Modified LIFT via a Lateral Approach Versus Standard LIFT for Transsphincteric Anal Fistula: A Prospective Randomized Study

AIM: To compare the early clinical outcomes of modified ligation of the intersphincteric fistula tract (LIFT) via a lateral approach with those of standard LIFT in patients with magnetic resonance imaging (MRI)-confirmed transsphincteric anal fistula.METHODS: This single-center prospective randomized study included adult patients with transsphincteric anal fistula who were treated between January and May 2024 and were followed through August 2024. Among 96 patients assessed for eligibility, 46 met the eligibility criteria, and 40 consenting patients were randomized at a 1:1 ratio to standard LIFT or modified LIFT via a lateral approach. Follow-up was performed at postoperative weeks 1, 4, 8, and 12. The primary outcome was wound healing time. Secondary outcomes included early recurrence or persistence, postoperative pain assessed using the visual analog scale (VAS), and continence evaluated using the Cleveland Clinic Fecal Incontinence Scale.RESULTS: A total of 40 patients were analyzed, with 20 patients in each group. Baseline demographic and available clinical characteristics were comparable between the groups. The median wound healing time was significantly shorter in the modified LIFT group than in the standard LIFT group (13 [interquartile range, 10–17] days vs. 29.5 [26–32] days; p < 0.001). No early recurrence or persistence was observed in the modified LIFT group by week 12. In the standard LIFT group, recurrence/persistence was observed in 3 of the 20 patients (15.0%) at week 8 and in 6 of the 20 patients (30.0%) at week 12 (Fisher exact test at week 12; p = 0.020). The median VAS pain scores were low and comparable in the standard LIFT versus modified LIFT groups at week 1 (0.90 vs. 0.95; p = 0.942) and week 4 (0.00 vs. 0.00; p = 0.115). No case of fecal incontinence was noted in either group during follow-up.CONCLUSIONS: In selected patients with transsphincteric anal fistula, compared with standard LIFT, modified LIFT via a lateral approach was associated with faster early wound healing and a lower rate of early recurrence/persistence within 12 weeks, without an observed increase in postoperative pain or fecal incontinence. Larger studies with longer follow-up are warranted before definitive conclusions can be drawn regarding long-term recurrence.TRIAL REGISTRATION: ClinicalTrials.gov: NCT07603635.