How is ligation of the intersphincteric fistula tract (LIFT) performed in the treatment of fistula-in-ano (anal fistula)?

Updated: Mar 27, 2020
  • Author: Juan L Poggio, MD, MS, FACS, FASCRS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

The intersphincteric tract is identified and isolated by performing meticulous dissection through the intersphincteric plane after making a small incision overlying the probe connecting the external and internal openings. Once isolated, the intersphincteric tract is hooked with a small right-angle clamp, and the tract is ligated close to the internal sphincter and then divided distal to the point of ligation. Hydrogen peroxide is injected through the external opening to confirm the division of the correct tract. The external opening and the remnant fistulous tract are curetted to the level of the proximity of the external sphincter complex.

Finally, the intersphincteric incision is loosely reapproximated with an absorbable suture. The curettaged wound is left opened for dressing. [47, 48, 49]

Because of its relative novelty, LIFT has not been extensively researched. In a randomized trial of 39 patients with complex fistula-in-ano who had failed previous procedures and were treated with LIFT technique, success rates were comparable to those seen with the anorectal advancement flap technique. [50]  The probability of recurrence at 19 months was 8% for the LIFT technique versus 7% for the anorectal advancement flap. Time to return to work was shorter in the LIFT group (1 vs 2 wk), but there was no difference in incontinence scores. [50]

Further randomized surgical trials are needed to determine whether this technique is a viable—or, possibly, a better—alternative to the other previously mentioned procedures for the treatment of fistula-in-ano.


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