Surgery · 1 h ago
FOISF associated with higher healing than LIFT in a small cohort
A retrospective, single-center cohort study compared fistula occlusion with an internal sphincter flap (FOISF) with LIFT in 69 patients with anal fistulas. Healing was more frequent after FOISF, while measured continence outcomes did not differ significantly; the nonrandomized design limits interpretation.
- Healing: 89.3% with FOISF versus 48.8% with LIFT
- Treatment allocation was not randomized
- Measured continence outcomes did not differ significantly
Ligation of the intersphincteric fistula tract (LIFT) is an established sphincter-preserving operation for anal fistulas. Researchers at a tertiary hospital retrospectively compared it with fistula occlusion using an internal sphincter flap (FOISF), a technique standardized at the institution in 2020. The cohort included 69 patients treated between November 2020 and February 2023: 28 underwent FOISF and 41 underwent LIFT. Procedure choice was part of routine care, not randomized; median follow-up was 39 months (IQR 35–43).
Primary healing was reported in 89.3% of the FOISF group and 48.8% of the LIFT group (P<0.001). In multivariable analysis, FOISF was associated with higher odds of healing (OR 23.27, 95% CI 4.35–204.34; P=0.001), and treatment failure-free survival also favored FOISF. Postoperative Wexner scores and anorectal manometry measurements did not differ significantly between groups, and neither group showed statistically detectable continence deterioration.
The findings suggest a potential healing advantage for FOISF without a detected difference in measured continence outcomes. However, the study was small, retrospective, and conducted at one center; treatment selection may have introduced confounding, and the wide confidence interval indicates substantial uncertainty. Larger comparative studies are needed before drawing firm conclusions about relative effectiveness.
In practice
For patients undergoing surgery for complex anal fistula, this single-center retrospective cohort found higher observed healing after FOISF than after LIFT, with no statistically significant differences in measured continence outcomes. These results may inform discussion of emerging sphincter-preserving options, but they do not establish that FOISF is superior: only 69 patients were included, procedure selection reflected routine clinical judgment rather than random allocation, and the adjusted estimate was imprecise. The findings do not by themselves justify changing practice.
AI-generated clinical interpretation · Not editor-reviewed
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
Surgical Endoscopy: Fistula occlusion with an internal sphincter flap versus ligation of intersphincteric fistula tract for complex anal fistula: a retrospective single-center cohort study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.