Comparison of LIFT and cutting seton methods in the treatment of high transsphincteric anal fistulas

Objective: Many treatment modalities have been recommended for high transsphincteric anal fistulas, but none have been proven to be ideal. This study aims to compare the ligation of intersphincteric fistula tract (LIFT) and cutting seton methods in the treatment of high transsphincteric anal fistulas. Materials and methods: This study was conducted in the general surgery department of Health Sciences University Gazi Yaşargil Training and Research Hospital. Retrospective data of patients who underwent surgery for perianal fistula in our clinic were reviewed. Patients diagnosed with high transsphincteric anal fistulas were included in the study. According to the treatment method, patients were categorized into two groups: LIFT (Group 1) and cutting seton (Group 2). The groups were compared in terms of recovery time, recurrence rate, postoperative pain, and incontinence. Results: There were a total of 60 patients in the study, with 30 patients in each group. The mean recovery time was significantly shorter in Group 1. At the end of 1-year follow-up, successful results were obtained in 21 (70%) patients in Group 1 and in 24 (80%) patients in Group 2 (p=0.371). While there was no significant difference between the groups in the visual analog scale evaluation in the preoperative period (p=0.398), there were significantly higher pain scores in Group 2. There was no difference between the two groups in the Wexner score at preoperative, postoperative 4th and 12th weeks. Conclusion: Both LIFT and cutting seton procedures exhibit similar long-term healing, recurrence, and continence preservation rates in patients with high transsphincteric anal fistulas. However, LIFT has the advantage of less postoperative pain and shorter recovery time.