{
    "abstract": "There is no consensus on the standard approach for trans-sphincteric perianal fistulas (TPAF) in the elderly population. The most commonly used sphincter-saving procedures are ligation of the inter-sphincteric fistula tract (LIFT) and mucosal advancement flap (MAF). We aimed to evaluate the incidence and risk factors for recurrence and incontinence in elderly patients with TPAF using both approaches.\nThis retrospective study included 257 patients who underwent LIFT (136 patients) or MAF (121 patients) for de novo and cryptoglandular TPAF between July 2018 and July 2021. Recurrent fistulas were clinically and radiologically detected using MRI. Postoperative incontinence was evaluated using the Wexner score and anorectal manometry. Logistic regression analysis was used to detect the risks of recurrence and incontinence.\nThe median ages of the patients were 68 (64, 74) and 68 (65, 74) years in the LIFT and MAF groups, respectively. Higher recurrence rates were observed after LIFT (17 (12.5%)) than after MAF (13 (10.7%)), but the difference was not statistically significant (P\u2009=\u20090.662). Postoperative incontinence was observed in 18 patients (13.2%) and seven patients (5.8%) in the LIFT and MAF groups, respectively (P\u2009=\u20090.044). The predictors for fistula recurrence were smoking (OR, 75.52; 95% CI, 1.02 to 5611.35; P\u2009=\u20090.049), length of tract (OR, 17.3; 95% CI, 1.49 to 201.13; P\u2009=\u20090.023), and CD classification (OR, 7.08; 95% CI, 1.51 to 33.14; P\u2009=\u20090.013). A low Charlson comorbidity index score (\u2264\u20095) (OR, 0.68; 95% CI, 0.47 to 0.99; P\u2009=\u20090.046) and high postoperative mean squeeze anal pressure (OR, 0.97; 95% CI, 0.95 to 0.99; P\u2009=\u20090.001) were significant factors associated with reduced risk of incontinence. In particular, LIFT was associated with a significantly higher risk of incontinence than MAF (OR, 2.089; 95% CI, 1.006 to 4.33; P\u2009=\u20090.04).\nThe healing rates of MAF and LIFT procedures did not differ significantly; however, continence was significantly better after MAF. MAF should be added to the guidelines as a good option for the treatment of TPAF in elderly patients.\nThe study was registered as a clinical trial www.\ngov (NCT06616662).",
    "authors": [
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt. tameralnaimy@hotmail.com.",
            "firstname": "Tamer A A M",
            "initials": "TAAM",
            "lastname": "Habeeb"
        },
        {
            "affiliation": "Department of General Surgery Specialties and Organ Transplant, Faculty of Pharmacy and Medicine, Sapienza Rome University, Rome, Italy.",
            "firstname": "Massimo",
            "initials": "M",
            "lastname": "Chiaretti"
        },
        {
            "affiliation": "Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv, Ukraine.",
            "firstname": "Igor A",
            "initials": "IA",
            "lastname": "Kryvoruchko"
        },
        {
            "affiliation": "Azienda Unit\u00e0 Sanitaria Locale Ferrara, Ferrara, Italy.",
            "firstname": "Antonio",
            "initials": "A",
            "lastname": "Pesce"
        },
        {
            "affiliation": "Department of Surgery, Athens Metropolitan General Hospital, and University of Nicosia Medical School by HEAL Academy, Athens, Greece.",
            "firstname": "Aristotelis",
            "initials": "A",
            "lastname": "Kechagias"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.",
            "firstname": "Abd Al-Kareem",
            "initials": "AA",
            "lastname": "Elias"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.",
            "firstname": "Abdelmonem A M",
            "initials": "AAM",
            "lastname": "Adam"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.",
            "firstname": "Mohamed A",
            "initials": "MA",
            "lastname": "Gadallah"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.",
            "firstname": "Saad Mohamed",
            "initials": "SM",
            "lastname": "Ali Ahmed"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.",
            "firstname": "Ahmed",
            "initials": "A",
            "lastname": "Khyrallh"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.",
            "firstname": "Mohammed H",
            "initials": "MH",
            "lastname": "Alsayed"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.",
            "firstname": "Esmail",
            "initials": "E",
            "lastname": "Tharwat Kamel Awad"
        },
        {
            "affiliation": "General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.",
            "firstname": "Mohammed Hassan",
            "initials": "MH",
            "lastname": "Elshafey"
        },
        {
            "affiliation": "General Surgery Department, Faculty of Medicine, Merit University, Sohag, Egypt.",
            "firstname": "Mohamed Ibrahim",
            "initials": "MI",
            "lastname": "Abo Alsaad"
        },
        {
            "affiliation": "Misr University for Science and Technology, Cairo, Egypt.",
            "firstname": "Abouelatta Kh",
            "initials": "AK",
            "lastname": "Ali"
        },
        {
            "affiliation": "Mataryia Teaching Hospital (GOTHI), Cairo, Egypt.",
            "firstname": "Hamdi",
            "initials": "H",
            "lastname": "Elbelkasi"
        },
        {
            "affiliation": "General Surgery Department, El Mahala Hepatic Insistute, Al Gharbia, El Mahala, Tanta, Egypt.",
