SLOFT vs LIFT in the treatment of Fistula in Ano

Dr D.U.PathakMS FACRSI

Coloproctologist, Shalby hospital , Jabalpur (M.P) India

Innovators of LIFT and SLOFT

Method

• SLOFT is Sub Mucosal Ligation of Fistula Tract

• LIFT is Ligation of Intersphincteric Fistula Tract

• The approach in SLOFT is near internal opening

SLOFT

• Level of ligation is just outside internal opening

LIFT

• Level of ligation is in the intersphincteric plane

Case selection

SLOFT

• No exclusion, all patients of fistula including the abscess fistula complex and immature distal tracts can be done

LIFT

• It is possible only in the mature fibrosed fistula tracts. Cannot be done till the abscess is resolved.

Limitation of LIFT

The inter sphincteric abscess cavity cannot be

ligated, until it drains, resolves, collapses, forms itself in the shape of tube while draining the pus out from external opening and becoming a mature fibrous tract, called as the distal tract of fistula in ano.

SLOFT in abscess

• Drainage and curettage of abscess done

• SLOFT seen in the abscess cavity, which indicates the ligation medial to inter sphincteric abscess, of the anal duct

SLOFT in acute abscess fistula complex

• Acute fistula complex• SLOFT could be done, as

the ligation is medial to the inter sphincteric abscess.

• This is the immediate post op picture.

SLOFT in Acute abscess

• SLOFT done and abscess cavity curetted

• Patient healed completely in 40 days

Post operative healing of abscess after SLOFT

• Abscess heals after SLOFT as the communication feeding the infection is broken

Post op failure in LIFT

• The reformation of abscess is deep in the inter sphincteric plane, which needs a proper drainage under anaesthesia

• To ensure break in communication, now bioLIFT is attempted.

Post operative failure in SLOFT

Since the ligation is very

close to the internal opening and sub mucous, the collection is also superficial , which bursts open spontaneous or can be dealt on OPD basis

Results

• Comparable to LIFT.• Recurrences are less , but these are short term

results of only two years.• No incontinence in both methods

Conclusion

• SLOFT is more simple and reproducible.• Can be done in all cases, no exclusion criteria.• Early results are encouraging

Now choice is yoursThanks ...