{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T07:29:53Z","timestamp":1781076593517,"version":"3.54.1"},"reference-count":68,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007102","name":"Zagazig University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007102","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Colorectal Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>There is no consensus on the standard approach for trans-sphincteric perianal fistulas (TPAF) in the elderly population. The most commonly used sphincter-saving procedures are ligation of the inter-sphincteric fistula tract (LIFT) and mucosal advancement flap (MAF). We aimed to evaluate the incidence and risk factors for recurrence and incontinence in elderly patients with TPAF using both approaches.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective study included 257 patients who underwent LIFT (136 patients) or MAF (121 patients) for de novo and cryptoglandular TPAF between July 2018 and July 2021. Recurrent fistulas were clinically and radiologically detected using MRI. Postoperative incontinence was evaluated using the Wexner score and anorectal manometry. Logistic regression analysis was used to detect the risks of recurrence and incontinence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The median ages of the patients were 68 (64, 74) and 68 (65, 74) years in the LIFT and MAF groups, respectively. Higher recurrence rates were observed after LIFT (17 (12.5%)) than after MAF (13 (10.7%)), but the difference was not statistically significant (<jats:italic>P<\/jats:italic>\u2009=\u20090.662). Postoperative incontinence was observed in 18 patients (13.2%) and seven patients (5.8%) in the LIFT and MAF groups, respectively (<jats:italic>P<\/jats:italic>\u2009=\u20090.044). The predictors for fistula recurrence were smoking (OR, 75.52; 95% CI, 1.02 to 5611.35; <jats:italic>P<\/jats:italic>\u2009=\u20090.049), length of tract (OR, 17.3; 95% CI, 1.49 to 201.13; <jats:italic>P<\/jats:italic>\u2009=\u20090.023), and CD classification (OR, 7.08; 95% CI, 1.51 to 33.14; <jats:italic>P<\/jats:italic>\u2009=\u20090.013). A low Charlson comorbidity index score (\u2264\u20095) (OR, 0.68; 95% CI, 0.47 to 0.99; <jats:italic>P<\/jats:italic>\u2009=\u20090.046) and high postoperative mean squeeze anal pressure (OR, 0.97; 95% CI, 0.95 to 0.99; <jats:italic>P<\/jats:italic>\u2009=\u20090.001) were significant factors associated with reduced risk of incontinence. In particular, LIFT was associated with a significantly higher risk of incontinence than MAF (OR, 2.089; 95% CI, 1.006 to 4.33; <jats:italic>P<\/jats:italic>\u2009=\u20090.04).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The healing rates of MAF and LIFT procedures did not differ significantly; however, continence was significantly better after MAF. MAF should be added to the guidelines as a good option for the treatment of TPAF in elderly patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>The study was registered as a clinical trial <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.clinicaltrials.gov\" ext-link-type=\"uri\">www.clinicaltrials.gov<\/jats:ext-link> (NCT06616662).<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00384-025-04846-5","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T04:28:13Z","timestamp":1741753693000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study"],"prefix":"10.1007","volume":"40","author":[{"given":"Tamer A. A. M.","family":"Habeeb","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Chiaretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor A.","family":"Kryvoruchko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pesce","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristotelis","family":"Kechagias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abd Al-Kareem","family":"Elias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelmonem