One of five fistula operations · see all techniques
LIFT (Ligation of Intersphincteric Fistula Tract): for trans-sphincteric fistula
LIFT reaches the fistula tract in the plane between the internal and external sphincter, ties it off on both sides and divides it — closing the tunnel without cutting either muscle. It suits a mature trans-sphincteric tract in a patient with an intact sphincter. Day-care; desk work in 5–10 days (results vary). Performed by Dr. Kundan Kharde at Sharvari Hospital, Pimple Nilakh, Pune — 5 min from Wakad.
Who is this operation for?
LIFT is for the deep trans-sphincteric tract row of Dr. Kharde's framework — a tract crossing more than half of the external sphincter, where fistulotomy would divide too much muscle. It needs a single, well-formed (fibrosed) tract, which is why a seton is often placed for 6–8 weeks first. It is not used for an acute abscess or a horseshoe tract. Almost every fistula at Sharvari Hospital is imaged before surgery — MRI fistulogram or trans-rectal ultrasound — and the tract on that scan decides the operation (how Dr. Kharde decides).
How is it done?
- Anaesthesia and probing. Spinal anaesthesia; the tract is probed to confirm the mapped path.
- Intersphincteric incision. A 1.5–2 cm curved incision in the groove between the internal and external sphincter, over the tract.
- Isolating the tract. The intersphincteric plane is opened and the tract is identified as it passes between the muscles, and looped.
- Ligation and division. The tract is tied close to each sphincter and divided between the ties; the segment is removed.
- Curettage and closure. The outer tract is scraped out, the external opening widened for drainage, the incision closed loosely. Neither sphincter is cut.
About 30–45 minutes · one 1.5–2 cm incision in the intersphincteric groove · both sphincters preserved.
What does recovery look like?
| Day | Discharge & follow-up | Dressing & bowel movement | Return to work |
|---|---|---|---|
| Day 1 | Same-day discharge after observation; walking and normal diet that evening. | Small dressing over the intersphincteric wound; sitz-bath routine taught; first bowel movement next day with a stool softener. | Rest at home; antibiotics and painkillers as prescribed. |
| Day 7 | Free first review at the hospital. | Twice-daily sitz baths; the small wound is usually dry; a little discharge from the external opening is normal. | Desk work from Day 5–10; avoid gym and long sitting (results vary). |
| Day 30 | Healing review; MRI if the external opening still drains. | Intersphincteric wound healed; external opening closing; continence unchanged. | Resume gym, cycling and long sitting. |
Same 30-day roadmap as the main fistula page. Results vary.
What are the risks and the alternatives?
- •Bleeding: minor spotting is usual; heavy bleeding is uncommon and is an emergency (we are open 24×7).
- •Infection: fever, rising pain or new swelling needs review; antibiotics are prescribed routinely.
- •Non-healing or recurrence: published series report healing in roughly 60–80% of trans-sphincteric tracts (literature range, not Sharvari data). When LIFT fails the fistula usually "downgrades" to a short intersphincteric tract that a simple fistulotomy can cure. Results depend on tract anatomy.
- •Continence change: low risk — the sphincters are separated in their natural plane, not divided.
- • Alternatives: Fistulotomy / fistulectomy, FiLaC (laser), VAAFT, Seton (staged) — the imaging decides which.
Technique selection follows the ASCRS Clinical Practice Guideline for Anorectal Abscess, Fistula-in-Ano and Rectovaginal Fistula (2022).
How does LIFT compare?
LIFT is the only sphincter-preserving operation that physically removes a segment of tract, which is why its failures are often easy to convert.
| Technique | Best for | Sphincter cut? | Day-care? | Typical return to desk work | Published healing range* | Recurrence risk |
|---|---|---|---|---|---|---|
| Fistulotomy / fistulectomy | Simple, superficial tract, <30% sphincter | Yes, minimal | Yes | 3–7 days | ~90–95% | Low |
| LIFT (this page) | Trans-sphincteric tract; intact sphincter needed | No | Yes | 5–10 days | ~60–80% | Moderate |
| FiLaC (laser) | Trans-sphincteric tract; patient wants no cut | No | Yes | 2–5 days | ~60–70% | Moderate |
| VAAFT | Complex / branched tract, unclear internal opening | No | Yes | 3–7 days | ~70–80% | Moderate |
| Seton (staged) | Active sepsis; high / recurrent / horseshoe; Crohn's | No (drainage) | Yes (stage 1) | 2–5 days per stage | Bridge to definitive operation | n/a |
*Published literature ranges, not Sharvari outcome data; results vary and depend on tract anatomy.
Why have it at Sharvari Hospital?
- ✓Routine pre-operative imaging — MRI fistulogram or trans-rectal ultrasound for almost every fistula.
- ✓Same surgeon consults and operates — Dr. Kundan Kharde, MS, FMAS, 19+ years, 6,000+ surgeries (Dr Kharde's fistula profile).
- ✓Our own 50-bed hospital, open 24×7 — in-house beds if anything needs observation.
- ✓Cashless with 50+ insurers — pre-authorisation by our TPA desk. ISO 9001:2015 · PCMC Reg. 884.
Frequently asked questions
What is the intersphincteric plane? +
It is the natural gap between the two rings of muscle that control the anus — the internal sphincter (inner, involuntary) and the external sphincter (outer, voluntary). A trans-sphincteric fistula must pass through this plane on its way out. LIFT works in that gap, so the surgeon reaches the tract without cutting either muscle.
Why is LIFT sphincter-saving? +
Because the muscles are separated along the plane where they already lie against each other, not cut across. The tract is tied and divided in that gap, the muscle rings are left whole, and the small incision is outside the anal canal. That is why LIFT is offered for deep tracts where fistulotomy would risk bowel control.
What is the LIFT success rate? +
Published series report healing in roughly 60–80% of well-selected trans-sphincteric fistulas — literature ranges, not Sharvari outcome data. Results vary with tract length, previous surgery and whether the tract matured under a seton first. The ASCRS 2022 guideline supports LIFT as a sphincter-preserving option for exactly this tract.
LIFT or FiLaC — which is better? +
Neither is better for every tract. LIFT physically removes a segment and suits a well-formed tract in a patient who accepts a small incision and a slightly longer recovery. FiLaC has no incision and a faster return to work, with a somewhat lower published healing range. Both preserve the sphincter; the imaging decides.
Can LIFT be repeated if it fails? +
Yes. A failed LIFT usually leaves a shorter intersphincteric tract, which is re-imaged and then treated by a simple fistulotomy or a repeat LIFT. Because no sphincter was divided the first time, the full range of options remains. Results of any repeat operation depend on tract anatomy.
Cost, insurance and beds: see the full fistula treatment page.
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