Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis

Sphincter-preserving approaches to treat anal fistula do not jeopardize continence; however, healing rates are suboptimal. In this context, ligation of the intersphincteric fistula tract (LIFT) can be considered promising offering high success rates and a relatively simple procedure. This review aimed to investigate the outcomes of LIFT to treat anal fistula. We conducted a systematic review of the Pubmed, Web of Science, and Cochrane databases, to retrieve all relevant scientific original articles and scientific abstracts (Web of Science) related to the LIFT procedure for anal fistula between January 2007 and March 2013. The search yielded 24 original articles including 1,110 patients; these included one randomized controlled study, three case control studies, and 20 case series. Most studies included patients with trans-sphincteric or complex fistula, not amenable to fistulotomy. During a pooled mean 10.3 months of follow-up, the mean success, incontinence, intraoperative, and postoperative complication rates were 76.4, 0, 0, and 5.5 %, respectively. A sensitivity analysis showed that the impact on success in terms of follow-up duration, study size, and combining other procedures was limited. There was no association between pre-LIFT drainage seton and success of LIFT. Ligation of the intersphincteric fistula tract appears to be an effective and safe treatment for trans-sphincteric or complex anal fistula. Combining other procedures and a pre-LIFT drainage seton does not seem to confer any added benefit in terms of success. However, given the lack of prospective randomized trials, interpretation of these data must be cautious. Further trials are mandatory to identify predictive factors for success, and true effectiveness of the LIFT compared to other sphincter-preserving procedures to treat anal fistula.