Clinical and Functional Outcomes of Open Fistulectomy Compared with LIFT Procedure in Management of Simple Perianal Fistula

Background: Simple perianal fistula remains a challenging anorectal condition, requiring procedures that achieve durable healing while preserving continence and minimizing recurrence across variable anatomical presentations. Objective: To compare the clinical and functional outcomes of open fistulectomy and LIFT procedures by evaluating healing rates, complications, continence changes, and recurrence patterns using detailed quantitative and statistical analysis. Methods: A prospective observational study was conducted from January 2023 to June 2024 in the Surgery Department of Rajshahi Medical College Hospital and affiliated private institutions. Forty patients with simple fistulas were enrolled (LIFT=20; fistulectomy=20). Demographic patterns, fistula types, operative time, complications, healing duration, postoperative continence, and recurrence were analyzed using means, standard deviations, chi-square tests, and independent t-tests. Results: Among 40 patients, 30 (75%) were male; mean age was 37.3 ± 6.4 years. Inter-sphincteric fistulas comprised 68%, trans-sphincteric 32%. Mean operative time was significantly shorter in fistulectomy (28.6 ± 4.1 min) than LIFT (36.8 ± 5.3 min; p < 0.001). Mean healing time showed no significant difference (fistulectomy 34.2 ± 6.9 days vs. LIFT 32.7 ± 5.8 days; p = 0.18). Postoperative incontinence was lower in LIFT (Wexner score 1.2 ± 0.4) compared with fistulectomy (2.6 ± 0.7; p = 0.008). Recurrence was also lower in LIFT (10%) than fistulectomy (30%; p = 0.04). Spinal headache occurred in 7.5%. Long-term recurrence showed no significant difference (p = 0.30). Pain scores (VAS) were lower in LIFT at 48 hours (3.4 ± 1.1 vs. 4.8 ± 1.3; p = 0.002). Conclusion: LIFT demonstrates superior short-term functional outcomes, lower incontinence rates, reduced recurrence, and lower postoperative pain while maintaining comparable healing. Both procedures remain effective, but LIFT offers enhanced sphincter preservation advantages.