A Study between Open Fistulotomy and Ligation of Intersphincteric Fistula Tract for Uncomplicated Perianal Fistula

Abstract Background: Perianal fistula is a common anorectal condition associated with pain, discharge, recurrence, and risk of fecal incontinence following surgery. Conventional open fistulotomy remains the standard treatment for uncomplicated low trans-sphincteric fistulas but carries a potential risk of sphincter damage. Ligation of the intersphincteric fistula tract (LIFT) is a newer sphincter-preserving technique aimed at reducing postoperative morbidity while maintaining satisfactory healing rates. Aim: To compare the clinical outcomes of open fistulotomy and LIFT in the management of uncomplicated low trans-sphincteric perianal fistulas. Materials and Methods: This longitudinal descriptive study was conducted at in department of general surgery. Thirty-two patients aged 18–60 years with low trans-sphincteric fistulas were included and allocated to either open fistulotomy or LIFT. Postoperative outcomes assessed included pain scores (VAS), analgesic requirement, wound healing time, fecal continence, hospital stay, and recurrence. Statistical analysis was performed using appropriate parametric and non-parametric tests with a significance level of P ≤ 0.05. Results: Patients undergoing LIFT experienced significantly lower postoperative pain scores, required fewer analgesic doses, demonstrated faster wound healing, and had shorter hospital stays compared to those undergoing fistulotomy ( P < 0.05). No recurrence was observed in either group. Minor fecal incontinence was noted only in one fistulotomy patient, while none occurred in the LIFT group. Conclusion: LIFT is a safe and effective sphincter-saving alternative to open fistulotomy for uncomplicated low trans-sphincteric perianal fistulas, offering faster recovery, reduced postoperative pain, and minimal risk of fecal incontinence.