Comparative analysis of ligation of intersphincteric fistula tract and fistulectomy for complex fistula-in-ano: a prospective observational study

Background: Fistula-in-ano is a debilitating condition that poses significant treatment challenges, particularly in complex cases. Ligation of intersphincteric fistula tract (LIFT) and fistulectomy are two common procedures used for management, with differing outcomes in recurrence, pain, and morbidity. This study aimed to compare these two methods in a resource-limited setting. Methods: This prospective observational study was conducted at Shri Sathya Sai Medical College and Research Institute from July 2023 to July 2024 – six months of study and six months of follow up period. Sixty patients diagnosed with complex fistula-in-ano were randomly assigned to either the LIFT or fistulectomy group. Postoperative outcomes, including recurrence rates, pain (using the visual analogue scale), bleeding, and incontinence (Browning and Park’s scale), were recorded and analyzed using statistical package for the social sciences (SPSS) version 22.0 software. Results: The recurrence rate was significantly lower in the LIFT group (10%) compared to the fistulectomy group (37%, p=0.0069). LIFT patients experienced less postoperative pain (mean VAS score: 3.5±1.2) compared to fistulectomy (mean VAS score: 5.2±1.5, p=0.0082). Bleeding rates and incontinence showed no significant differences between the groups. Conclusions: LIFT is a superior technique for managing complex fistula-in-ano due to lower recurrence rates and reduced postoperative pain. This sphincter-preserving method is particularly advantageous in resource-limited settings.