A. M.","family":"Adam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Gadallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad Mohamed","family":"Ali Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Khyrallh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed H.","family":"Alsayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esmail","family":"Tharwat Kamel Awad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Hassan","family":"Elshafey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Ibrahim","family":"Abo Alsaad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abouelatta Kh.","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamdi","family":"Elbelkasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud Ali","family":"Abou Zaid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda A. A.","family":"Youssef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona Mohammad Farid","family":"Al-Zamek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Fiad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer Mohamed","family":"Elshahidy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud R.","family":"Elballat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Kamal","family":"El Taher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Mahmoud Mokhtar","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Khaled","family":"AboZeid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Ibrahim","family":"Mansour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud Abdou","family":"Yassin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Salah","family":"Arafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Lotfy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassam","family":"Mousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baher","family":"Atef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameh Mohamed","family":"Naguib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim A.","family":"Heggy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Elnemr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abdallah","family":"Zaitoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehab Shehata","family":"AbdAllah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad S.","family":"Moussa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abd Elwahab M.","family":"Hamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha S.","family":"Elsayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,12]]},"reference":[{"key":"4846_CR1","doi-asserted-by":"publisher","unstructured":"Malik A, Hall D, Devaney R, Sylvester H, Yalamarthi S (2011) The impact of specialist experience in the surgical management of perianal abscesses\u2606. Int J Surg 9(6). https:\/\/doi.org\/10.1016\/j.ijsu.2011.06.002","DOI":"10.1016\/j.ijsu.2011.06.002"},{"issue":"1","key":"4846_CR2","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s00384-023-04576-6","volume":"39","author":"DM Skovgaards","year":"2023","unstructured":"Skovgaards DM, Perregaard H, Dibbern CB, Nordholm-Carstensen A (2023) Fistula development after anal abscess drainage\u2014a multicentre retrospective cohort study. Int J Colorectal Dis 39(1):4. https:\/\/doi.org\/10.1007\/s00384-023-04576-6","journal-title":"Int J Colorectal Dis"},{"issue":"4","key":"4846_CR3","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1111\/codi.16917","volume":"26","author":"N Iqbal","year":"2024","unstructured":"Iqbal N, Alrubaiy L, Hart A, Siviter R, Wilson L, Tozer P (2024) The development of a cryptoglandular anal fistula quality of life scale (AF-QoL). Colorectal Dis: Off J Assoc Coloproctology Great Brit Ireland 26(4):716\u2013725. https:\/\/doi.org\/10.1111\/codi.16917","journal-title":"Colorectal Dis: Off J Assoc Coloproctology Great Brit