Clinical experience with ligation of the intersphincteric fistula tract with internal opening distalization combined with laser fistula tract coagulation (LIFT-IOD + FiLaC) in the treatment of perianal fistulas

Introduction. Modern coloproctology demonstrates a growing trend toward the use of minimally invasive procedures, particularly in the management of complex anal fistulas. One of the most widely adopted and effective sphincter-preserving techniques for anal fistulas is the LIFT (Ligation of Intersphincteric Fistula Tract) procedure. However, according to theliterature, recurrence rates after minimally invasive fistula surgery remain relatively high.

Aim. To evaluate the outcomes and analyze a seven-year clinical experience withligation of the fistula tract with internal opening distalization combined with laser fistula tract coagulation (LIFT-IOD + FiLaC – Ligation of Intersphincteric Fistula Tract and Internal Opening Distalization + Fistula Laser Closure) in the treatment of perianal fistulas.

Materials and methods. This study was designed as a retrospective cohort analysis and included patients who underwent surgical treatment for complex transsphincteric and extrasphincteric fistulas of cryptoglandular origin using a modified technique at the surgical department of the Clinical Hospital “RZD-Medicine” in Rostov-on-Don between 2018 and 2025. A total of 124 patients with transsphincteric fistulas involving more than one-half of the anal sphincter circumference and extrasphincteric fistulas were included. The analysis included the incidence and nature of postoperative complications,length of hospital stay, postoperative analgesic requirements, the impact of surgery on anal continence function assessed by sphincterometry and the Wexner score, and recurrence rates.

Results. Primary healing was achieved in 74.2% of cases. The mean Wexner score before surgery was 6.4 ± 2.3 points, after surgery – 6.7 ± 3.4 points (p > 0.05). According to sphincterotonometry, the mean resting pressure before surgery was 66.1 ± 15.1 mmH₂O, with voluntary contraction 110.3 ± 23.5 mmH₂O, after surgery – 67.4 ± 12.5 mmH₂O and 108.7 ± 26.4 mmH₂O, respectively (p > 0.05).

Conclusions. The modified technique combining LIFT with internal opening distalization and laser fistula tract coagulation (LIFT-IOD + FiLaC) demonstrates high efficacy in the treatment of complex transsphincteric, and extrasphincteric fistulas while preserving anal continence function.

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