Perirectal Fistula: Need a LIFT?

Medically reviewed by: Gary H. Hoffman, MD

The Fistula.  A LIFT.  A Promising Technique.

A perirectal abscess, which is a collection of pus in the tissues around the rectum, is the precursor of a perirectal fistula.  The infection begins in a small area of the anal canal and burrows its way outward toward the skin.  When it erupts through the skin, or when the proctologist, also known as a colon and rectal surgeon, incises the skin to allow the pus to drain, a fistula is created.

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In its simplest form, a fistula is an abnormal connection between two surfaces.  Sometimes, the fistula heals and closes on its own.  However, sometimes, the fistula remains open and will not heal without an operation.  The operation obliterates the fistulous tract.

Why Not Just Have An Operation?

The traditional operation is called a fistulotomy.  In a fistulotomy, the surgeon opens the area down to the fistulous tract and lets the area heal with scar tissue.  The fistula is obliterated.  However, the operation may come at a cost.  At a minimum, a fistulotomy is associated with a fair amount of postoperative pain.

The anal sphincter is a series of muscles surrounding the anal opening.  The sphincters provide continence, and the ability to hold and control our stool, our gas (flatus) and our liquid.  When the muscle is partially cut during a fistulotomy, patients may be left with minor or major incontinence.  This may be temporary or permanent.  Either way, incontinence, although relatively rare, may be a problem.

Traditional Operations.

Until recently, the operations available for curing the perirectal fistula were:

  • Fistulotomy (opening the entire area)
  • Advancement flap (covering the inside opening with new lining)
  • Glue (plugging the tract)
  • Fistula plug (closing the opening with tissue which promotes the ingrowth of scar tissue)

All of these procedures are associated with major or minor shortcomings.


Known as Ligation of the Intersphincteric Fistula Tract (LIFT), the LIFT is an operation performed through a small incision, hopefully allowing for minimal postoperative pain.  The surgeon dissects down to the tract, between the sphincter muscles.  No muscles are cut.  In its purest form, continence is totally preserved.  The surgeon obliterates the tract and the entire area then heals with scar.

Los Angeles Colon and Rectal Surgical Associates.

The results of LIFT to date have been very strong.  The board certified surgeons of Los Angeles Colon and Rectal Surgical Associates will be able to tell you more about the LIFT and will be available to answer your questions.

By calling (310)273-2310, you will be able to schedule your confidential consultation and begin treatment which may ultimately lead to the cure of the perianal or perirectal fistula.

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