Post on 11-Jul-2015
SLOFT (Sub mucous Ligation Of Fistula Tract)
For Fistula in Ano
Dr D.U.PathakMS FACRSI
Jabalpur (M.P) India
Basic understanding
• The internal opening is always at the dentate line.
• High opening is usually Iatrogenic.
Role of Investigations
• Mandatory in recurrent fistulae and undetectable internal openings
• MRI is the best one.
The Aim of treatment
• Control of sepsis
• Prevention of incontinence and recurrence
• Giving him less pain, morbidity and job loss
Existing methods
• Lay open
• Seton
• Cut and repair of the sphincter after excision of the tract.
• Fistula plug
• VAAFT
• LIFT
Lay open
• Big painful wound with long term recovery
• Makes the patient incontinent at least for flatus.
• Gives a bad scar and furrow.
Excision of the tract and
Primary repair of sphincter
• Needs high expertise
• Associated with high incidence of incontinence.
Fistula plug
• Very attractive choice for affluent class
• The zero morbidity way but associated with high recurrence rate
LIFT
• Sound surgical principle
• Low morbidity
• No incontinence
But
• Difficult to learn,
to do and to teach
SLOFT (Sub mucous Ligation Of Fistula Tract)
• Basic principle is of LIFT- ligation of the tract
• In SLOFT -
• It is more proximal
• It is more superficial
• Leaves behind a smaller stump of the proximal tract
Probing
• Probe is gently introduced to come out from internal opening
• Then it is bent and pulled out of the Anus.
Injection Xylocaine adrenaline
• This blanches the area and does hydro dissection around the tract
Muco-Cutaneous
Junction
Hooking the tract
• Incision is at the muco cutaneous junction
• The tract is hooked
• Here it is superficial.
Multiple tracts – method is the same
Opening at 6-O clock
Opening at 2-O clock
Opening at 2-O clock
passing gas from scrotum
All the three tracts SLOFT done separately
What is new in this method?
• Nothing
• In LIFT also the tract was tied and cut.
• I have just made it simple and reproducible.
Aim remains the same
disconnect the internal opening which is like a funnel pouring infection out.
This study
• This prospective study was carried out from January 17th 2014, till date.
• 43 patients have been operated of all types of fistulas with no exclusion criteria.
• Of them, 4 were recurrent cases
• The early results and recovery have been uneventful.
Recurrences ??
• Time only will tell the percentage but
• They are bound to occur
Recurrence bothers the patient
if
the procedure was either costly
or the recovery was painful.