EP515 - LIFT Versus Fistulotomy for Complex Anal Fistulas: Recurrence and Predictive Factors in a Five-Year Experience at a Tertiary Center

Purpose/Background: Complex anal fistulas remain a challenging entity in colorectal surgery, as achieving definitive healing while preserving continence is difficult. Although the ligation of the intersphincteric fistula tract (LIFT) technique has emerged as a sphincter-sparing alternative, its long-term efficacy compared with conventional fistulotomy remains debated. Recent meta-analyses (Abbas et al., Tech Coloproctol, 2022; Garg et al., Dis Colon Rectum, 2023) show variable recurrence rates between 8-20% for LIFT and 5-15% for fistulotomy. The aim of this study was to compare recurrence, healing time, and functional outcomes between LIFT and fistulotomy procedures for complex anal fistulas in a tertiary referral center.

Methods/Interventions: A retrospective cohort study was conducted of a tertiary referral hospital between January 2019 and December 2024. Clinical records of 112 patients diagnosed with complex anal fistulas were analyzed. Demographic data, fistula classification, surgical technique, postoperative complications, healing time, recurrence, and continence outcomes were recorded. Patients were divided into two groups: LIFT (n=50) and fistulotomy (n=62). Fistula complexity was defined according to the Parks classification, including transsphincteric, suprasphincteric, and recurrent tracts. Exclusion criteria included simple intersphincteric tracts, Crohn's disease, and malignancy. Statistical analysis was performed using chi-square or Fisher's exact test for categorical variables and Student's t-test for continuous variables; significance was set at p< 0.05.

Results/Outcomes: The cohort included 78 men (70%) and 34 women, with a mean age of 43.2 ± 10.8 years. Transsphincteric tracts were the most common type (80%), with no significant difference between groups (p=0.18). Previous surgery for fistula was documented in 24% of cases.

The mean healing time was significantly shorter for the fistulotomy group (6.5 ± 2.4 weeks) compared with the LIFT group (8.1 ± 2.1 weeks, p=0.03).

The overall healing rate was 88%, with no significant difference between LIFT (86%) and fistulotomy (90%) (p=0.47).

The recurrence rate was 14% in the LIFT group and 10% after fistulotomy (p=0.49).

Postoperative incontinence occurred in 5% of the fistulotomy group but was not observed after LIFT (p=0.08).

No major complications such as abscess formation or reoperation occurred in either group.

Long-term follow-up (mean 18 months) demonstrated stable results with no significant deterioration in continence scores among LIFT patients.

Conclusion/Discussion: Our findings align with recent literature indicating that both LIFT and fistulotomy achieve high healing rates in complex anal fistulas, with a trade-off between healing speed and functional preservation. A 2023 systematic review by Garg et al. showed comparable recurrence (12-15%) but emphasized the lower risk of incontinence with LIFT. Similarly, a multicenter analysis by Tan et al. (Int J Colorectal Dis, 2022) concluded that LIFT is particularly beneficial in transsphincteric fistulas where sphincter preservation is paramount.

In our series, fistulotomy resulted in slightly faster healing but carried a higher tendency toward postoperative minor incontinence, likely due to partial division of sphincter fibers. The LIFT technique, although requiring longer healing, maintained continence and offered a valuable sphincter-sparing approach. These results reinforce the importance of individualized treatment selection based on fistula anatomy and patient continence status.

Comparison of LIFT Versus Fistulotomy for Complex Anal Fistulas (2019-2024)