Feasibility of ambulatory surgery for anal fistula with LIFT procedure

BACKGROUND: Ambulatory surgery maintains the advantages of a more rapid return to work and overall reduced hospital costs. The specific impact of ambulatory surgery for anal fistula using the LIFT procedure (ligation of the intersphincteric fistula tract) is presented. METHODS: A total of 218 consecutive patients with anal fistula who underwent ambulatory LIFT surgery were retrospectively compared with 386 cases managed as in-patients. Patient demographics, comorbidities, postoperative morbidity and pain as well as readmission rates within 30 days and satisfaction ratings were compared between the two groups. RESULTS: When compared with patients undergoing in-patient surgery, those in the ambulatory group were younger with a better level of education (P < 0.05). Ambulatory cases returned to work after shorter postoperative periods (P < 0.01) but experienced more frequent postoperative external hemorrhoidal thrombosis and more reported postoperative pain (P < 0.05). There were no differences in the overall rate of complications or readmissions between the two groups. Ambulatory patients reported higher satisfaction ratings than in-patients (P < 0.05). CONCLUSIONS: The LIFT procedure for anal fistula can be safely performed in the ambulatory setting resulting in an acceptable level of satisfaction and a more rapid return to work when compared with in-patient fistula management.