Comparative Evaluation of IFTAK and LAFT Techniques in the Management of Trans-Sphincteric Fistula-in-Ano: A Prospective Study

Abstract Anorectal fistulas are chronic abnormal connections between the anal canal and perianal skin, often resulting from cryptoglandular infections. Despite advancements in surgical techniques, recurrence remains a significant challenge. Traditional methods like fistulotomy and seton placement show variable success rates, while newer sphincter-sparing approaches like IFTAK and LAFT offer promise. This study compares the efficacy of IFTAK and LAFT in managing trans-sphincteric fistulas. This prospective study at Sir Sundar Lal Hospital, BHU, compared IFTAK and LAFT for managing trans-sphincteric fistula-in-ano. Forty-four patients were randomized into two groups (22 each). Patients underwent preoperative preparation, postoperative care, and follow-ups at regular intervals. Outcomes, including pain (VAS), healing, and recurrence, were analyzed statistically using SPSS. Group A (IFTAK) showed significantly lower recurrence rates (0% vs. 27.3%, p = 0.000) and superior healing of the fistulous tract compared to Group B (LAFT). Pain reduction, discharge, inflammation, and induration improved significantly in both groups (p < 0.001). However, Group A demonstrated faster pain reduction and better wound dryness at 45 and 60 days (p < 0.05). Hospital stays were shorter in Group A. Overall, IFTAK exhibited better clinical outcomes and fewer complications. The study indicates that IFTAK is more effective than LAFT for managing trans-sphincteric fistulas, with no recurrences, better healing, and higher success rates, especially for posterior fistulas. LAFT offers less pain, and shorter hospital stays but has a higher recurrence rate. Combining IFTAK and LAFT may optimize outcomes, warranting further research.