The modified clipped ligation of intersphincteric fistula tract (clipped-LIFT) for high transsphincteric/suprasphincteric fistula

BACKGROUND: Although the ligation of the intersphincteric fistula tract (LIFT) is a well-established sphincter-preserving technique for treating anal fistulas, its application in complex high cases remains challenging and often results in suboptimal outcomes. This study introduces a modified LIFT technique and evaluates its effectiveness and safety. MATERIALS AND METHODS: A retrospective analysis was performed on 96 patients who underwent modified LIFT procedures to treat transsphincteric or suprasphincteric fistulas. In addition to the refined technique for deep intersphincteric tract dissection, two distinct methods were utilized to ligate the internal sphincter side of the intersphincteric tract: one group received conventional ligation with absorbable sutures (Suturing-LIFT, n = 74), while the other group was treated with absorbable clips commonly used for vascular or biliary duct occlusion (Clipped-LIFT, n = 22). The primary outcome was the one-stage healing rate, which was compared between the two groups, and the safety profile of the clipped-LIFT approach was analyzed. Both univariate and multivariate analyses were conducted to identify potential prognostic factors associated with therapeutic outcomes. RESULTS: The cohort was predominantly composed of male patients (78.1%), with a median age of 34 years, and mainly presented with high transsphincteric (56.2%) or suprasphincteric (26.0%) fistulas. The clipped-LIFT group demonstrated a higher one-stagehealing rate than the suturing-LIFT group across the entire cohort (68.2% vs. 51.4%). Specifically, for high transsphincteric and suprasphincteric fistulas, the healing rate in the clipped-LIFT group was 66.7%, compared to 44.8% in the suturing-LIFT group. Multivariate analysis revealed that clipped ligation was an independent predictor of improved efficacy compared to sutured ligation (OR = 0.33, 95% CI: 0.11-0.98; p = 0.046). Minor clip-related complications including complete or partial clip expulsion, occurred in 27.2% of patients in the clipped-LIFT group, but no severe complications were reported. CONCLUSION: This proof-of-concept study demonstrates that modified clipped-LIFT is a safe, more effective, and technically feasible method, thereby warranting further validation through large-scale prospective studies.