Surgical treatment of anal fistula: classic elastic seton application and LIFT method

Abstract

Anal fistulas remain a challenging problem in colorectal surgery, and the optimal sphincter-preserving technique is still debated. We compared the LIFT procedure and elastic seton application in terms of treatment outcomes, postoperative pain, anal continence, and quality of life in transsphincteric and intersphincteric fistulas. In this single-centre retrospective cohort study, patients who underwent surgery for anal fistula between January 2018 and December 2022 were grouped by the technique they had received. Of 220 patients identified (LIFT n = 108; elastic seton n = 112), 11 in the seton group who did not complete follow-up were excluded, leaving 108 and 101 patients for analysis. Pain (VAS), continence (Wexner score), healing time, recurrence, and quality of life (FIQL) were assessed over 12 months. Mean follow-up was approximately 19 months. Recurrence rates were similar (LIFT 11.1% vs. seton 8.9%, p = 0.59). Postoperative day 1 VAS was 2.0 ± 1.0 versus 6.3 ± 1.1, and week 1 VAS 1.7 ± 0.7 versus 6.1 ± 1.0 ( p < 0.001). Complete epithelialisation occurred in 17.2 ± 5.4 days with LIFT and 42.3 ± 8.2 days with seton ( p < 0.001). At 12 months the Wexner score was 0.1 ± 0.3 versus 1.5 ± 0.7, and the total FIQL 3.5 ± 0.4 versus 3.2 ± 0.6 (both p < 0.001). Both methods achieved acceptable success with comparable recurrence, but LIFT better preserved continence, improved quality of life, and offered greater patient comfort, whereas elastic seton treatment involved more pain, multiple procedures, and longer recovery.