At a glance
The LIFT procedure (ligation of the intersphincteric fistula tract) is a surgical technique for treating anal fistulas that pass through the sphincter muscles. It was developed as a sphincter-preserving alternative to fistulotomy — meaning it aims to close the fistula without cutting through the sphincter.
This guide explains how the procedure works, who it is suitable for, what recovery looks like, and what the realistic expectations are.
How the LIFT procedure works
The anatomy
To understand LIFT, it helps to know that the anal sphincter has two layers — the internal sphincter (inner) and the external sphincter (outer). Between these two muscles is a space called the intersphincteric space. Many fistulas pass through this space.
The surgical technique
- The surgeon makes a small incision in the skin overlying the intersphincteric space
- The fistula tract is identified where it passes between the two sphincter muscles
- The tract is carefully dissected (separated from the surrounding tissue)
- The tract is tied off (ligated) on both the internal and external sphincter sides
- The tract between the ties is divided and removed
- The wound is closed or left to heal
The critical feature: the sphincter muscles themselves are not cut. This is what makes LIFT a sphincter-preserving procedure.
Who it is suitable for
LIFT is typically considered for:
- Transsphincteric fistulas — fistulas that pass through both sphincter muscles, where a simple fistulotomy would risk continence
- Fistulas where sphincter preservation is a priority — particularly important for people who already have any degree of continence concern
- Fistulas that have been managed with a seton — LIFT is often performed after a period of seton drainage to ensure the tract is mature and infection is controlled
LIFT may not be suitable for:
- Very superficial fistulas (where a simple fistulotomy is safe and straightforward)
- Very complex fistulas with multiple tracks
- Fistulas associated with active Crohn’s disease (though this varies)
- Fistulas where the tract cannot be identified in the intersphincteric space
What to expect
The procedure
LIFT is usually performed as a day case under general anaesthetic. The surgery itself typically takes thirty to sixty minutes. Most people go home the same day.
Recovery
Week 1: pain at the incision site, manageable with standard pain relief. The area may drain slightly. Bowel movements are uncomfortable but tolerable, especially with stool softeners.
Weeks 2 to 4: gradual improvement. Most people return to work during this period. The wound closes and drainage reduces.
Weeks 4 to 8: continued healing. Most people describe feeling close to normal by this point.
Beyond 8 weeks: the surgical team will assess healing. Full closure of the fistula tract can take several months to confirm.
Success rates
Published success rates for LIFT vary between studies but generally fall in the 60 to 80 percent range. This means the procedure works well for many people, but there is a meaningful chance that the fistula may recur.
Factors that may influence success:
- The type and complexity of the fistula
- Whether infection is fully controlled before surgery
- The surgeon’s experience with the technique
- Individual healing characteristics
If it does not work
Recurrence after LIFT is not a failure that closes doors. The sphincter muscles are intact. Further options remain available:
- Repeat LIFT procedure
- Advancement flap repair
- Fistulotomy (if now considered safe given the remaining sphincter)
- Further seton placement
- Newer techniques such as VAAFT or fistula plug
Compared to other fistula procedures
| Feature | LIFT | Fistulotomy | Advancement flap |
|---|---|---|---|
| Sphincter preservation | Yes | No (sphincter divided) | Yes |
| Success rate | 60-80% | 90%+ | 60-80% |
| Continence risk | Very low | Higher (depends on amount of sphincter) | Low |
| Recovery | 2-4 weeks | 4-8 weeks (open wound) | 2-4 weeks |
| Suitable for complex fistulas | Moderate | Simple fistulas only | Yes |
The practical message
LIFT offers a meaningful advantage for people whose fistula involves enough sphincter muscle that a fistulotomy would pose a continence risk. It trades a slightly lower success rate for substantially better sphincter preservation. Whether this trade-off makes sense depends on your specific fistula and your priorities — a conversation best had with a colorectal surgeon experienced in the technique.