            "firstname": "Mahmoud Ali",
            "initials": "MA",
            "lastname": "Abou Zaid"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.",
            "firstname": "Hoda A A",
            "initials": "HAA",
            "lastname": "Youssef"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.",
            "firstname": "Mona Mohammad Farid",
            "initials": "MMF",
            "lastname": "Al-Zamek"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Alaa",
            "initials": "A",
            "lastname": "Fiad"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Tamer Mohamed",
            "initials": "TM",
            "lastname": "Elshahidy"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mahmoud R",
            "initials": "MR",
            "lastname": "Elballat"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Ahmed Kamal",
            "initials": "AK",
            "lastname": "El Taher"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mohamed Mahmoud Mokhtar",
            "initials": "MMM",
            "lastname": "Mohamed"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Ahmed Khaled",
            "initials": "AK",
            "lastname": "AboZeid"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mohamed Ibrahim",
            "initials": "MI",
            "lastname": "Mansour"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mahmoud Abdou",
            "initials": "MA",
            "lastname": "Yassin"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Ahmed Salah",
            "initials": "AS",
            "lastname": "Arafa"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mohamed",
            "initials": "M",
            "lastname": "Lotfy"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Bassam",
            "initials": "B",
            "lastname": "Mousa"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Baher",
            "initials": "B",
            "lastname": "Atef"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Sameh Mohamed",
            "initials": "SM",
            "lastname": "Naguib"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Ibrahim A",
            "initials": "IA",
            "lastname": "Heggy"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mohamed",
            "initials": "M",
            "lastname": "Elnemr"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mohamed Abdallah",
            "initials": "MA",
            "lastname": "Zaitoun"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Ehab Shehata",
            "initials": "ES",
            "lastname": "AbdAllah"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Mohamad S",
            "initials": "MS",
            "lastname": "Moussa"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Abd Elwahab M",
            "initials": "AEM",
            "lastname": "Hamed"
        },
        {
            "affiliation": "Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.",
            "firstname": "Rasha S",
            "initials": "RS",
            "lastname": "Elsayed"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2025. The Author(s).",
    "doi": "10.1007/s00384-025-04846-5",
    "journal": "International journal of colorectal disease",
    "keywords": [
        "Elderly",
        "Incontinence",
        "Ligation inter-sphincteric fistula surgery",
        "Mucosal advancement flap",
        "Observational study",
        "Recurrence",
        "Trans-sphincteric perianal fistula"
    ],
    "methods": null,
    "publication_date": "2025-03-12",
    "pubmed_id": "40072575\n21757037\n38093036\n38363007\n37349532\n39228196\n21431388\n33730796\n38466439\n37646885\n39008124\n36905475\n37707561\n33881573\n31455971\n34057576\n31037566\n28882770\n32300885\n33860363\n20388562\n16538494\n30506546\n25203377\n28247060\n22067182\n18322659\n17427539\n31490832\n23320466\n28891851\n27878618\n34098630\n23739197\n37737881\n23551996\n33580275\n31114719\n24452294\n34339882\n19220375\n38445501\n14719157\n30178915\n23657401\n35217938\n8416784\n15273542\n19636496\n30199606\n14668594\n38946090\n25566951\n12972959\n27626024\n25487858\n31183438\n24187455\n28271064\n26990602\n20010349\n25652877\n21178860\n30535666\n23392149\n31400504\n1323208\n15868234\n38050857",
    "results": "The median ages of the patients were 68 (64, 74) and 68 (65, 74) years in the LIFT and MAF groups, respectively. Higher recurrence rates were observed after LIFT (17 (12.5%)) than after MAF (13 (10.7%)), but the difference was not statistically significant (P\u2009=\u20090.662). Postoperative incontinence was observed in 18 patients (13.2%) and seven patients (5.8%) in the LIFT and MAF groups, respectively (P\u2009=\u20090.044). The predictors for fistula recurrence were smoking (OR, 75.52; 95% CI, 1.02 to 5611.35; P\u2009=\u20090.049), length of tract (OR, 17.3; 95% CI, 1.49 to 201.13; P\u2009=\u20090.023), and CD classification (OR, 7.08; 95% CI, 1.51 to 33.14; P\u2009=\u20090.013). A low Charlson comorbidity index score (\u2264\u20095) (OR, 0.68; 95% CI, 0.47 to 0.99; P\u2009=\u20090.046) and high postoperative mean squeeze anal pressure (OR, 0.97; 95% CI, 0.95 to 0.99; P\u2009=\u20090.001) were significant factors associated with reduced risk of incontinence. In particular, LIFT was associated with a significantly higher risk of incontinence than MAF (OR, 2.089; 95% CI, 1.006 to 4.33; P\u2009=\u20090.04).",
    "title": "Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study.",
    "xml": "<Element 'PubmedArticle' at 0x788504a61850>"
}