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PubMed This is a summary of 23 peer-reviewed journal articles Updated
Colorectal Surgery

What is the LIFT Procedure for Anal Fistula Treatment?

At a Glance

The LIFT procedure (Ligation of the Intersphincteric Fistula Tract) is a sphincter-sparing surgery for complex anal fistulas. It involves tying off the infected tunnel between the anal muscles, which effectively treats the fistula while preserving bowel control.

Living with an anal fistula can be an exhausting, painful, and frustrating experience. If you are exploring surgical options, you may have been told about a procedure called LIFT.

The LIFT procedure stands for Ligation of the Intersphincteric Fistula Tract. It is a specialized, “sphincter-sparing” surgery used to treat complex anal fistulas [1][2]. Because it involves tying off the infected tunnel (fistula) rather than cutting the sphincter muscles to reach it, LIFT significantly lowers the risk of post-surgery bowel leakage or fecal incontinence [3][4]. It is primarily recommended for transsphincteric fistulas, which are complex tunnels that cross through both layers of your anal sphincter muscles [1][5].

The Crucial First Step: Seton Placement

It is important to know that the LIFT procedure is almost never an immediate, one-step fix. In most cases, you will need a preliminary procedure to place a draining seton—a small piece of soft surgical thread looped through the fistula [6][7].

The seton is typically left in place for several weeks (often 6 to 12 weeks) before the actual LIFT surgery [6]. This critical step allows active infection and inflammation to drain and helps the fistula tunnel “mature” into a tougher, more defined tract. A mature tract is much easier and safer for the surgeon to tie off during the LIFT procedure, improving the chances of success [6][8].

What to Expect on Surgery Day

The LIFT surgery is usually performed as an outpatient (ambulatory) procedure, meaning you get to go home the same day [9]. You will typically be under general anesthesia (fully asleep) or spinal anesthesia (numb from the waist down), so you will not feel anything during the operation [9].

How the LIFT Procedure Works

Traditional fistula surgeries often involve cutting the muscle to lay the tunnel open (fistulotomy). While effective, cutting too much muscle can impact your ability to control your bowels [10]. The LIFT procedure avoids this by accessing the tunnel from between the muscle layers [11].

The surgery generally involves the following steps:

  1. Making an incision: The surgeon makes a small cut in the groove between the internal and external sphincter muscles (the intersphincteric groove) [11].
  2. Finding the tract: The surgeon locates the infected tunnel as it passes between the two muscle layers [11].
  3. Ligating (tying off) the tract: The surgeon securely ties off the tunnel close to where it opens inside the rectum [11].
  4. Removing infected tissue: The portion of the tract containing infected tissue is scraped out or removed [11].
  5. Closure: The small defect is stitched closed, leaving the sphincter muscles untouched and intact [11].

Recovery and Post-Operative Care

Because the sphincter muscles are not cut, recovery is typically faster and less painful than traditional fistulotomy operations [12][13]. Most patients can expect to return to work and light activities within 1 to 2 weeks, depending on how physically demanding their job is [9].

Going to the bathroom after any anal surgery is a major source of anxiety. To manage pain and protect the surgical site, your recovery plan will typically include:

  • Stool softeners and a high-fiber diet: Keeping your bowel movements soft prevents straining and protects the stitches [9][13].
  • Sitz baths: Soaking the area in shallow, warm water helps keep the wound clean, reduces pain, and relaxes the muscles [9].
  • Pain management: Your doctor will provide instructions for pain medications. Sometimes, prolonged antibiotics are also prescribed to prevent wound infection [14].

Success Rates and Surgical Risks

The LIFT procedure is considered a safe and efficient option. Studies show that LIFT has an overall success rate of roughly 70% to 76.5% for complex fistulas [15][16][17]. However, individual success can vary widely depending on how complex your fistula is and your overall health.

As with any surgery, there are general risks, including localized bleeding, post-operative pain, and wound infection or opening at the incision site (dehiscence) [14].

