Introduction: A novel procedure called Ligation of the Intersphincteric Fistula Tract is demonstrated in this video. This can be used for simple or complex transsphincteric fistulae while preserving continence through avoidance of sphincter division.

Methods: After the fistula tract is identified with a probe, an incision is made in the intersphincteric groove. The tract is dissected circumferentially and divided. It is then ligated on both sides of the tract. The remaining tract communicating cutaneously is simply curetted and left open. The incision is then closed with absorbable sutures. A prospectively collected database has been created to evaluate results of this approach.

Results: Thirteen patients with trans-sphincteric fistula have been treated with this procedure in the last 8 months. 78% had prior attempts at repair of their fistula with methods including fistulotomy, fistula plug, fibrin glue and advancement flap. Eleven patients with a median follow up of 19 weeks demonstrate a success rate of 82%. There have been no cases of incontinence.

Conclusion: The LIFT procedure is a promising new technique in the management of fistula-inano that could potentially revolutionize the approach to this problem. It is a simple, safe, cost-effective procedure without the use of prosthetic material. No sphincter muscle is divided and continence is therefore preserved. The data in this series is consistent with a larger published series from Asia. Further studies and longer follow up is required to prove the durability and efficacy of this surgery.