QS126 - Is Ligation of the Intersphincteric FistulaTract (LIFT) Useful in Crohn’s Disease of the Ileal Pouch?

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Purpose/Background: Ileal pouch-anal anastomosis (IPAA) is the procedure of choice for ulcerative colitis patients requiring surgery. However, some patients can develop CD of the ileal pouch, frequently accompanied by fistula formation in the perianal or vaginal areas. Pouch fistulizing disease (PFD) is very difficult to treat. Ligation of the intersphincteric fistula tract (LIFT) offers reasonable long-term success in the treatment of non-pouch fistulizing disease (NPFD) in CD patients. Herein, we compare outcomes of LIFT for PFD and NFPD in CD patients.

Methods/Interventions: A single-institution retrospective study was conducted on CD patients with PFD and NPFD undergoing LIFT between January 2011 and June 2024. Patient and fistula characteristics were tabulated. Patients were classified into 2 groups (healed or failed). Fistula healing at last follow-up was defined as closure of external wounds, cessation of drainage and absence of pain. Demographic and disease characteristics were compared between groups using Fisher’s exact test or Wilcoxon rank sum test.

Results/Outcomes: The study cohort of 67 patients included 15 (22%) PFD patients and 52 (78%) NPFD patients. Fistulas were classified as transsphincteric (n=51; 76%) and vaginal (n=16; 24%). Median age (range) and gender (% males) were similar between the PFD (41 (17-65), 42%) and the NPFD (32 (11-66), 33%) patient groups. There was no significant difference in the incidence of vaginal fistulas in the PFD patient group (n=4; 27%) compared to the NPFD patient group (n=12; 23%). PFD patients were less likely (all p=NS) to be smokers (13% vs 27%), more likely to have a lateral fistula (73% vs 50%), and less likely to have multiple fistulas (33% vs 50%). After a median follow up of 56 [1-146] months, fistula healing was seen in 45 (67%) patients. Median follow up was 55 (1-142) months in the PFD patient group compared to 61 (2-146) months in the NPFD patient group (p=NS). LIFT healing was observed in 11 (73%) PFD patients compared to 34 (65%) NPFD patients (p=NS). No clinical factor was associated with LIFT healing in the PFD patient group.

Conclusion/Discussion: CD patients with an ileal pouch fistula undergoing LIFT have a similar incidence of success compared to CD patients without an ileal pouch undergoing LIFT. LIFT should be an integral part of the surgical approach to patients with fistulizing CD of the ileal pouch.