While LIFT is effective, the fistula can sometimes recur [18][19]. Certain factors increase the risk of the surgery failing, such as a history of prior fistula surgeries, a high body mass index (BMI), “horseshoe” fistulas (tunnels that curve around the anus), or underlying Crohn’s disease [20][21][22]. For patients with Crohn’s disease, smoking has been shown to negatively impact healing [22].

If a recurrence happens, it is not a complete loss. A failed LIFT often converts a complex fistula into a simpler type of fistula that is much easier to treat the second time around, either with a repeat LIFT or another minor procedure [5][23].

Common questions in this guide

Do I need a seton placed before LIFT surgery?
Yes, in most cases, a draining seton is placed 6 to 12 weeks before the LIFT procedure. This allows active infection to drain and helps the fistula tunnel mature into a tougher tract, making it safer and easier for the surgeon to tie off during surgery.
Will the LIFT procedure affect my bowel control?
The LIFT procedure is designed to be a sphincter-sparing surgery. It accesses the fistula tract between the muscle layers rather than cutting through them, which significantly lowers the risk of post-surgery bowel leakage or fecal incontinence.
How long does it take to recover from the LIFT procedure?
Recovery is generally faster and less painful than traditional operations that cut the sphincter muscle. Most patients can return to work and light activities within one to two weeks, depending on how physically demanding their job is.
What happens if the LIFT procedure fails?
If the fistula returns, a failed LIFT procedure often converts a complex fistula into a simpler one. This usually makes the fistula much easier to treat the second time around with either a repeat LIFT or another minor procedure.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do I need a draining seton placed before the LIFT surgery, and if so, how long will I need to wear it?
  2. 2.How many LIFT procedures have you performed, and what is your personal success rate?
  3. 3.What happens if this procedure fails for me? Will the resulting fistula be simpler to treat?
  4. 4.What are your specific protocols for pain management and wound care in the first week of recovery?
  5. 5.When will I realistically be able to return to my specific type of work?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

How to Relieve Anal Fistula Pain at Home Before SurgeryCan an Anal Fistula Heal Without Surgery?Anal Abscess vs. Anal Fistula: What's the Difference?Hemorrhoid vs. Anal Fistula: What's the Difference?Can a Chronic, Untreated Anal Fistula Cause Cancer?Can You Work and Exercise With an Anal Seton Drain?Can My Anal Fistula Be Glued or Plugged Shut?How Are Anal Fistulas Mapped and Diagnosed for Surgery?How Long Does a Seton Stay in for an Anal Fistula?How to Poop With an Anal Seton Drain: Patient TipsWill I Lose Bowel Control After Anal Fistula Surgery?Does Stem Cell Therapy Work for Crohn's Anal Fistulas?Why Do Anal Fistulas Recur? Causes and Next Steps

References

References (23)
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    Ligation of Intersphincteric Fistula Tract: a Sphincter-Sparing Option for Complex Fistula-in-Ano.

    Lange EO, Ferrari L, Krane M, Fichera A

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    Effective and long-term outcome following ligation of the intersphincteric fistula tract (LIFT) for transsphincteric fistula.

    Chen HJ, Sun GD, Zhu P, et al.

    International journal of colorectal disease 2017; (32(4)):583-585 doi:10.1007/s00384-016-2723-2.

    PMID: 27878618
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    THE LIGATION OF THE INTERSPHINETRIC TRACT PROCEDURE OF THE PERIANAL FISTULA: CASE REPORT.

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    Comparative study between intersphinecteric ligation of perianal fistula versus conventional fistulotomy with or without seton in the treatment of perianal fistula: A prospective randomized controlled trial.

    Al Sebai OI, Ammar MS, Mohamed SH, El Balshy MA

    Annals of medicine and surgery (2012) 2021; (61()):180-184 doi:10.1016/j.amsu.2020.12.014.

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    Complex Anal Fistula: Long-Term Results of Modified Ligation of Intersphincteric Fistula Tract=LIFT.

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    Comparison of incision and drainage procedure with drainage and ligation of the intersphincteric fistula tract in the treatment of deep perianal abscess.

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This page provides educational information about the LIFT procedure for anal fistulas. It is not intended to replace professional medical advice, diagnosis, or treatment from a qualified colorectal surgeon.

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