The Journal of Practical Medicine >

2025 , Vol. 41 >Issue 1: 65 - 70

DOI: https://doi.org/10.3969/j.issn.1006-5725.2025.01.011

Clinical Research

Feasibility of modified LIFT guided by magnetic resonance imaging in the treatment of deep anorectal abscess

  • Zhilong SI ,
  • Hao WANG ,
  • Fei XIAO
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  • Department of Colorectal and Anal Surgery，Wuhan Fourth Hospital，Wuhan 430032，Hubei，China

Received date: 2024-10-10

  Online published: 2025-01-14

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Abstract

Objective To evaluate the efficacy and safety of magnetic resonance?guided modified ligation of the intersphincteric fistula tract in the treatment of deep anorectal abscess. Methods A retrospective study was conducted on 148 patients with deep anorectal abscess treated at our hospital from September 2019 to June 2023， who met the inclusion criteria. Of these， 51 patients in the observation group underwent modified LIFT， while 97 patients in the control group received incision and drainage. Using propensity score matching， 47 patients from each group with balanced baseline characteristics were selected， resulting in a total of 94 patients being included in the analysis. The study compared operation time， hospital stay， pain index， postoperative complications， anal function， and healing rate between the two groups. Results Primary lesions originating in the sphincter space were identified through preoperative magnetic resonance imaging in all 94 patients. The mean operation time for the observation group was （43.75 ± 11.77） minutes， significantly longer than that of the control group at （28.90 ± 8.67） minutes （P < 0.05）. At three months post?surgery， the healing rate in the observation group was 80.9%， which was significantly higher than the 57.4% observed in the control group （P < 0.05）. Among patients with fistulas in the observation group， the healing rate was 73.1%， although this difference was not statistically significant in the univariate analysis of clinical characteristics （P > 0.05）. No significant differences were found between the two groups regarding the length of hospital stay， pain index， postoperative complications， or anal function （all P > 0.05）. Conclusions Modified LIFT guided by MRI can be conditionally applied in the treatment of deep anorectal abscesses. This approach can enhance the initial surgical healing rate without significantly increasing the incidence of postoperative complications， thereby avoiding potential damage to anal function.

Key words： anorectal abscess; magnetic resonance imaging; ligation of intersphincteric fistula tract; closure of internal opening; seton; propensity score matching

Cite this article

Zhilong SI , Hao WANG , Fei XIAO . Feasibility of modified LIFT guided by magnetic resonance imaging in the treatment of deep anorectal abscess[J]. The Journal of Practical Medicine, 2025 , 41(1) : 65 -70 . DOI: 10.3969/j.issn.1006-5725.2025.01.011