Ireland"},{"issue":"1","key":"4846_CR4","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1007\/s00384-023-04467-w","volume":"38","author":"M Morales-Cruz","year":"2023","unstructured":"Morales-Cruz M, Ali M, Christou C, Crothers H, McNulty D, Ward ST (2023) Repeat operations in patients with anal fistula, a retrospective study across England and Wales. Int J Colorectal Dis 38(1):174. https:\/\/doi.org\/10.1007\/s00384-023-04467-w","journal-title":"Int J Colorectal Dis"},{"issue":"4","key":"4846_CR5","doi-asserted-by":"publisher","first-page":"321","DOI":"10.3393\/ac.2024.00325.0046","volume":"40","author":"P Garg","year":"2024","unstructured":"Garg P, Bhattacharya K, Yagnik VD, Mahak G (2024) Recent advances in the diagnosis and treatment of complex anal fistula. Ann Coloproctology 40(4):321\u2013335. https:\/\/doi.org\/10.3393\/ac.2024.00325.0046","journal-title":"Ann Coloproctology"},{"issue":"2","key":"4846_CR6","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s10151-011-0676-6","volume":"15","author":"GK Atkin","year":"2011","unstructured":"Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RKS (2011) For many high anal fistulas, lay open is still a good option. Tech Coloproctol 15(2):143\u2013150. https:\/\/doi.org\/10.1007\/s10151-011-0676-6","journal-title":"Tech Coloproctol"},{"issue":"1","key":"4846_CR7","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3393\/ac.2021.02.08","volume":"37","author":"JL Lee","year":"2021","unstructured":"Lee JL, Yoon YS, Yu CS (2021) Treatment Strategy for perianal fistulas in Crohn disease patients: the surgeon\u2019s point of view. Ann Coloproctology 37(1):5\u201315. https:\/\/doi.org\/10.3393\/ac.2021.02.08","journal-title":"Ann Coloproctology"},{"issue":"1","key":"4846_CR8","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s00384-024-04602-1","volume":"39","author":"S Khan","year":"2024","unstructured":"Khan S, Kotcher R, Herman P, Wang L, Tessler R, Cunningham K et al (2024) Predictors of recurrence and long-term patient reported outcomes following surgical repair of anal fistula, a retrospective analysis. Int J Colorectal Dis 39(1):37. https:\/\/doi.org\/10.1007\/s00384-024-04602-1","journal-title":"Int J Colorectal Dis"},{"issue":"1","key":"4846_CR9","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s00384-023-04516-4","volume":"38","author":"S Hannes","year":"2023","unstructured":"Hannes S, Kochergin M, Al-Haidary J, G\u00f6tze T, Habbe N (2023) OTSC Proctology clip as appropriate treatment for complicated anorectal fistula. Int J Colorectal Dis 38(1):222. https:\/\/doi.org\/10.1007\/s00384-023-04516-4","journal-title":"Int J Colorectal Dis"},{"issue":"1","key":"4846_CR10","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1007\/s00384-024-04683-y","volume":"39","author":"X-L Tang","year":"2024","unstructured":"Tang X-L, Xu Z-Y, Yang J, Yang Z, Wang Z-G, Zhang Z-Y et al (2024) Assessing the suitability of video-assisted anal fistula treatment for obese patients compared to conventional surgery: a question worth investigating. Int J Colorectal Dis 39(1):108. https:\/\/doi.org\/10.1007\/s00384-024-04683-y","journal-title":"Int J Colorectal Dis"},{"issue":"1","key":"4846_CR11","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s00384-023-04367-z","volume":"38","author":"Y Wang","year":"2023","unstructured":"Wang Y, Rao Q, Ma Y, Li X (2023) Platelet-rich plasma in the treatment of anal fistula: a systematic review and meta-analysis. Int J Colorectal Dis 38(1):70. https:\/\/doi.org\/10.1007\/s00384-023-04367-z","journal-title":"Int J Colorectal Dis"},{"issue":"1","key":"4846_CR12","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1007\/s00384-023-04519-1","volume":"38","author":"H Zhang","year":"2023","unstructured":"Zhang H, Lin M, Nan Z, Zhang Y, Liu S, Li A et al (2023) Comparing the efficacy and safety of different thread-drawing surgery method for treating high complex anal fistula: a systematic review and network