Comparison of Ligation of Intersphincteric Fistula Tract and Conventional Fistulectomy in the Management of Perianal Fistula.

Background Perianal fistula is a chronic anorectal disorder characterized by an epithelialized tract extending between the anal canal and the perianal skin, most frequently developing after cryptoglandular abscess formation. Patients commonly experience persistent discharge, pain, recurrent infections, and impaired quality of life. Although conventional fistulectomy remains an established treatment option, it may result in greater postoperative discomfort, slower wound healing, and potential impairment of continence. The ligation of intersphincteric fistula tract (LIFT) technique has gained acceptance as a sphincter-preserving procedure intended to minimize these complications while maintaining satisfactory treatment outcomes. Aim This study aimed to compare the clinical outcomes of the sphincter-preserving LIFT procedure with conventional fistulectomy in patients with perianal fistula by evaluating postoperative pain, wound infection, wound healing, postoperative fecal incontinence, and recurrence. Methods This prospective, randomized controlled trial was conducted in the Department of General Surgery at a tertiary care institution. Thirty patients with perianal fistula were randomly allocated in a 1:1 ratio to undergo either the LIFT procedure (n = 15) or conventional fistulectomy (n = 15). Outcomes assessed during follow-up included postoperative pain, wound infection, wound healing, postoperative fecal incontinence, and recurrence. Continuous variables were compared using the Mann-Whitney U test, while categorical variables were analysed using Fisher's exact test. Statistical significance was defined as a two-sided p value <0.05. Results Compared with conventional fistulectomy, the LIFT procedure was associated with significantly lower postoperative pain scores (median Visual Analogue Scale score: 2 vs. 5; Mann-Whitney U test, p < 0.001), lower rates of postoperative wound infection (6.7% vs. 46.7%; Fisher's exact test, p = 0.035), and improved postoperative wound healing (93.3% vs. 53.3%; Fisher's exact test, p = 0.035). Although postoperative recurrence (6.7% vs. 26.7%) and fecal incontinence (0.0% vs. 6.7%) occurred less frequently following the LIFT procedure, these differences were not statistically significant. Conclusion The LIFT procedure was associated with lower postoperative pain, fewer wound infections, and improved wound healing compared with conventional fistulectomy. Although lower rates of postoperative recurrence and fecal incontinence were observed following LIFT, these differences were not statistically significant. Larger multicenter studies with longer follow-up are required to confirm these findings.