Ligation of the intersphincteric fistula tract vs. fistulotomy for complex anal fistula: a retrospective study

To evaluate the clinical efficacy and functional outcome of ligation of the intersphincteric fistula tract (LIFT) versus fistulotomy in patients with complex anal fistulas.

A retrospective review was conducted of patients with complex anal fistulas treated at The Affiliated People's Hospital of Ningbo University from May 2020 to May 2022. To reduce confounding and selection bias, 1:1 matching was performed based on key baseline variables such as fistula type and patient comorbidities. A total of 100 matched patients were assigned to either the LIFT group (n=50) or the fistulotomy group (n=50).

The LIFT procedure required more operative time but resulted in significantly less intraoperative blood loss, faster wound healing, and shorter hospital stay (all P<0.05). Postoperative pain scores on days 1, 3, and 7 and Wexner incontinence scores at 1, 2, and 7 months were all significantly lower in the LIFT group (all P<0.05). After a median follow-up of 18.5 months, no significant difference in recurrence-free survival was observed between the two groups (log-rank P=0.695). The LIFT group had a significantly lower overall complication rate (4.00% vs. 16.00%, P<0.05) and a higher overall treatment efficacy rate (96.00% vs. 82.00%, P<0.05). Cox regression identified diabetes mellitus - but not surgical procedure - as an independent predictor of recurrence.

LIFT offers advantages in sphincter preservation, reduced bleeding, faster recovery, and fewer complications, while providing comparable long-term recurrence outcomes to fistulotomy.