Li X, Zhi CC, Wang XL, Zheng LH, Cheng YC. Ligation of the intersphincteric fistula tract vs conventional surgery for anal fistula in Chinese patients. World J Gastrointest Surg 2026; 18(2): 113979 [DOI: 10.4240/wjgs.v18.i2.113979]
Corresponding Author of This Article
Li-Hua Zheng, Department of Proctology, China-Japan Friendship Hospital, No. 11 Beisanhuan East Road, Chaoyang District, Beijing 100029, China. zhenglihua0819@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 27, 2026 (publication date) through Feb 26, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Li X, Zhi CC, Wang XL, Zheng LH, Cheng YC. Ligation of the intersphincteric fistula tract vs conventional surgery for anal fistula in Chinese patients. World J Gastrointest Surg 2026; 18(2): 113979 [DOI: 10.4240/wjgs.v18.i2.113979]
Xue Li, Xiao-Long Wang, Beijing University of Chinese Medicine, Beijing 100105, China
Xue Li, Cong-Cong Zhi, Xiao-Long Wang, Li-Hua Zheng, Yi-Cheng Cheng, Department of Proctology, China-Japan Friendship Hospital, Beijing 100029, China
Co-first authors: Xue Li and Cong-Cong Zhi.
Co-corresponding authors: Li-Hua Zheng and Yi-Cheng Cheng.
Author contributions: Li X and Zhi CC drafted the manuscript and they contributed equally to this manuscript and are co-first authors; Li X and Wang XL participated in study design; Li X conceived the study; Zhi CC acquired data and executed the research; Wang XL revised the manuscript; Zheng LH provided overall supervision, quality control, and critical revision of the manuscript for important intellectual content; Cheng YC performed the statistical analysis and contributed to data interpretation and writing; Zheng LH and Cheng YC contributed equally to this manuscript and are co-corresponding authors. All authors have read and approved the final manuscript.
Supported by the Clinical Research and Translational Promotion Project of China-Japan Friendship Hospital, No. 2022-NHLHCRF-LX-02.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Li-Hua Zheng, Department of Proctology, China-Japan Friendship Hospital, No. 11 Beisanhuan East Road, Chaoyang District, Beijing 100029, China. zhenglihua0819@163.com
Received: September 10, 2025 Revised: October 26, 2025 Accepted: December 10, 2025 Published online: February 27, 2026 Processing time: 169 Days and 19.2 Hours
Abstract
BACKGROUND
Anal fistula is a common anorectal disorder for which conventional surgical procedures often result in relatively high recurrence and complication rates. Ligation of the intersphincteric fistula tract (LIFT), a sphincter-preserving technique, has emerged as a potential alternative.
AIM
To systematically evaluate and compare the clinical efficacy, safety, and postoperative outcomes of LIFT vs conventional surgical approaches in the management of anal fistula using evidence from randomized controlled trials (RCTs).
METHODS
In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted a comprehensive systematic search of both Chinese and international databases to identify RCTs published during January 2014 to 2025. Studies were deemed eligible if they directly compared LIFT with conventional surgical approaches, such as seton placement, fistulotomy, and fistulectomy. The extracted data were analyzed using Review Manager; the methodological quality of the included trials was rigorously evaluated by using the Cochrane risk-of-bias tool.
RESULTS
In total, 107 RCTs involving 9401 participants met the inclusion criteria. LIFT yielded higher healing rates and significantly lower recurrence and complication rates than conventional surgery. Patients undergoing LIFT reported a lower postoperative pain, shorter wound-healing duration, and better preservation of the anal sphincter function. No significant difference was recorded in the operative time between the two groups.
CONCLUSION
The LIFT procedure demonstrated clear advantages over conventional surgical methods in terms of clinical efficacy, safety, and postoperative recovery, supporting the former’s role as an effective and sphincter-preserving treatment for anal fistula. Nevertheless, most available trials are limited by short follow-up durations and heterogeneous outcome definitions, underscoring the need for undertaking large, multicenter RCTs employing standardized endpoints.
Core Tip: Ligation of the intersphincteric fistula tract offers a sphincter-preserving alternative to conventional surgery for anal fistula. This systematic review of randomized controlled trials demonstrates that the procedure improves cure rates, reduces recurrence and complications, shortens wound-healing time, and better preserves anal function. These findings highlight its potential as a preferred treatment option and provide strong evidence for clinical decision-making.
