Laser-assisted LIFT/SLOFT for Complex Anal Fistula: A Retrospective Study of over 5 Years of Follow-up with High Healing Rates, Sphincter-preserving Approach

A BSTRACT Background: Fistula-in-ano remains a challenging condition, particularly in complex variants where recurrence is high and continence preservation is crucial. The ligation of fistula tract in intersphincteric plane/submucosal ligation of fistula tract (LIFT/SLOFT) procedures have gained popularity as a sphincter-sparing approach but have variable success rates. Laser fulguration (LF) using radial diode laser fibers targets epithelialized tracts, promoting obliteration. Combining both techniques has enhanced healing outcomes by addressing both the internal opening and the tract more comprehensively. Aim: To assess the efficacy, healing time, and recurrence rates of LIFT/SLOFT combined with LF (LIFT/SLOFT + LF) in treating complex anal fistulas for over 5 years. Methodology: A retrospective study was conducted at a tertiary care center involving patients who underwent the LIFT/SLOFT + LF procedure between November 2019 and December 2024. Inclusion criteria were complex transsphincteric or intersphincteric/submucosal fistulas, without active sepsis or Crohn’s disease, without any supralevator extension. Patient demographics, fistula type, operative notes, postoperative complications, healing duration, and recurrence were recorded. Primary healing was defined as closure of all external openings and wound of LIFT/SLOFT with cessation of discharge within 8 weeks. Follow-up was conducted for minimum of 6 months and maximum up to 5 years. Results: Among 893 patients (mean age 36.4 years; 59.5% male), the primary healing rate was 91.6% and recurrence occurred in 8.4%. Postoperative pain declined rapidly (Visual Analog Scale 4 at 6 h to 0 by day 14). Minor bleeding occurred in 24.8% which resolved by 8 weeks and infections in 3%. No incontinence or sphincter damage (zero cases) was reported. Delayed healing (>8 weeks) was seen in 27.3%. Quality of life improved significantly, with over 90% resuming normal activity by day 2. Conclusion: The LIFT/SLOFT + LF technique appears to be a safe, effective, and continence-preserving method for treating complex anal fistulas, showing high healing rates and low recurrence in long term.