Presentation Information
[INTS4-3]Clinical Outcomes of LIFT, TROPIS, and Augmented LIFT for Complex Anal Fistula
*Pohsien Wu1, Yi-Chiao Cheng1 (1. Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan)
Purpose
To compare the clinical outcomes and surgical efficiency of ligation of the intersphincteric fistula tract (LIFT), trans-anal opening of intersphincteric space (TROPIS), and augmented LIFT for patients with complex anal fistula.
Methods:
Retrospectively reviewed 82 patients with complex anal fistulas (Garg Grade III–V) treated between 2020 and 2025 at a single institution. Patients were categorized into three groups: LIFT (n=37), TROPIS (n=18), and augmented LIFT (n=27; including LIFT plus Mesh, LIFT plus PRP, LIFT plus PRP & PRP). The primary outcome was the 3-month primary success rate. Secondary outcomes included operative time and factors influencing healing duration.
Results:
The three-month primary success rates were 75.7%, 72.2%, and 63.0% for LIFT, TROPIS, and augmented LIFT (p=0.54). Surgery time was significantly shorter for TROPIS (median 46 min) than augmented LIFT (53 min, p=0.040). Within augmented LIFT, the PRP-only subgroup achieved 100% success (95% CI 57-100%), but these five patients had uniformly favorable profiles (all Garg III, no prior surgery, no smokers); after their exclusion the augmented LIFT success rate fell to 54.5%. Stratified analysis revealed that TROPIS performed best in Garg III fistulas (88% success), whereas conventional LIFT outperformed augmented LIFT in Garg IV disease (84% vs 33%). Multivariable logistic regression identified age as the only independent predictor of failure (aOR 1.05/year, p=0.018). Cox model showed prior fistula surgery halved healing speed (HR 0.48, p=0.023).
Conclusions:
In this head-to-head comparison, all three sphincter-sparing approaches achieved statistically comparable outcomes. TROPIS appears advantageous for moderately complex (Garg III) fistulas due to its high efficiency. Conversely, conventional LIFT remains the most reliable option for anatomically severe or recurrent disease. Biomaterial augmentation did not provide additional benefits in truly complex cases. Patient age and prior surgical history remain the most critical prognostic factors.
To compare the clinical outcomes and surgical efficiency of ligation of the intersphincteric fistula tract (LIFT), trans-anal opening of intersphincteric space (TROPIS), and augmented LIFT for patients with complex anal fistula.
Methods:
Retrospectively reviewed 82 patients with complex anal fistulas (Garg Grade III–V) treated between 2020 and 2025 at a single institution. Patients were categorized into three groups: LIFT (n=37), TROPIS (n=18), and augmented LIFT (n=27; including LIFT plus Mesh, LIFT plus PRP, LIFT plus PRP & PRP). The primary outcome was the 3-month primary success rate. Secondary outcomes included operative time and factors influencing healing duration.
Results:
The three-month primary success rates were 75.7%, 72.2%, and 63.0% for LIFT, TROPIS, and augmented LIFT (p=0.54). Surgery time was significantly shorter for TROPIS (median 46 min) than augmented LIFT (53 min, p=0.040). Within augmented LIFT, the PRP-only subgroup achieved 100% success (95% CI 57-100%), but these five patients had uniformly favorable profiles (all Garg III, no prior surgery, no smokers); after their exclusion the augmented LIFT success rate fell to 54.5%. Stratified analysis revealed that TROPIS performed best in Garg III fistulas (88% success), whereas conventional LIFT outperformed augmented LIFT in Garg IV disease (84% vs 33%). Multivariable logistic regression identified age as the only independent predictor of failure (aOR 1.05/year, p=0.018). Cox model showed prior fistula surgery halved healing speed (HR 0.48, p=0.023).
Conclusions:
In this head-to-head comparison, all three sphincter-sparing approaches achieved statistically comparable outcomes. TROPIS appears advantageous for moderately complex (Garg III) fistulas due to its high efficiency. Conversely, conventional LIFT remains the most reliable option for anatomically severe or recurrent disease. Biomaterial augmentation did not provide additional benefits in truly complex cases. Patient age and prior surgical history remain the most critical prognostic factors.