meta-analysis. Int J Colorectal Dis 38(1):228. https:\/\/doi.org\/10.1007\/s00384-023-04519-1","journal-title":"Int J Colorectal Dis"},{"issue":"9","key":"4846_CR13","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1007\/s00384-021-03932-8","volume":"36","author":"A Nordholm-Carstensen","year":"2021","unstructured":"Nordholm-Carstensen A, Perregaard H, Hagen KB, Krarup P-M (2021) Fistula Laser Closure (FiLaC\u2122) for fistula-in-ano\u2014yet another technique with 50% healing rates? Int J Colorectal Dis 36(9):1831\u20131837. https:\/\/doi.org\/10.1007\/s00384-021-03932-8","journal-title":"Int J Colorectal Dis"},{"issue":"10","key":"4846_CR14","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1007\/s00384-019-03367-2","volume":"34","author":"IB Amor","year":"2019","unstructured":"Amor IB, Lainas P, Kassir R, Chenaitia H, Dagher I, Gugenheim J (2019) Treatment of complex recurrent fistula-in-ano by surgery combined to autologous bone marrow\u2013derived mesenchymal stroma cells and platelet-rich plasma injection. Int J Colorectal Dis 34(10):1795\u20131799. https:\/\/doi.org\/10.1007\/s00384-019-03367-2","journal-title":"Int J Colorectal Dis"},{"issue":"10","key":"4846_CR15","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.1007\/s00384-021-03917-7","volume":"36","author":"M Pescatori","year":"2021","unstructured":"Pescatori M (2021) Surgery for anal fistulae: state of the art. Int J Colorectal Dis 36(10):2071\u20132079. https:\/\/doi.org\/10.1007\/s00384-021-03917-7","journal-title":"Int J Colorectal Dis"},{"issue":"6","key":"4846_CR16","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1007\/s00384-019-03290-6","volume":"34","author":"F de la Portilla","year":"2019","unstructured":"de la Portilla F, Mu\u00f1oz-Cruzado MVD, Maestre MV, Garc\u00eda-Cabrera AM, Reyes ML, V\u00e1zquez-Monchul JM et al (2019) Platelet-rich plasma (PRP) versus fibrin glue in cryptogenic fistula-in-ano: a phase III single-center, randomized, double-blind trial. Int J Colorectal Dis 34(6):1113\u20131119. https:\/\/doi.org\/10.1007\/s00384-019-03290-6","journal-title":"Int J Colorectal Dis"},{"key":"4846_CR17","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1016\/j.ijsu.2017.08.582","volume":"46","author":"P Garg","year":"2017","unstructured":"Garg P, Singh P (2017) Video-assisted anal fistula treatment (VAAFT) in cryptoglandular fistula-in-ano: a systematic review and proportional meta-analysis. Int J Surg 46:85\u201391. https:\/\/doi.org\/10.1016\/j.ijsu.2017.08.582","journal-title":"Int J Surg"},{"issue":"6","key":"4846_CR18","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1007\/s00384-020-03584-0","volume":"35","author":"M La Torre","year":"2020","unstructured":"La Torre M, Lisi G, D\u2019Agostino E, Boccuzzi M, Campanelli M, Varriale M et al (2020) Lift and VAAFT for high trans-sphincteric anal fistula: a single center retrospective analysis. Int J Colorectal Dis 35(6):1149\u20131153. https:\/\/doi.org\/10.1007\/s00384-020-03584-0","journal-title":"Int J Colorectal Dis"},{"issue":"6","key":"4846_CR19","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1007\/s10151-021-02446-3","volume":"25","author":"L Dekker","year":"2021","unstructured":"Dekker L, Zimmerman DDE, Smeenk RM, Schouten R, Han-Geurts IJM (2021) Management of cryptoglandular fistula-in-ano among gastrointestinal surgeons in the Netherlands. Tech Coloproctol 25(6):709\u2013719. https:\/\/doi.org\/10.1007\/s10151-021-02446-3","journal-title":"Tech Coloproctol"},{"key":"4846_CR20","doi-asserted-by":"publisher","unstructured":"Khafagy W, Omar W, El Nakeeb A, Fouda E, Yousef M, Farid M (2010) Treatment of anal fistulas by partial rectal wall advancement flap or mucosal advancement flap: a prospective randomized study. Int J Surg 8(4). https:\/\/doi.org\/10.1016\/j.ijsu.2010.03.009","DOI":"10.1016\/j.ijsu.2010.03.009"},{"issue":"8","key":"4846_CR21","doi-asserted-by":"publisher","first-page":"784","DOI":"10.1007\/s00384-005-0072-7","volume":"21","author":"SJ van der Hagen","year":"2006","unstructured":"van der Hagen SJ, Baeten CG, Soeters PB, van Gemert WG (2006) Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas. Int J Colorectal Dis 21(8):784\u201390. https:\/\/doi.org\/10.1007\/s00384-005-0072-7","journal-title":"Int J Colorectal Dis"},{"issue":"5","key":"4846_CR22","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1111\/codi.14504","volume":"21","author":"H Lin","year":"2019","unstructured":"Lin H, Jin Z, Zhu Y, Diao M, Hu W (2019) Anal fistula plug vs rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis of studies with long-term follow-up. Colorectal Dis 21(5):502\u2013515. https:\/\/doi.org\/10.1111\/codi.14504","journal-title":"Colorectal Dis"},{"key":"4846_CR23","doi-asserted-by":"publisher","unstructured":"Madbouly KM, El Shazly W, Abbas KS, Hussein AM (2014) Ligation of intersphincteric fistula tract versus mucosal advancement flap in patients with high transsphincteric fistula-in-ano: a prospective randomized trial. Dis Colon Rectum 57(10). https:\/\/doi.org\/10.1097\/DCR.0000000000000194","DOI":"10.1097\/DCR.0000000000000194"},{"issue":"5","key":"4846_CR24","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1007\/s00384-017-2779-7","volume":"32","author":"Z Balciscueta","year":"2017","unstructured":"Balciscueta Z, Uribe N, Balciscueta I, Andreu-Ballester JC, Garc\u00eda-Granero E (2017) Rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis. Int J Colorectal Dis 32(5):599\u2013609. https:\/\/doi.org\/10.1007\/s00384-017-2779-7","journal-title":"Int J Colorectal Dis"},{"key":"4846_CR25","doi-asserted-by":"publisher","unstructured":"Jarrar A, Church J (2011) Advancement flap repair: a good option for complex anorectal fistulas. Dis Colon Rectum 54(12). https:\/\/doi.org\/10.1097\/DCR.0b013e31822d7ddd","DOI":"10.1097\/DCR.0b013e31822d7ddd"},{"issue":"7","key":"4846_CR26","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s00384-008-0460-x","volume":"23","author":"PJ van Koperen","year":"2008","unstructured":"van Koperen PJ, Wind J, Bemelman WA, Slors JFM (2008) Fibrin glue and transanal rectal advancement flap for high transsphincteric perianal fistulas; is there any advantage? Int J Colorectal Dis 23(7):697\u2013701. https:\/\/doi.org\/10.1007\/s00384-008-0460-x","journal-title":"Int J Colorectal Dis"},{"key":"4846_CR27","first-page":"581","volume":"90","author":"A Rojanasakul","year":"2007","unstructured":"Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K (2007) Total anal sphincter saving technique for fistula-inano; the ligation of intersphincteric fistula tract. J Med Assoc Thai 90:581\u2013586","journal-title":"J Med Assoc Thai"},{"issue":"10","key":"4846_CR28","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1097\/DCR.0000000000001448","volume":"62","author":"KWA G\u00f6ttgens","year":"2019","unstructured":"G\u00f6ttgens KWA, Wasowicz DK, Stijns J, Zimmerman D (2019) Ligation of the intersphincteric fistula tract for high transsphincteric fistula yields moderate results at best: is the tide turning? Dis Colon Rectum 62(10):1231\u20131237. https:\/\/doi.org\/10.1097\/DCR.0000000000001448","journal-title":"Dis Colon Rectum"},{"issue":"5","key":"4846_CR29","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1111\/codi.12104","volume":"15","author":"JP Lehmann","year":"2013","unstructured":"Lehmann JP, Graf W (2013) Efficacy of LIFT for recurrent anal fistula. Colorectal Dis 15(5):592\u20135. https:\/\/doi.org\/10.1111\/codi.12104","journal-title":"Colorectal Dis"},{"key":"4846_CR30","doi-asserted-by":"publisher","unstructured":"Sugrue J, Mantilla N, Abcarian A, Kochar K, Marecik S, Chaudhry V et al (2017) Sphincter-sparing anal fistula repair: are we getting better?. Dis Colon Rectum 