What it is

What is the LIFT Procedure?

The Ligation of Intersphincteric Fistula Tract (LIFT) procedure is a sphincter-preserving operation designed to treat complex transsphincteric anal fistulas. The procedure is based on the principle of securely closing the internal fistula opening and removing the infected cryptoglandular tissue in the intersphincteric plane, thereby eliminating the source of the fistula without dividing the sphincter muscles. The surgeon makes an incision in the intersphincteric groove, dissects through the intersphincteric plane to identify the fistula tract as it passes between the internal and external sphincter muscles, and then ligates and divides it. The external portion of the tract is then curetted to remove granulation tissue.

Am I a candidate?

Who is a Good Candidate for the LIFT Procedure?

The LIFT procedure is an ideal treatment for patients with complex, high transsphincteric anal fistulas where a traditional fistulotomy would carry a significant risk of incontinence. It is suitable for patients with a mature, well-defined fistula tract, which can be facilitated by the placement of a draining seton for several weeks or months prior to the definitive procedure. It is a good option for patients who wish to avoid the risks associated with a cutting seton or a more complex flap repair.

How it's done

1A draining seton is often placed several weeks beforehand, so the tract firms up and is easier to find and repair.

2Under anesthesia, a small incision is made in the groove between the internal and external sphincter muscles.

3The fistula tunnel is found where it crosses that space, tied off on both sides, and divided — cutting the fistula's supply line without cutting any muscle.

4The outer part of the tract is cleaned out and left to drain while it heals.

What to expect

Same day

Home once the anesthesia wears off.

First week

Soreness and a small amount of drainage from the incision and the old external opening. Warm sitz baths help; keep stools soft.

1–2 weeks

Most patients are back to work and normal activity.

Next 2–3 months

The tract shrinks and closes. Healing is judged over the following weeks, at follow-up visits, until the openings have fully sealed.

If it doesn't heal

A LIFT can be repeated or converted to another repair — and because no muscle was cut, every other option stays open.

Risks & considerations

What are the Risks?

While the LIFT procedure is designed to be safe and sphincter-preserving, potential risks include:

Recurrence: The most common complication is failure of the fistula to heal, or recurrence, which can occur in 20-40% of cases. Failure may result from breakdown of the suture line on the fistula tract or the presence of unidentified secondary tracts.
Infection or Abscess: An abscess can form in the intersphincteric wound, which may require drainage.
Pain: Postoperative pain is expected but is typically well-controlled with oral pain medication.
Bleeding: Minor bleeding from the incision is common, but significant bleeding is rare.
Incontinence: The risk of major incontinence is very low as no sphincter muscle is divided. Minor temporary continence disturbances can occur due to the dissection but are uncommon.