A prospective interventional study of postoperative pain, healing rates and incontinence rates following ligation of intersphincter fistula tract procedure

Arunraj P., Viswanathan M. S., Anbazhagan R., Kulwant Singh


Background: Fistula in ano is one of the oldest ailments known to us, troublesome both to the patient and also challenging to the treating surgeon. The treatment of fistula in ano has evolved so much, to reduce complications and to improve patient’s compliance. This study was conducted to compare the age old method of open fistulectomy to that of recently developed technique of ligation of intersphincter fistula tract (LIFT), in patients suffering from low fistula in ano.

Methods: A totally of 80 patients, suffering from low anal fistula was divided randomly into two groups. Group A: undergoing LIFT procedure and Group B: undergoing open fistulectomy procedure .The two groups were compared in the postoperative period for wound healing, postoperative pain (by visual analog scale) and fecal incontinence (by Wexner incontinence score).

Results: Group A patients who underwent LIFT at the end of 3rd postoperative week had a pain score of 0.43 when compared to group B patients (1.33) who underwent fistulectomy. Group A patients had 100% continence preservation, whereas a 17.5% of moderate incontinence was documented in Group B patients. About 97.5% of patients under Group A had complete wound healing by the 3rd postoperative week, as compared to group B patients, where100% complete wound healing was noted at 6 weeks, postoperatively.

Conclusions: It was found that LIFT was a promising procedure in reducing the postoperative pain significantly, with better wound healing rates. It was effective in maintaining good sphincter function, thereby providing better faecal continence following surgery, in low anal fistula.


Low anal fistula, Ligation of intersphincter fistula tract, Open fistulectomy

Full Text:



Jebakumar A, Shanmugam S, Anbarasan. A comprehensive study of fistula in ano. IAIM. 2016;3(8):66-72.

Eisenhammer S. The internal anal sphincter and the anorectal abscess. Surg Gynecol Obstet. 1956;103:501-6.

Abcarian H. Anorectal infection: abscess-fistula. Clin Colon Rectal Surg. 2011;24:14-21.

Lunniss PJ, Sheffield JP, Talbot IC, Thomson JPS, Phillips RKS. Persistence of idiopathic anal fistula may be related to epithelialization. Br J Surg. 1995;82:32-3.

Vasilevsky CA, Gordon PH. Benign anorectal abscess and fistula. Wolff BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD, editors. The ASCRS Textbook of Colon and Rectal Surgery. Ch. 13. New York, NY: Springer;2007.

Williams JG, Farrands PA, Williams AB, Taylor BA, Lunniss PJ, Sagar PM, et al. The treatment of anal fistula: ACPGBI position statement. Colorectal Dis. 2007;9:18-50

Rojanasakul A. LIFT procedure: a simplified technique for fistula-in-ano. Epub. 2009;13(3):237-40.

Shanwani A, Nor AM, Amri N. Ligation of the intersphincteric fistula tract (LIFT): a sphincter-saving technique for fistula-in-ano. Dis Colon Rectum. 2010;53:39-42.

Ooi K, Skinner I, Croxford M, Faragher I, McLaughlin S. Managing fistula-in-ano with ligation of the intersphincteric fistula tract procedure: the Western Hospital experience. Colorectal Dis. 2012;14:599-603.

Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum. 2010;53:43-6.

Jia Gang H, Zhen Jun W, Yi Z. Ligation of Intersphincteric Fistula Tract vs Ligation of the Intersphincteric Fistula Tract Plus a Bioprosthetic Anal Fistula Plug Procedure in Patients With Transsphincteric Anal Fistula: Early Results of a Multicenter Prospective Randomized Trial. Annals Surg. 2016;264(6):917-22.

Aboulian A, Kaji AH, Kumar RR. Early result of ligation of the intersphincteric fistula tract for fistula-in-ano. Dis Colon Rectum. 2011;54:289-92.

Abcarian AM, Estrada JJ, Park J, Corning C, Chaudhry V, Cintron J, et al. Ligation of intersphincteric fistula tract: early results of a pilot study. Dis Colon Rectum. 2012;55(7):778-82.