Avaliação clínica, funcional e morfológica dos pacientes submetidos a tratamento cirúrgico da fístula anal com ligadura interesfincteriana do trajeto fistuloso (LIFT)

Abstract

Clinical, Functional and Morphological Assessment of Patients Undergoing surgical treatment of anal fístula with inter-sphincteric ligation of the fistulous tract (LIFT). Felipe Ramos Nogueira. Stricto Sensu Post-Graduate Course in Medical and Surgical Sciences, Faculty of Medicine of Universidade Federal do Ceará (Master's thesis). September, 2022. Advisor: Profa. Dra. Sthela Maria Murad Regadas. The treatment of anal fístula has historically been a challenge for the surgeon, due to the risk of fecal incontinence. Three-dimensional anorectal ultrasound (3D-US) is a tool in the clinical and anatomical evaluation of patients with anal fístula. The purpose of the study was to evaluate the role of 3D-US in the surgical treatment of transsphincteric fístulas, in the following aspects: anatomically evaluating the transsphincteric fístula before and after the surgical intervention; select, based on the 3DUS, patients eligible for the LIFT technique; identify possible recurrences or even early failure after surgical treatment; and to compare clinical data related to fecal incontinence, before and after surgery. A prospective observational study included 63 patients with transsphincteric anal fístula of cryptogenic origin. Patients were evaluated preoperatively by three-dimensional anorectal ultrasound, fecal incontinence score and anal manometry. Based on 3D-US data, male and female patients with greater involvement of the sphincter musculature (>30%) were selected for the LIFT surgical technique. Two months after the intervention, they were again evaluated by three-dimensional anorectal ultrasonography, by the fecal incontinence score, and their data were compared. The 3D-US correctly quantified the involvement of the sphincter muscles with the fistulous tract, correlating anatomically with scar fibrosis in the postoperative evaluation, as well as surprising 13 cases of failures of the LIFT technique, 9 of which were due to early treatment failure, and 5 for recurrence. No patient evolved with symptoms of postoperative incontinence. The 3D-US proved to be useful in the preoperative evaluation of fístulas by quantifying the percentage of muscle involved by the fistulous tract, in the follow-up after surgical treatment using the LIFT technique when identifying scar tissue, the type of failure or recurrence, contributing to the appropriate choice in the evaluation of all stages of anal fístula treatment.