Published: 2021-02-25

A prospective interventional study on ligation of intersphincteric fistula tract in patients with fistula-in-ano-as a tertiary care centre

Pradeep Panwar, Richa Jain, Mohit Jain, Rajendra Bagree, Hetish M. Reddy, Gaurav Jalendra


Background: Fistula-in-ano is a very common condition encountered in proctology OPD. The treatment of fistula-in-ano is difficult due to potential risk of recurrence and fecal incontinence. Ligation of Intersphincteric Fistulous Tract is new modality of treatment for the condition. LIFT is a sphincter preserving surgery, aim of our study to evaluate the effectiveness of LIFT surgery.

Methods: We did LIFT surgery in 35 cases of intersphincteric and transsphincteric types of fistula-in-ano during the period of December 2019 to July 2020. Standard investigation protocol was followed in all cases. Evaluation of effectiveness of procedure done in terms of anal incontinence, wound healing time, recurrence rate and wound infection rate.

Results: 35 patients (23 men, 12 women) were included with mean age of 40 SD 10.38 years. Most of study population have Inter sphincteric fistula (62.9%), and 37.1% participants have trans sphincteric fistula. Healing time was 10-15 days (42.9%) and mean healing time is 17 SD 4.25 days. We didn’t see a single case of anal incontinence with LIFT in our study. 6 cases of recurrence were seen.

Conclusions: Result from our study showed that LIFT surgery is effective modality and fulfilling the outcome of sphincter preservation.


Anal incontinence, Fistula-in-ano, Ligation of intersphincteric fistula tract

Full Text:



Malik A, Hall D, Devaney R, Sylvester H, Yalamarthi S. The impact of specialist experience in the surgical management of perianal abscesses. Int J Surg. 2011;9(6):475-7.

Parks AG, Gordon PH, Hardcastle JD. A classifcation of fistula-in ano. Br J Surg. 1976;63(1):1-12.

Whiteford MH, Kilkenny J, Hyman N. For the Standards Practice Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of perianal abscess and fistula-in-ano. Dis Colon Rectum. 2005;48:1337-42.

Seow-Choen F, Nicholls RJ. Anal fistula. Br J Surg. 1992;79: 197-205.

Kodner IJ, Mazor A, Shemesh EI, Fry RD, Fleshman JW, Birnbaum EH. Endorectal advancement flap repair of rectovaginal and other complicated anorectal fistulas. Surgery. 1993;114:682-90.

Mizrahi N, Wexner SD, Zmora O, et al. Endorectal advancement flap: Are there predictors of failure? Dis Colon Rectum. 2002;45:1616-21.

Lindsey I, Humphreys MM, Cunningham C, Mortensen NJ, George BD. A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum. 2002;45:1608-15.

Williams JG, MacLeod CA, Rothenberger DA, Goldberg SM. Seton treatment of high anal fistulae. Br J Surg. 1991;78:1159-61.

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

Aboulian A, Kaji AH, Kumar RR. Early result of ligation of the intersphincteric fistula tract for fistula-in-ano. Dis Colon Rectum. 2011;54(3):289-92.

Ellis CN. Outcomes with the use of bioprosthetic grafts to reinforce the ligation of the inter sphincteric fistula tract (BioLIFT procedure) for the management of complex anal fistulas. Dis Colon Rectum. 2010;53(10):1361-4.

Eisenhammer P. Emergency fistulectomy of the acute anorectal crypto glandular intermuscular abscess-fistula-in-ano. S A J Surg. 1985;23:1-7.

Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984.73(4):219-24.

Hamadani A, haigh PI, Liu IL, Abbas MA. Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess? Dis Colon Rectum. 2009;52:217-21.

Lunniss PJ, Jenkins PJ, Besser GM, Perry LA, Phillips RK.Gender differences in incidence of idiopathic fistula-in-ano are not explained by circulating sex hormones. Int J colorectal Dis. 1995;10:25-8.

Koh CE, Lee PJ, Byrne CM, Wright CM, Chew EH. The lift procedure for fistula-in-ano. initial experience at a single tertiary referral center. Colorectal Dis. 2011;13(5):19.

Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73(4):219-24.

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(1):39-42.

Mushaya C, Bartlett L, Schulze B, Ho YH. Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requiring initial seton drainage. Am J Surg. 2012;204(3):283-9.

Aguilar J, Darey CS, Le CT, Lowry AC, Rothenberger DA. Patient satisfaction after surgical treatment for fistula- in-ano. Dis Colon Rectum. 2000;43:1206-12.

Abcarian AM, Estrada JJ, Park J. Ligation of inter- sphincteric fistula tract: early results of a pilot study. Dis Colon Rectum. 2012;55:778-82.