Ligation of Intersphincteric Fistula Tract (LIFT) Procedure

Abstract

Essential Steps 1. Prone positioning 2. Prep and drape 3. Digital rectal exam prior to instrumentation 4. Curvilinear incision at the intersphincteric groove overlying fistula 5. Intersphincteric dissection 6. Ligation of internal opening of fistula 7. Curettage of fistula tract 8. Closure of external opening approaching from intersphincteric groove incision 9. Re-aproximation of mucosa 10. Flip patient Possible Variations • Positioning prone versus dorsal lithotomy • Surgical prep solution • Local anesthetic block (perianal field block, pudendal nerve block) • Fixed versus bivalve speculum for exposure • Drain placement through external opening of fistula • Temporary fecal diversion • Hemostatic packing agent Complications • Recurrence of fistula • Intersphincteric abscess • Fecal incontinence Operative Note Preoperative Diagnosis Fistula-in-ano Procedure Ligation of intersphincteric fistula tract procedure Postoperative Diagnosis Same Indications This _______-year-old male/female has had a history of recurrent perirectal abscesses. On (date), an examination under anesthesia was performed with incision and drainage of perirec-tal abscess followed by seton placement. The patient presents today for definitive repair of his/her anal fistula. Description of Operation The patient was brought to the operating room, and while on the transport cart, cardiopulmo-nary monitors were placed by the anesthesi-ologist and vital signs were stable. Time-outs were performed using both preinduction and pre-incision safety checklists to verify correct