involuntarily through the leak. This was a problem in previous procedures even if scrupulous repair was done after damage occurred.
Although there is a small risk of damage to the sphincter using the LIFT® technique, the problem of cut-off blood supply and broken sutures was reduced because this procedure seals the opening more securely using ligation. It is considered much safer than previous similar procedures because it goes into the space between the sphincters, as opposed to the going through the muscles themselves. This is the reason the LIFT® technique is referred to as a sphincter-sparing procedure.
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