Effective and long-term outcome following ligation of the intersphincteric fistula tract (LIFT) for transsphincteric fistula

Objective The purpose of this study was to evaluate the efficacy and long-term outcome of the ligation of the intersphincteric fistula tract (LIFT) procedure for transsphincteric fistula-in-ano. Methods A total of 43 patients that were treated with LIFT procedure and had a follow-up time of more than 1 year were included. Results The median age was 37.18 years, and 32 (74.4%) of the patients were male. The median follow-up time was 26.2 months (range 13-63 months). There were 29 (67.4%) uncomplicated transsphincteric fistulas, 10 (23.3%) horseshoe transsphincteric fistulas, and 4 (9.3%) multiple fistulas. Eight (18.5%) patients presented with dehiscence or infection at the intersphincteric wound and were successfully treated with either laying open (n = 5) or local application of silver nitrate (n = 3). The success rate, as determined from the last followup time point, was 83.7% (36/43). The mean time to complete failure was 8.6 weeks (range 1-28) in 7 patients. With the exception of these 7 patients, 32/36 (88.9%) patients had a Cleveland Clinic Florida Faecal incontinence score of 0, 3 patients had a score of 1, and 1 had a score of 2. No significant association was found between laying open and incontinence in these partial failure patients. Conclusion The LIFT procedure can be considered an effective sphincter-sparing procedure in the management of transsphincteric fistula with an acceptable long-term outcome.