Anal fistula repair remains a challenging problem. Existing surgical procedures include fistulotomy with or without sphincter repair, LIFT, endoanal flap and plugs. Reported failure rates for these traditional anal fistula procedures range from 30–70%.1,2
Many papers have been published over the years that highlight the mixed results from such procedures. As part of our goal to improve outcomes for anal fistula care, the Signum Surgical team has gathered links to some key relevant journal articles to share here.
Endoanal Flap and LIFT
Ergüder E, Verkade C, Ersak C, van Oostendorp JY, Han-Geurts IJM, Wasowicz DK, Zimmerman DDE. Outcome of transanal advancement flap repair (TAFR) as salvage therapy after failed ligation of intersphincteric fistula tract (LIFT)-A proposed algorithm after failed LIFT. Colorectal Dis. 2025 Aug;27(8):e70199. doi: 10.1111/codi.70199. PMID: 40775663; PMCID: PMC12332107.
Read the full research paper on PubMed.
Madbouly KM, Emile SH, Issa YA, Omar W. Ligation of intersphincteric fistula tract (LIFT) with or without injection of platelet-rich plasma (PRP) in management of high trans-sphincteric fistula-in-ano: Short-term outcomes of a prospective, randomized trial. Surgery. 2021 Jul;170(1):61-66. doi: 10.1016/j.surg.2020.12.025. Epub 2021 Jan 31. PMID: 33536119.
Read the full randomized trial on PubMed.
Madbouly KM, El Shazly W, Abbas KS, Hussein AM. Ligation of intersphincteric fistula tract versus mucosal advancement flap in patients with high transsphincteric fistula-in-ano: a prospective randomized trial. Dis Colon Rectum. 2014 Oct;57(10):1202-8. doi: 10.1097/DCR.0000000000000194. PMID: 25203377.
Read the full clinical trial on PubMed.
Malakorn S, Sammour T, Khomvilai S, Chowchankit I, Gunarasa S, Kanjanasilp P, Thiptanakij C, Rojanasakul A. Ligation of Intersphincteric Fistula Tract for Fistula in Ano: Lessons Learned From a Decade of Experience. Dis Colon Rectum. 2017 Oct;60(10):1065-1070. doi: 10.1097/DCR.0000000000000880. PMID: 28891850.
Read the full research paper on PubMed.
Wallin UG, Mellgren AF, Madoff RD, Goldberg SM. Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery? Dis Colon Rectum. 2012 Nov;55(11):1173-8. doi: 10.1097/DCR.0b013e318266edf3. PMID: 23044679.
Read the full research paper on PubMed.
Schwandner T, Thieme A, Scherer R et al (2018) Randomized clinical trial comparing a small intestinal submucosa anal fistula plug to advancement flap for the repair of complex anal fistulas. Int J Surg Open 15:25–3
Read the full clinical trial on ScienceDirect.
Seifarth C, Lehmann KS, Holmer C, Pozios I. Healing of rectal advancement flaps for anal fistulas in patients with and without Crohn’s disease: a retrospective cohort analysis. BMC Surg. 2021 Jun 5;21(1):283. doi: 10.1186/s12893-021-01282-4. PMID: 34088303; PMCID: PMC8178918.
Read the full cohort study on PubMed.
Fistulotomy
Aguilar-Martínez MDM, Sánchez-Guillén L, Barber-Valles X, Alcaide-Quirós MJ, Bosch-Ramírez M, López-Delgado A, Tozer P, Arroyo A. Long-term Evaluation of Fistulotomy and Immediate Sphincteroplasty as a Treatment for Complex Anal Fistula. Dis Colon Rectum. 2021 Nov 1;64(11):1374-1384. doi: 10.1097/DCR.0000000000001800. PMID: 34623349.
Read the full research paper on PubMed.
Sørensen KM, Qvist N. Fistulectomy and primary sphincter reconstruction for high cryptoglandular anal fistula: a retrospective cohort study with long-term results. Surg Endosc. 2025 Mar;39(3):2073-2079. doi: 10.1007/s00464-025-11585-9. Epub 2025 Feb 3. PMID: 39900860; PMCID: PMC11870885.
Read the full cohort study on PubMed Central.
Plugs
Bondi J, Avdagic J, Karlbom U, Hallböök O, Kalman D, Šaltytė Benth J, Naimy N, Øresland T. Randomized clinical trial comparing collagen plug and advancement flap for trans-sphincteric anal fistula. Br J Surg. 2017 Aug;104(9):1160-1166. doi: 10.1002/bjs.10549. Epub 2017 May 10. PMID: 28489253.
Read the full clinical trial on PubMed.
Han JG, Wang ZJ, Zhao BC, Zheng Y, Zhao B, Yi BQ, Yang XQ. Long-term outcomes of human acellular dermal matrix plug in closure of complex anal fistulas with a single tract. Dis Colon Rectum. 2011 Nov;54(11):1412-8. doi: 10.1097/DCR.0b013e31822c5398. PMID: 21979187.
Read the full research paper on PubMed.
Schwandner T, Roblick MH, Kierer W, Brom A, Padberg W, Hirschburger M. Surgical treatment of complex anal fistulas with the anal fistula plug: a prospective, multicenter study. Dis Colon Rectum. 2009 Sep;52(9):1578-83. doi: 10.1007/DCR.0b013e3181a8fbb7. PMID: 19690485.
Read the full study on PubMed.
References from Introduction
- Ergüder et al. Outcome of transanal advancement flap repair (TAFR) after failed LIFT. Colorectal Disease. 2025;27:e70199.
- Aguilar-Martínez MDM, et al. Dis Colon Rectum. 2021 Nov 1;64(11):1374-1384.