En los últimos dos años, ha llamado la atención tanto en artículos en revistas prestigiosas como en presentaciones a congresos internacionales de la especialidad, un nuevo método que se ha denominado LIFT (Ligation of Interesphinteric Fistula Tract), este método, descrito inicialmente por Rojanasakul A y col. de Tailandia, en marzo de 2007, como “una nueva técnica de cirugía de fístula anal con preservación completa del esfínter”, presentando 18 pacientes con fístula anal, con cicatrización exitosa de la fístula anal en 17 de ellos (94.4%), sin alteración alguna del mecanismo de continencia, lo que obviamente despertó el interés mundial de los especialistas en este tema.
Recomiendo la lectura del articulo del Dr. Rubén Vargas-de la Llata, publicado en Cirujano General Vol. 33 Supl. 1 – 2011
"La técnica es sencilla: enema rectal previo, anestesia regional, posición proctológica, identificación de las características de la fístula y del orificio primario, incisión curvilínea a nivel del espacio interesfintérico, sobre el trayecto de la fístula, el cual se diseca hasta liberarlo, procediendo luego a ligarlo con poliglactina a nivel del esfínter interno y seccionar el trayecto, para interrumpir el flujo fistuloso, se legra la parte distal y se amplía el orificio externo para facilitar el drenaje.
Originalmente fue recomendado para fístulas transesfintéricas y posteriormente refieren su utilidad en prácticamente cualquier tipo de fístula.
En la reunión anual de la Sociedad Americana de Cirujanos de Colon y Recto, realizado en Hollywood, Florida, en 2009, se presentaron en pódium dos trabajos, el primero de los autores J Bleier, H. Moloo, avalado por el Dr. Stanley Goldberg, de Minneapolis Minnesota, bajo el título de ligadura interesfintérica del tracto fistuloso (lift): una nueva técnica efectiva, que representa la introducción del método a los EUA. Presentaron 32 pacientes, con fístulas trans y supraesfintéricas corro- boradas por ultrasonido, 81% de ellos con falla con otros procedimientos previos, en los que se resolvió la fístula con esta técnica en 50% de ellos, en un seguimiento de 10 meses, sin alteración alguna de la continencia. Concluyen que si bien es un nuevo procedimiento den- tro del armamentario de los métodos preservadores de esfínter, hace falta mayor evaluación de los resultados del procedimiento.
En esa misma reunión un segundo trabajo presentado por A. Sahanwani y col, de Malasia, denominado: la ligadura del tracto fistuloso interesfintérico (lift) para fístula anal: técnica salvadora de esfínter, presentaron 45 pacientes, 11% recidivantes, en los que se obtuvo éxito en 82.2%, en un seguimiento de 3 a 8 meses.
En el 2010, también en la Reunión Anual de la ASCRS, realizada en Minneapolis, Minnesota, en el mes de mayo, nuevamente fue abordado el tema en dos trabajos presentados.
De acuerdo con estos resultados la técnica LIFT parece ser útil sobre todo en fístulas complejas o recidivantes, es una técnica fácil de aprender, sencilla, económica, repetible en caso necesario, pero en la que aun estan pendientes resultados de seguimiento a mas largo plazo y estudios randomizados controlados, para valorar eficacia y durabilidad del procedimiento, lo cual ha sido recomendado en la revisión Cochrane hecha por Jacob TJ y col recientemente."
Podeis acceder al articulo completo pinchando aquí
En la próxima reunión de la Asociación Española de Cirujanos que se celebrará en Pamplona el Dr. E. Espín Basany presentará sus resultados en esta técnica.
Espero vuestros comentarios.
A continuación un video sobre la misma, realizado por el autor que describió la técnica.
Blog de Cirugia Colorrectal editado por el Dr. Alba Mesa del Hospital HOSPITEN ROCA desde Las Palmas de Gran Canaria.
HEMICOLECTOMÍA DERECHA PUERTO UNICO SILS
Accede al video completo, sin editar de una hemicolectomía derecha realizada por puerto único , tipo SILS.
Puedes revisar la videoteca completa en nuestro canal LAPSURGERY de LIVESTREAM
martes, 2 de agosto de 2011
LIFT en el tratamiento de la fístula anal
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