EP511 - Clinical Study on Modified LIFT Procedure for the Treatment of Transsphincteric Anal Fistula

Purpose/Background: The conventional LIFT procedure preserves the anal sphincter by ligating and dividing the intersphincteric fistula tract. However, its incision site-medial to the anal verge-is prone to hematoma or seroma formation. Furthermore, the potential for fecal contamination increases the risk of postoperative infection, which often prolongs healing and increases the recurrence rate.

Objective: This study aims to compare the therapeutic efficacy of modified LIFT procedure versus conventional LIFT procedure in the treatment of transsphincteric anal fistula.

Methods/Interventions: This study included patients with transsphincteric anal fistula who underwent either a modified or conventional LIFT procedure at the Affiliated Hospital of Jiangxi University of Chinese Medicine between September 2022 and September 2024. The conventional LIFT procedure utilizes the intersphincteric groove as the surgical approach. It involves ligation and division of the fistula tract within the intersphincteric plane, followed by tunnel excision of the extrasphincteric tract.In contrast, the modified LIFT technique involves creating a U-shaped skin flap approximately 1.5-2 cm in length and 2 cm in width, starting from the intersphincteric groove. This is followed by ligation and division of the intersphincteric fistula tract, with the extrasphincteric tract similarly removed via tunnel excision.The primary outcomes were clinical cure rate and wound healing time. Secondary outcomes comprised operative time, the incidence of postoperative complications, the Wexner incontinence score, and recurrence rate.

Results/Outcomes:

Results: A total of 40 patients with transsphincteric anal fistula were enrolled and randomized to undergo either the modified LIFT procedure (n = 20; 7 males and 13 females; mean age 38.31 years) or the conventional LIFT procedure (n = 20; 5 males and 15 females; mean age 37.47 years). No significant difference was observed in the clinical healing rate between the two groups (95% in the modified group vs. 85% in the conventional group, P = 0.605). The median wound healing time was significantly shorter in the modified LIFT group than in the conventional LIFT group [30.0 days (IQR 27.0-35.0) vs. 35.0 days (IQR 31.0-43.0), Z = -2.10, P = 0.036]. However, the operative time was longer in the modified group (48.5 ± 8.2 minutes vs. 40.3 ± 7.5 minutes, t = 3.43, P = 0.002). At 1 month postoperatively, the Wexner score increased significantly from baseline in both groups (both P < 0.05), with no significant difference between the groups (P = 0.083). By 3 months, the scores had decreased compared to the 1-month values, and no significant intergroup difference was observed. The overall complication rate was 10.0% (2/20; one case each of wound dehiscence and flap necrosis) in the modified group and 20.0% (4/20; two cases each of wound dehiscence and surgical site infection) in the conventional group, with no statistically significant difference between the groups (P = 0.664). During the 12-month follow-up, there was no significant difference in recurrence rates between the two groups (5.0% in the modified group vs. 10.0% in the conventional group, P = 1.000).

Conclusion/Discussion: For transsphincteric anal fistula, the modified and conventional LIFT procedures demonstrated comparable overall efficacy and safety profiles. Although the modified technique was associated with a longer operative time, it significantly accelerated wound healing and reduced the incidence of wound infection, representing a valuable alternative.

Fig.1 (a). Surgical diagram of Modified LIFT. Yellow arrow: Sutured U-shaped flap, Red arrow: The open wound after coring-out excision of the extrasphincteric fistula tract. (b). Postoperative Day 18 wound photograph.