A modified LIFT approach of offsetting sphincter muscle plication aimed at decreasing recurrence rates - a single-center retrospective review

Sep 28, 2026

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Transsphincteric anal fistula is a common, difficult problem for both patients and surgeons, and the standard LIFT procedure after non-cutting seton placement still fails in up to 53% of attempts. This study describes a modified LIFT method that offsets transected fistula ends with interposed muscle plication, closes the internal opening, and excises the external opening widely. Outcomes were assessed in 32 retrospective cases with healing, recurrence patterns, and continence.

LanguageEnglish

CategoryHealthcare

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Pages7

Reading Time18 min

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Abstract

Background

Methods

Study population

Results

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Techniques in Coloproctology (2026) 30:12 [https://doi.org/10.1007/s10151-025-03241-0](https://doi.org/10.1007/s10151-025-03241-0) A modified LIFT approach of offsetting sphincter muscle plication aimed at decreasing recurrence rates: a single‑center retrospective review A. Troester1 · J. Frebault1 · E. Von Der Marwitz2 · E. Arsoniadis2 · S. M. Goldberg2 · P. Goffredo2 · C. Jahansouz2 Received: 31 March 2025 / Accepted: 8 October 2025 © The Author(s) 2025 Abstract Background Transsphincteric anal fistula is a common and challenging diagnosis for patients and surgeons alike. Ligation of the intersphincteric fistula tract (LIFT) following non-cutting seton placement represents an established definitive treatment with many technical variations. Unfortunately, up to 53% of attempted LIFTs fail. We aim to describe a modified LIFT approach and evaluate outcomes at our institution. Methods Thirty-two patients from 2021 to 2024 underwent the modified LIFT approach which included the offsetting of the transected fistula ends with interposing muscle plication, along with closure of the internal opening, and wide excision of the external opening. Retrospective chart review was performed to assess rates of primary wound healing, complications, recurrence, and incontinence. Recurrences were grouped into three types: type I, sinus tract or recurrent abscess without an internal opening; type II, conversion to an intersphincteric fistula; and type III, transsphincteric recurrence. Results The majority of patients were male (69%) with a mean age of 44 years and mean BMI 31.6 kg/m2. Median operative time was 88 min. Primary healing rate was 94%. Median healing period was 7 (range 4–16) weeks. Of the 10 recurrences,(5 type I, 5 type II, and 0 type III), median time to recurrence was 6 months after the primary wound healed. No patients experienced any postoperative incontinence or urinary retention. Conclusions In this cohort of patients with transsphincteric fistulas undergoing the LIFT procedure, the addition of offsetting muscle plication effectively limited transsphincteric recurrence. Further investigation is warranted to directly compare this LIFT adaptation to previously published literature. Keywords Anal fistula · Intersphincteric · Transsphincteric · LIFT · Surgical technique Introduction Anal fistulas, defined as abnormal pathologic tracts between the anal canal and perianal skin, develop in approximately one-third of patients after acute anorectal abscess treatment | Alexander Troester and Julia Frebault share co-first authorship. | | --- | | Paolo Goffredo and Cyrus Jahansouz share co-senior authorship. | * C. Jahansouz [jahan023@umn.edu](jahan023@umn.edu) 1 Department of Surgery, University of Minnesota, Minneapolis, MN, USA 2 Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 450, Minneapolis, MN 55455, USA with a male predominance and a mean age at presentation of 40 years [1]. They are classified both relative to the internal and external anal sphincters and as either simple or complex, with complex fistulas being transsphincteric involving > 30% of the external sphincter, suprasphincteric, extrasphincteric, or horseshoe fistulas and those associated with concomitant processes such as inflammatory bowel disease or malignancy [2, 3] . The management of complex anal fistulas comprises a vast array of surgical approaches, including endorectal advancement flaps, ligation of the intersphincteric fistula tract (LIFT), and novel therapies such as the fistula tract laser closure. These techniques are typically preceded by placement of a draining seton for acute infection control. First described in 2007, the LIFT is primarily indicated for transsphincteric fistulas, and initially reported a 94% success rate with no impact on continence [4] . Despite the promising results from this early case-series, subsequent systematic reviews have reveale

FAQs

What modification does the study’s LIFT technique include?

It offsets the transected fistula ends with interposing muscle plication, closes the internal opening, and performs wide excision of the external opening.

How were recurrences categorized in the review?

Recurrences were grouped into three types: type I without an internal opening (sinus tract or recurrent abscess), type II conversion to an intersphincteric fistula, and type III transsphincteric recurrence.

What were the main outcomes reported for healing and recurrence?

Primary healing was 94% with a median healing period of 7 weeks. Ten recurrences occurred, and no postoperative incontinence or urinary retention was reported.

Sep 28, 2026

Uploaded by Miles