Lift Versus Tropis in Complex Cryptoglandular Anal Fistula: Clinical Evidence and Treatment Outcomes
DOI:
https://doi.org/10.35381/s.v.v10i2.5247Keywords:
Rectal fistula, anal glands, focal infection, (Source: DeCS).Abstract
The cryptoglandular anal fistula usually originates from an infection of the anal glands and extends from the anal canal into the perianal tissues. Objectives: The objective was to critically analyze Lift versus Tropis in complex cryptoglandular anal fistulas: Clinical evidence and therapeutic outcomes. Methods: A structured review was conducted in PubMed/MEDLINE, supplemented with ASCRS, ESCP, and AWMF guidelines, references, and primary publications. Priority was given to high or complex transsphincteric fistulas, meta-analyses, long-term cohorts, and direct comparisons, while avoiding the inclusion of TROPIS variants or cases of Crohn’s disease. Results: TROPIS shows promising results and offers a particularly attractive rationale for high and complex fistulas, but direct evidence comparing it to LIFT is insufficient; cure rates decrease in some external validations with long-term follow-up; and functional assessment remains imperfect. Conclusions: TROPIS should be considered a significant conceptual advancement, not a proven replacement for LIFT.
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References
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg. 1976;63(1):1-12. https://n9.cl/xciat
Gaertner WB, Burgess PL, Davids JS, et al. Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum. 2022;65(8):964-985. doi:10.1097/DCR.0000000000002473
Reza L, Gottgens K, Kleijnen J, et al. European Society of Coloproctology: Guidelines for diagnosis and treatment of cryptoglandular anal fistula. Colorectal Dis. 2024;26(1):145-196. doi:10.1111/codi.16741
Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie Kryptoglanduläre Analfisteln. Version 3.1. AWMF-Registernummer 088-003. Stand 28.04.2026. https://n9.cl/7bf4y
Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in-ano: the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007;90(3):581-586. https://n9.cl/s2r9qt
Rojanasakul A. LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol. 2009;13(3):237-240. https://n9.cl/7pgc6
Emile SH, Khan SM, Adejumo A, Koroye O. Ligation of intersphincteric fistula tract (LIFT) in treatment of anal fistula: an updated systematic review, meta-analysis, and meta-regression of the predictors of failure. Surgery. 2020;167(2):484-492. doi:10.1016/j.surg.2019.09.012
Van Oostendorp JY, Verkade C, Han-Geurts IJM, van der Mijnsbrugge GJH, Wasowicz-Kemps DK, Zimmerman DDE. Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence. BJS Open. 2024;8(3): zrae055. doi:10.1093/bjsopen/zrae055
Tan IJW, Siew BE, Lau J, et al. Is the ligation of the intersphincteric fistula tract (LIFT) procedure truly a sphincter preserving procedure for anal fistula? A scoping review of the literature. Eur J Med Res. 2025; 30:243. https://n9.cl/kelcw
Zhang L, Zhan C, Li L, Shao W, Sun G, Chen Y, Chen G, Lang Y, Xiao Z, Xiao X. Ligation of the intersphincteric fistula tract (LIFT) for high transsphincteric fistulas: a double-center retrospective study with long-term follow-up. Ann Coloproctol. 2025;41(1):77-83. doi:10.3393/ac.2024.00024.0003. PMID:39818537
Fuschillo G, Pata F, D'Ambrosio M, Selvaggi L, Pescatori M, Selvaggi F, Pellino G. Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano: a systematic review and network meta-analysis. Tech Coloproctol. 2025; 29:116. doi:10.1007/s10151-025-03152-0. PMID:40392371.
Garg P. Transanal opening of intersphincteric space (TROPIS): a new procedure to treat high complex anal fistula. Int J Surg. 2017; 40:130-134. doi:10.1016/j.ijsu.2017.02.095
Garg P, Kaur B, Menon GR. Transanal opening of the intersphincteric space: a novel sphincter-sparing procedure to treat 325 high complex anal fistulas with long-term follow-up. Colorectal Dis. 2021;23(5):1213-1224. doi:10.1111/codi.15555
Li YB, Chen JH, Wang MD, et al. Transanal Opening of Intersphincteric Space for Fistula-in-Ano. Am Surg. 2022;88(6):1131-1136. doi:10.1177/0003134821989048
Mishra S, Thakur DS, Somashekar U, Verma A, Sharma D. The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results. Ann Coloproctol. 2024;40(5):474-480. doi:10.3393/ac.2022.01018.0145
Wang C, Huang T, Wang X. Efficacy and safety of transanal opening of intersphincteric space in the treatment of high complex anal fistula: a meta-analysis. Exp Ther Med. 2024; 28:306. doi:10.3892/etm.2024.12595
Zhou P, Lu J, Sun Y, Wang J. Transanal Opening of Intersphincteric Space (TROPIS) treatment for high complex anal fistula: a systematic review and meta-analysis. Int J Surg. 2025;111(10):7301-7311. doi:10.1097/JS9.0000000000002880
Reyes Díaz ML, Hinojosa-Ramirez F, Ramallo Solís IM, et al. Results at one year of the TROPIS technique in the treatment of complex anal fistula. Cir Esp (Engl Ed). 2025;103(3):135-142. doi:10.1016/j.cireng.2024.12.001
Pehlevan-Özel H, Yurdakul ZN, Martlı HF, et al. TROPIS Procedure in Complex Anal Fistulas: Single-Center Long-Term Results. ANZ J Surg. 2026;96(3):556-561. https://n9.cl/9aosp
Zhang ZJ, Ali MS, Hegde R, Jugo RH, Zhang TA, Kurtzman SH. Modified transanal opening of the intersphincteric space (TROPIS): a safe and effective procedure for transsphincteric fistula-in-ano in comparison with ligation of intersphincteric fistula tract (LIFT). Tech Coloproctol. 2025; 29:153. doi:10.1007/s10151-025-03193-5
Chen YT, Wang ZC, Xie YM, Wang X, Wu XX, Li Y, Shi R, Wang J. Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula. Surg Open Sci. 2025; 27:15-30. doi:10.1016/j.sopen.2025.05.010. PMID:40607121.
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