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Ass. Lect. Sherif Mohamed Hussien Elkaffas :: Publications:

Ligation of Intersphincteric Fistula Tract Versus Fistulotomy in Treatment of Anal Fistulas
Authors: Hany Salah El-Din Tawfik MD, Emad El-din Mostafa Abdel Hafez MD, Hazem El-Sayed Ali MD, Sherif Mohammed El-Kaffas
Year: 2019
Keywords: Not Available
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Local/International: Local
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Full paper Sherif Mohamed Hussien Elkaffas_2 anatomy.docx
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Background: Perianal fistula is one of the most common benign anal conditions in daily surgical practice. Perianal fistula is a chronic phase of anorectal sepsis and is characterized by chronic purulent drainage or cyclical pain associated with abscess formation, followed by intermittent spontaneous decompression. The complex anal fistula remains a challenging condition to manage despite the best of technologic advances. Therefore, the colorectal surgeon should become familiar with various new techniques for treating an anal fistula and remember that conventional fistula surgery, such as cutting seton and advancement flap, has an important role. Definitive evidence of the advantage of the new sphincter-preserving techniques e.g LIFT compared with the traditional intervention requires randomized control studies, which are now being conducted. Aim: The aim of this study was to compare the efficacy of ligation of intersphincteric fistula track (LIFT) versus fistulotomy in the treatment of perianal fistulas. Methodology: This thesis is a prospective study where the patients were recruited from the Department of General Surgery Faculty of medicine, Benha University Hospital. The present study includes a total of 30 adult patients with a clinical diagnosis of a perianal fistula. Enrollment of eligible patients began on September 2016 and took place till September 2018. Patients were randomly divided into two groups (A and B). Group A included patients who underwent a fistulotomy whereas Group B included group of patients that underwent LIFT. Results: The mean age of the patients was 30 (±6) years for group A and 32 (±8) years for group B, with about 19 (%63.3) female patients. Mean operative time was 17 (±3) mins for group A and 34 (±5) mins for group B. Mean Visual Analogue Scale (VAS) for pain was significantly higher in group A (8) compared to group B (6). Post-operative perianal discharge was more with group A than group B. Mean hospital stay for both groups was 2 days. Mean time needed for healing was significantly higher in group A (7 weeks) compared to group B (5 weeks). Healing occurred in 13 patients (%86.7) with failure of 2 cases in group A while healing occurred in 14 patients (%93.3) with persistence of one case. Wound infection was the common complication that occurred in 4 (%26.7) cases in group A and 3 (%20.0) cases in group B. There were no cases that developed incontinence in both groups (%0.0). Conclusion: LIFT procedure in intersphincteric perianal fistulas should be more popular, to be implemented as a corner stone procedure along various and classic operations for such cases as it is easy, feasible, sphincter saving technique

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