Ligation of Intersphincteric Fistula Tract (LIFT) Procedure Versus Fistulotomy for the Management of Trans-sphincteric Anal Fistulas

Background: Trans-sphincteric perianal fistulas is a surgical challenge due to their complex anatomy and the potential risk of compromising sphincter function. Among the available surgical options, open fistulotomy remains a widely used standard, while the Ligation of Intersphincteric Fistula Tract (LIFT) technique has emerged as a sphincter-preserving alternative. So, we aimed to compare the effectiveness of open fistulotomy and the LIFT procedure in terms of postoperative recurrence rates and incidence of fecal incontinence. Methods: This prospective comparative study included 38 patients with trans-sphincteric perianal fistulas. Participants were divided into: Group A underwent LIFT technique, while Group B was treated with conventional fistulotomy. Postoperative outcomes evaluated included recurrence, fecal incontinence, operative duration, pain intensity, complications, and time to complete wound healing. Results: The mean operative time was significantly longer in the LIFT group compared to the fistulotomy group. Postoperative pain was significantly lower in LIFT group than fistulotomy group. Wound healing was faster in LIFT group compared to fistulotomy group. Postoperative complications were comparable, with no significant difference in incidence. Temporary gas incontinence occurred in two patients (10.5%) in the fistulotomy group and none in the LIFT group. No cases of permanent incontinence were observed in either group. Recurrence was slightly higher in the LIFT group compared to the fistulotomy group. Conclusion: LIFT technique serves as a safe and effective sphincter-sparing option for treating trans-sphincteric anal fistulas with less postoperative pain and a lower risk of incontinence compared to fistulotomy.