LIFT procedure

LIFT stands for Ligation of Intersphincteric Fistula Tract. It is a modern, sphincter-preserving operation for selected anal fistulas — fistulas being the small, abnormal tunnels that can form between the inside of the back passage and the skin, often after an abscess.

The clever part of LIFT is where it works. The fistula is approached through a tiny incision made between the two layers of the sphincter (the inner and outer ring of muscle that controls continence). The tract is identified, tied off on both sides, and divided. Crucially, no sphincter muscle is cut — so the risk of incontinence, even minor wind leakage, is very low.

It is a day procedure or a short hospital stay, and most people return to normal activity within a week.

A LIFT procedure may be suggested if:

• You have a transsphincteric fistula — meaning the tract passes through both layers of the sphincter muscle, making a simple fistulotomy (just cutting it open) risky for your continence
• You have had a seton in place for several months to mature the tract — a common preparation that helps the tract become well-defined and ready for definitive surgery
• You want a sphincter-preserving option rather than one that cuts muscle
• Your fistula is not too complex or branching — LIFT works best on a single, well-defined tract

LIFT is generally not the right operation for very low, simple fistulas (where straightforward fistulotomy is safer and more effective), for very complex or branching fistulas (where a flap procedure may be better), or for active perianal Crohn's disease that is not under medical control.

• Sphincter-preserving — no muscle is cut, so the risk of incontinence is low. This is the central rationale for using LIFT instead of a fistulotomy that would have to divide significant sphincter muscle.
• Day procedure or short stay — most people go home the same day or the following morning.
• Smaller wound than a fistulotomy or flap procedure, with quicker healing.
• Can be repeated if needed — if a LIFT does not fully close the fistula, another can sometimes be performed, or the fistula may become more superficial (and easier to treat) afterwards.

LIFT is a safe procedure, but no operation is risk-free. The main thing to know about:

• Healing failure or recurrence is the main consideration. In published series, cure rates are around 50–75%, with lower rates in complex or recurrent fistulas — lower than fistulotomy for simple fistulas, but with the trade-off of preserving continence, which is usually the priority. If a LIFT does not close the fistula completely, the tract often becomes more superficial, and a different procedure (fistulotomy or a flap) may then be possible.
• Wound infection at the small intersphincteric incision is uncommon.
• Incontinence is rare — because no muscle is divided, the sphincter is fully preserved.
• Bleeding is uncommon and rarely significant.

The realistic chance of success for your specific fistula will be discussed before any decision is made — along with the next-step options if it does not work first time.

You will be given fasting and medication instructions when your surgery is booked — see the Fasting Instructions guide for the standard rules.

If you have a seton in place, it stays in until the day of LIFT. An MRI may be repeated close to the operation to confirm the fistula anatomy. A single dose of antibiotics is usually given at the start of the procedure to reduce the small risk of infection.

You will need a responsible adult to drive you home and stay with you overnight, as the procedure is done under general anaesthetic.

Here is what to expect:

• You will be admitted to the day-surgery unit at Warringal Private Hospital or Epworth Eastern. The nursing team will check you in and answer any last questions.
• The anaesthetist will give you a general anaesthetic so you are completely asleep and comfortable throughout.
• A small incision (about 1–2 cm) is made over the intersphincteric groove — the natural gap between the two layers of the sphincter muscle. The fistula tract is identified in this space, tied off on both sides, and then divided.
• The wound is loosely closed or left to heal by secondary intention (from the inside out) — depending on what looks best.
• The procedure usually takes 30–60 minutes.
• You will rest in recovery for an hour or two and then go home, or stay overnight if needed.

• The first few days — mild discomfort is expected. Regular paracetamol and ibuprofen are usually sufficient. Sitz baths (sitting in a warm shallow bath for 10–15 minutes a few times a day) help with comfort and hygiene.
• Return to work and activity — most people are back to desk work within 5–7 days. Light walking is encouraged from the next day.
• Bowel motions — keep stools soft with plenty of fibre, water, and a stool softener if needed. The first bowel motion is usually only mildly uncomfortable.
• Follow-up — a review is routinely arranged at 4–6 weeks to check healing — this review is provided at no charge.

Full instructions are in the Post-major-anal-procedure aftercare guide.

Mr Nguyen offers LIFT as one of several options for transsphincteric fistulas, choosing based on the MRI anatomy and what matters most to you. For patients with a seton already in place, LIFT is typically performed after the tract has had 2–3 months to mature — this gives the best chance of success.

Sphincter preservation is the central principle. The honest conversation about cure rates and next steps if the operation does not fully succeed is part of the planning, not an afterthought.

Have questions about this procedure?

If you have questions or would like to be seen, Mr Nguyen consults at his rooms in Heidelberg and operates at Warringal Private and Epworth Eastern. A GP or specialist referral is needed to make an appointment.

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