Ligation of the intersphincteric fistula tract vs conventional surgery for anal fistula in Chinese patients.

Abstract

Background: Anal fistula is a common anorectal disorder for which conventional surgical procedures often result in relatively high recurrence and complication rates. Ligation of the intersphincteric fistula tract (LIFT), a sphincter-preserving technique, has emerged as a potential alternative.

Aim: To systematically evaluate and compare the clinical efficacy, safety, and postoperative outcomes of LIFT vs conventional surgical approaches in the management of anal fistula using evidence from randomized controlled trials (RCTs).

Methods: In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted a comprehensive systematic search of both Chinese and international databases to identify RCTs published during January 2014 to 2025. Studies were deemed eligible if they directly compared LIFT with conventional surgical approaches, such as seton placement, fistulotomy, and fistulectomy. The extracted data were analyzed using Review Manager; the methodological quality of the included trials was rigorously evaluated by using the Cochrane risk-of-bias tool.

Results: In total, 107 RCTs involving 9401 participants met the inclusion criteria. LIFT yielded higher healing rates and significantly lower recurrence and complication rates than conventional surgery. Patients undergoing LIFT reported a lower postoperative pain, shorter wound-healing duration, and better preservation of the anal sphincter function. No significant difference was recorded in the operative time between the two groups.

Conclusion: The LIFT procedure demonstrated clear advantages over conventional surgical methods in terms of clinical efficacy, safety, and postoperative recovery, supporting the former's role as an effective and sphincter-preserving treatment for anal fistula. Nevertheless, most available trials are limited by short follow-up durations and heterogeneous outcome definitions, underscoring the need for undertaking large, multicenter RCTs employing standardized endpoints.