Colorectal

Anal Fistula Surgery — LIFT Procedure

OPERATION: Ligation of the Intersphincteric Fistula Tract (LIFT)
ANAESTHETIC: General / spinal anaesthesia
POSITION: Prone jack-knife / lithotomy

INDICATION:
Trans-sphincteric anal fistula with a well-defined intersphincteric component — not amenable to simple fistulotomy due to sphincter involvement. [Pre-existing draining seton in situ — removed at this procedure]. MRI pelvis confirming single-track trans-sphincteric fistula without high extension. Preoperative continence assessment satisfactory.

PROCEDURE:
WHO Checklist performed. Perineum prepared and draped. Examination under anaesthesia confirmed trans-sphincteric fistula. [Draining seton removed]. Fistula probed from external to internal opening.

Curvilinear incision made in the intersphincteric groove overlying the fistula track. Dissection deepened to identify and enter the intersphincteric plane. Fistula track identified in the intersphincteric space between the internal and external anal sphincters — clearly defined cord-like structure traced on a probe.

Fistula track divided in the intersphincteric plane. Proximal end (towards internal opening) ligated with absorbable 2-0 Vicryl suture and divided. Distal end (towards external opening) similarly ligated. Core of intersphincteric track excised and sent to histopathology.

Externa wound curetted and left open for drainage. Internal opening laid partially open to allow internal drainage without a formal wound through the sphincter. Haemostasis confirmed.

Intersphincteric incision closed with interrupted absorbable sutures.

FINDINGS:
Trans-sphincteric fistula with clearly defined intersphincteric track. Track successfully identified and ligated in the intersphincteric plane. Both ends of the divided track ligated. Sphincter integrity maintained.

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. Sitz baths. High fibre diet. Outpatient review at 4–6 weeks. Success rate approximately 70% — patient counselled regarding possibility of further procedure if recurrence. MRI at 3 months if symptoms persist.