References

1 AMATO A， BOTTINI C， DE NARDI P， et al. Evaluation and management of perianal abscess and anal fistula： SICCR position statement［J］. Tech Coloproctol， 2020，24（2）：127-143. doi:10.1007/s10151-019-02144-1
2 MOCANU V， DANG JT， LADAK F， et al. Antibiotic use in prevention of anal fistulas following incision and drainage of anorectal abscesses： A systematic review and meta-analysis［J］. Am J Surg， 2019，217（5）：910-917. doi:10.1016/j.amjsurg.2019.01.015
3 ROJANASAKUL A， BOONING N， HUIMIN L， et al. Intersphincteric Exploration With Ligation of Intersphincteric Fistula Tract or Attempted Closure of Internal Opening for Acute Anorectal Abscesses［J］. Dis Colon Rectum， 2021，64（4）：438-445. doi:10.1097/dcr.0000000000001867
4 GAERTNER W B， BURGESS P L， DAVIDS J S， et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess， Fistula-in-Ano， and Rectovaginal Fistula［J］. Dis Colon Rectum， 2022，65（8）：964-985. doi:10.1097/dcr.0000000000002473
5 CHAVELI DíAZ C， ESQUIROZ LIZAUR I， EGUARAS CóRDOBA I， et al. Recurrence and incidence of fistula after urgent drainage of an anal abscess. Long-term results［J］. Cir Esp （Engl Ed）， 2022，100（1）：25-32. doi:10.1016/j.cireng.2021.11.012
6 PIGOT F. Treatment of anal fistula and abscess［J］. J Visc Surg， 2015，152（2）：S23-S29. doi:10.1016/j.jviscsurg.2014.07.008
7 EROL T， MENTES B， BAYRI H， et al. Preventing the recurrence of acute anorectal abscesses utilizing a loose seton： A pilot study［J］. Pan Afr Med J， 2020，35（18）：18. doi:10.11604/pamj.2020.35.18.21029
8 黄海进， 焦峰， 仲艳阳， 等. 高位肛周脓肿切开术后不同引流方式的临床对照研究［J］. 实用医学杂志， 2018，34（13）：2275-2279.
9 ROJANASAKUL A， PATTANAARUN J， SAHAKITRUNGRUANG C， et al. Total anal sphincter saving technique for fistula-in-ano； the ligation of intersphincteric fistula tract［J］. J Med Assoc Thai， 2007，90（3）：581-586.
10 WEN K， GU Y F， SUN X L， et al. Long-Term Outcomes Of Ligation Of Intersphincteric Fistula Tract for Complex Fistula-In-Ano： Modified Operative Procedure Experience［J］. Arq Bras Cir Dig， 2018，31（4）：e1404. doi:10.1590/0102-672020180001e1404
11 CELAYIR M F. Complex Anal Fistula： Long-Term Results of Modified Ligation of Intersphincteric Fistula Tract=LIFT［J］. Sisli Etfal Hastan T?p Bul， 2020，54（3）：297-301.
12 MALAKORN S， SAMMOUR T， KHOMVILAI S， et al. Ligation of Intersphincteric Fistula Tract for Fistula in Ano： Lessons Learned From a Decade of Experience［J］. Dis Colon Rectum， 2017，60（10）：1065-1070. doi:10.1097/dcr.0000000000000880
13 MINORDI L M， LAROSA L， BEVERE A， et al. Magnetic Resonance and Traditional Radiology in the Diagnosis of Cryptoglandular Anal Fistula and Abscess［M］. Anal Fistula and Abscess， 2022：165-192. doi:10.1007/978-3-030-76670-2_13
14 KUMMARI S， BURRA K G， REDDY V R K， et al. The Role of Magnetic Resonance Imaging in Pre-operative Assessment of Anorectal Fistula With Surgical Correlation［J］. Cureus， 2024，16（1）：e53237.
15 KING S K. Should we seek a fistula-in-ano when draining a perianal abscess？［J］. J Paediatr Child Health， 2010，46（5）：273-274. doi:10.1111/j.1440-1754.2009.01694.x
16 HANLEY P H. Conservative surgical correction of horseshoe abscess and fistula［J］. Dis Colon Rectum， 1965，8（5）：364-368. doi:10.1007/bf02627261
17 BROWDER L K， SWEET S， KAISER A M. Modified Hanley procedure for management of complex horseshoe fistulae［J］. Tech Coloproctol， 2009，13（4）：301-306. doi:10.1007/s10151-009-0539-6
18 WILLIAMS G， WILLIAMS A， TOZER P， et al. The treatment of anal fistula： second ACPGBI Position Statement-2018［J］. Colorectal Dis， 2018，20（3）：5-31. doi:10.1111/codi.14054
19 GARG P. A new understanding of the principles in the management of complex anal fistula［J］. Med Hypotheses， 2019，132：109329. doi:10.1016/j.mehy.2019.109329
20 GARG P， KAUR B， MENON G R. Transanal opening of the intersphincteric space： A novel sphincter‐sparing procedure to treat 325 high complex anal fistulas with long‐term follow‐up［J］. Colorectal Dis， 2021，23（5）：1213-1224. doi:10.1111/codi.15555
21 GARG P. Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space［J］. World J Gastrointest Surg， 2022，14（5）：374-382. doi:10.4240/wjgs.v14.i5.374
22 EMILE S H， KHAN S M， ADEJUMO A， et al. Ligation of intersphincteric fistula tract （LIFT） in treatment of anal fistula： An updated systematic review， meta-analysis， and meta-regression of the predictors of failure［J］. Surgery， 2020，167（2）：484-492. doi:10.1016/j.surg.2019.09.012
23 DURGUN C， TüZüN A. The use of a loose seton as a definitive surgical treatment for anorectal abscesses and complex anal fistulas［J］. Adv Clin Exp Med， 2023，32（10）：1149-1157. doi:10.17219/acem/161162
24 MALIK A I， NELSON R L， TOU S. Incision and drainage of perianal abscess with or without treatment of anal fistula［J］. Cochrane Database Syst Rev， 2010，7（7）：Cd006827.
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