Operation

• High transsphincteric fistula (involving more than 30% of the anal sphincter).
• High transsphincteric fistula (involving more than 30% of the anal sphincter).
• In case of recurrence of an anal fistula.
• In case of pre-existing fecal incontinence.
• Anal fistula with multiple internal openings and tracts.
• Fistula after inflammatory disease, radiotherapy, tuberculosis, malignancy.

The space between the two sphincters (internal and external sphincter) of the anus is dissected, to identify the fistula tract. The fistula tract is severed between to ligatures without injuring the muscle.. Then, the tract of the fistula between the skin (external opening) and the muscle is excised. The anal sphincter muscle should not be injured during the operation.

Bleeding

• Incidence : Rare

Urinary retention

• Incidence : Rare

Wound infection

• Incidence : 13 à 26 %

Recurrent anal fistula

• Incidence : +/- 10 à 40 %

Normal symptoms

• Anal pain is normal but should subside over time.
• Seepage of serous (yellowish) anal fluid.
• Fluid loss may be bloody but should subside over time.

Abnormal symptoms

Contact your surgeon or GP, or go to the emergency room:

• If pain increases over time.
• If fever does not subside over time.
• If pus volume increases or foul smelling viscous fluid increases.
• If blood loss persists.

If certain symptoms seem abnormal to you contact your doctor.

If this is not possible, you can contact avec your surgeon.

If you are unable to contact your GP or your surgeon, go to the emergency department at St Elizabeth Hospital in Uccle.

Incontinence

Intersphincteric ligation of the fistula tract has no effect on continence in the long term.

If postoperative incontinence for flatus (wind) occurs, it usually disappears after 6 to 8 weeks.
 

Perianal fistulas and the LIFT procedure : results , predictive factors for succes, and long-term results with subsequent  treatment:  Techniques in Coloproctology (2019) 23:639-647

Feasability of ambulatory surgery for anal fistule with LIFT procedure BMC Gastroenterology (2019) 19:81

Long-term outcomes of ligation of intersphincteric fistula tract  for complex  fistula-in-ano: Modified operative procedure experience Are Bras  Cir Dig 2018; 31 (4):e1404.

Comparative study between intersphincteric ligation of perianal fistula versus conventional fistulotomy with or without Seton in the treatment of perianal fistula: A prospective  randomized controlled trial. Annals of Medecine and Surgery 61(2021) 180- 184

Management of anal fistula by ligation of the intersphincteric fistula tract- a systematic review of the literature (Dan Med J 61/12 (2014)

Why do we have so much trouble treating anal fistula.

The Lift procedure Seminars in Colon and Rectal Surgery 29 (2018) 212 – 221

Operative management of anorectal fistulas  Up to date 2021