Comparison between recent sphincter-sparing procedures for complex anal fistulas-ligation of intersphincteric tract vs transanal opening of intersphincteric space

Table 1 Comparison between ligation of intersphincteric fistula tract and transanal opening of intersphincteric space procedures

	LIFT	TROPIS
Fistula tract in intersphincteric space	Ligated	Deroofed into anal canal
Healing of wound	Primary intention	Secondary intention
Tackling of infected crypt glands	Done	Much better
Technically	Difficult	Simpler
Indications	Not possible/ very difficult to perform in: Pure intersphincteric fistulas; Fistulas with more intersphincteric component like horseshoe fistulas; Fistulas in which intersphincteric component is high up like supralevator fistulas, suprasphincteric fistulas	Effective in all complex fistulas
Preferred over the other (LIFT or TROPIS)	Complex high fistula with minimal fistula component in the intersphincteric space (Figure 1); Patients having simple low fistula but they are not keen for fistulotomy	Horseshoe fistulas with extensive intersphincteric component (Figure 2); Recurrent fistulas especially fistulas recurring after undergoing LIFT; High transsphincteric (involving upper one-third of EAS); Suprasphincteric fistula (Figure 3)
Healing in postoperative period	Faster	Slower
Internal sphincter	Preserved	Partially incised; Study in a large number of patients with long-term follow-up have demonstrated that if patients did regular Kegel exercises in the postoperative period, then there was no significant deterioration in continence.

LIFT: Ligation of intersphincteric fistula tract; TROPIS: Transanal opening of intersphincteric space.