The LIFT procedure

The Ligation of Intersphincteric Fistula Tract (LIFT) procedure is a recent sphincter-preserving procedure added to the surgical armamentarium of managing anal fistulas. It has gained popularity for its simple, easy-to-learn technique and success rate reliably exceeding 70%. Studies using validated continence scores have verified its advantage in preserving continence. The procedure is aimed at the cryptoglandular source of infection within the intersphincteric space. This is achieved through a small incision parallel to the intersphincteric groove and corresponding to the internal opening. After excision of the intersphincteric portion of the fistula tract, the openings on the internal and external sphincter are suture-ligated. Wound care is simple with minimal post-operative pain. Pre-operative imaging with endoanal ultrasonography helps to position the incision. Most failures or recurrences occur in the intersphincteric wound. This can be treated successfully with simple fistulotomy. The use of a seton before a LIFT procedure has not been proven beneficial. This technique has also been applied to Crohn׳s disease-related fistulas with similar success. Modifications to the technique using bioprosthetic inserts have also been reported to confer better results albeit at a greater cost.