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LIFT (Ligation of Intersphincteric Fistula Tract)

Sphincter-Preserving Surgery for Anal Fistula

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is LIFT (Ligation of Intersphincteric Fistula Tract)?

LIFT procedure was first described by Rojanasakul in 2007 as a sphincter-preserving alternative to traditional fistulotomy.

Designed for transsphincteric anal fistulas, where conventional fistulotomy would risk significant sphincter damage and incontinence.

Mechanism: identification of the fistula tract within the intersphincteric plane, ligation on both internal and external sides, and excision of the intervening segment.

Preserves both internal and external anal sphincters; minimal continence risk.

Healing rates: 60-90% primary success; salvage procedures available for failures.

Compared to advancement flap or LIFT-plus modifications: similar healing rates with less morbidity.

Best for simple transsphincteric fistulas; complex or recurrent fistulas may need staged approach with seton placement first.

Symptoms

Indication: transsphincteric anal fistula (Park's classification type II) with mature fibrotic tract.
Persistent perianal discharge from fistula opening.
Recurrent perianal abscesses.
Failed previous fistula surgery with intact sphincter.
Crohn fistula in selected cases (with controlled disease).
Pre-procedure: examination under anesthesia, MRI fistulogram or endoanal ultrasound for tract anatomy.
Seton placement 6-12 weeks prior to LIFT for tract maturation if active inflammation.

Risk Factors

Active perianal sepsis or abscess (drainage and seton first).
Acute Crohn fistula activity (medical optimization first).
Multiple complex fistulas (consider alternative procedures).
Severe anal stenosis (technical limitation).
Pelvic radiation history (relative).
Active inflammatory bowel disease (control disease first).
Anatomic distortion preventing accurate intersphincteric plane access.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent perianal drainage from fistula opening.
  • Recurrent perianal pain or swelling (recurrent abscess).
  • Soiling or discharge affecting daily activities.
  • Documented anal fistula on imaging or examination.
  • Failed previous fistula treatment.
  • Crohn disease patient with new perianal symptoms.

Treatment Methods

01
Pre-procedure: clinical examination, MRI pelvis with fistulogram or 3D endoanal ultrasound, IBD workup if indicated.
02
Seton insertion (cutting or draining) 6-12 weeks prior if acute inflammation or undefined tract.
03
Anesthesia: spinal or general; lithotomy or prone position.
04
Procedure: identification of fistula tract with probe; curved incision in intersphincteric groove.
05
Dissection of intersphincteric plane to expose tract; passage of right-angle clamp around the tract.
06
Double ligation with absorbable suture (PDS or Vicryl) on both sides.
07
Division of tract between ligatures; removal of intervening segment.
08
Closure of internal opening with absorbable suture; curettage of distal tract; primary closure of intersphincteric incision.
09
External tract: leave open for drainage or curettage with secondary healing.
10
Postoperative care: sitz baths, analgesics, stool softeners, soft diet.
11
Outcomes: 60-90% primary healing; failure presents as persistent or recurrent drainage typically within 6 months.
12
Salvage options for failures: LIFT-plus (with bioprosthetic), advancement flap, fistula plug, or fistulotomy if low and sphincter sparing.
13
Follow-up: 2-week wound check, 6-week, 3-month, and 6-month examinations.
14
Long-term continence assessment: Wexner score, anorectal manometry if symptoms develop.

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.