Early experience of reinforcing the ligation of the intersphincteric fistula tract procedure with a bioprosthetic graft (BioLIFT) for anal fistula

Background The BioLIFT procedure involves placing a bioprosthetic graft in the intersphincteric space during the ligation of the intersphincteric fistula tract (LIFT) procedure. Our study was aimed to describe our experience in the BioLIFT procedure. Methods A review of all patients who underwent the BioLIFT procedure for anal fistula from September 2011 to August 2012 was performed. Endoanal ultrasonography and manometry tests were performed in all patients. Results Thirteen patients with 16 fistulas underwent the BioLIFT procedure. All of them had at least a seton inserted previously and the median interval to the BioLIFT procedure was 20 (range, 10-41) weeks. Four patients failed a prior LIFT procedure. More than half of the fistulas (56.3%) had anterior internal openings and there was a female preponderance (n = 7, 53.8%). Over a median follow up of 26 (12-51) weeks, 11 (68.8%) fistulas had healed. The median interval between the BioLIFT procedure to the diagnosis of failure was 3 (2-7) weeks. All five failures had only isolated discharges at the intersphincteric wounds. Two had already undergone successful lay-open fistulotomy, giving a secondary success rate of 81.3%. The remaining three patients are on review. No patient developed incontinent symptoms following the BioLIFT procedure and there were no significant differences between the pre-procedural or post-procedural maximal resting and squeeze anal manometric pressures. Conclusion The BioLIFT procedure can achieve a primary success rate of 68.8%. When coupled with a simple lay-open fistulotomy for the subsequent intersphincteric fistula, the success rate in eradicating the fistula rose to 81.3%.