Question:
All of the following are sphincter-preserving surgical techniques for anal fistula EXCEPT:
All of the following are sphincter-preserving surgical techniques for anal fistula EXCEPT:
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Which procedure excises the whole tract and therefore cuts muscle?
Updated On: Jun 25, 2026
- LIFT (Ligation of Intersphincteric Fistula Tract)
- FiLaC (Fistula-tract Laser Closure)
- VAAFT (Video-Assisted Anal Fistula Treatment)
- Fistulectomy
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The Correct Option is D
Solution and Explanation
Step 1: Define sphincter-preserving surgery. In anal fistula management, the chief complication of cutting techniques is faecal incontinence from sphincter division. Sphincter-preserving (sphincter-sparing) procedures aim to eradicate the tract without dividing functional sphincter muscle.
Step 2: Classify each option.
• LIFT - the tract is ligated and divided in the intersphincteric plane, sparing both the internal and external sphincter. Sphincter-preserving.
• FiLaC - a radial laser fibre ablates the tract epithelium from within; no muscle is cut. Sphincter-preserving.
• VAAFT - a fistuloscope identifies the internal opening and the tract is fulgurated/closed endoscopically; no sphincter division. Sphincter-preserving.
Step 3: Identify the exception. Fistulectomy involves coring out and excising the entire fistulous tract, which usually requires dividing the sphincter muscle the tract traverses, risking incontinence. It is NOT a sphincter-preserving procedure.
Key fact: LIFT, FiLaC and VAAFT spare the sphincter; fistulectomy (and fistulotomy) divides it.
Step 2: Classify each option.
• LIFT - the tract is ligated and divided in the intersphincteric plane, sparing both the internal and external sphincter. Sphincter-preserving.
• FiLaC - a radial laser fibre ablates the tract epithelium from within; no muscle is cut. Sphincter-preserving.
• VAAFT - a fistuloscope identifies the internal opening and the tract is fulgurated/closed endoscopically; no sphincter division. Sphincter-preserving.
Step 3: Identify the exception. Fistulectomy involves coring out and excising the entire fistulous tract, which usually requires dividing the sphincter muscle the tract traverses, risking incontinence. It is NOT a sphincter-preserving procedure.
Key fact: LIFT, FiLaC and VAAFT spare the sphincter; fistulectomy (and fistulotomy) divides it.
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