60(10). https:\/\/doi.org\/10.1097\/DCR.0000000000000885","DOI":"10.1097\/DCR.0000000000000885"},{"issue":"4","key":"4846_CR31","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00384-016-2723-2","volume":"32","author":"H-J Chen","year":"2017","unstructured":"Chen H-J, Sun G-D, Zhu P, Zhou Z-L, Chen Y-G, Yang B-L (2017) Effective and long-term outcome following ligation of the intersphincteric fistula tract (LIFT) for transsphincteric fistula. Int J Colorectal Dis 32(4):583\u2013585. https:\/\/doi.org\/10.1007\/s00384-016-2723-2","journal-title":"Int J Colorectal Dis"},{"issue":"2","key":"4846_CR32","doi-asserted-by":"publisher","first-page":"133","DOI":"10.3393\/ac.2021.01.06","volume":"38","author":"W Chadbunchachai","year":"2022","unstructured":"Chadbunchachai W, Lohsiriwat V, Paonariang K (2022) Long-term outcomes after anal fistula surgery: results from two university hospitals in Thailand. Ann Coloproctology 38(2):133\u2013140. https:\/\/doi.org\/10.3393\/ac.2021.01.06","journal-title":"Ann Coloproctology"},{"key":"4846_CR33","doi-asserted-by":"publisher","unstructured":"Tsunoda A, Sada H, Sugimoto T, Nagata H, Kano N. Anal function after ligation of the intersphincteric fistula tract. Diseases of the Colon & Rectum. 2013;56(7). https:\/\/doi.org\/10.1097\/DCR.0b013e31828d2e29","DOI":"10.1097\/DCR.0b013e31828d2e29"},{"issue":"1","key":"4846_CR34","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1097\/JS9.0000000000000776","volume":"110","author":"Y An","year":"2024","unstructured":"An Y, Gao J, Xu J, Qi W, Wang L, Tian M (2024) Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis. Int J Surg 110(1):441\u2013452. https:\/\/doi.org\/10.1097\/JS9.0000000000000776","journal-title":"Int J Surg"},{"issue":"5","key":"4846_CR35","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1111\/codi.12224","volume":"15","author":"NA Yassin","year":"2013","unstructured":"Yassin NA, Hammond TM, Lunniss PJ, Phillips RKS (2013) Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review Colorectal Disease 15(5):527\u2013535. https:\/\/doi.org\/10.1111\/codi.12224","journal-title":"A systematic review Colorectal Disease"},{"issue":"4","key":"4846_CR36","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1007\/s00384-021-03867-0","volume":"36","author":"C Chaveli Diaz","year":"2021","unstructured":"Chaveli Diaz C, Esquiroz Lizaur I, Marzo Virto J, Oteiza Mart\u00ednez F, Gonzalez \u00c1lvarez G, de Miguel VM et al (2021) Fistulectomy and endorectal advancement flap repair for cryptoglandular anal fistula: recurrence and functional outcome over 10 years of follow-up. Int J Colorectal Dis 36(4):841\u2013846. https:\/\/doi.org\/10.1007\/s00384-021-03867-0","journal-title":"Int J Colorectal Dis"},{"issue":"3","key":"4846_CR37","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.4200","volume":"11","author":"N Bakhtawar","year":"2019","unstructured":"Bakhtawar N, Usman M (2019) Factors increasing the risk of recurrence in fistula-in-ano. Cureus 11(3):e4200. https:\/\/doi.org\/10.7759\/cureus.4200","journal-title":"Cureus"},{"issue":"7","key":"4846_CR38","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1007\/s10151-013-1111-y","volume":"18","author":"D Wang","year":"2014","unstructured":"Wang D, Yang G, Qiu J, Song Y, Wang L, Gao J et al (2014) Risk factors for anal fistula: a case\u2013control study. Tech Coloproctol 18(7):635\u2013639. https:\/\/doi.org\/10.1007\/s10151-013-1111-y","journal-title":"Tech Coloproctol"},{"issue":"8","key":"4846_CR39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2021.106038","volume":"92","author":"Z Mei","year":"2021","unstructured":"Mei Z, Li Y, Wang Q, Shao Z, Du P, Zhu J et al (2021) Risk factors for postoperative recurrence of anal fistula identified by an international, evidence-based Delphi consultation survey of surgical specialists. Int J Surg 92(8):106038. https:\/\/doi.org\/10.1016\/j.ijsu.2021.106038","journal-title":"Int J Surg"},{"key":"4846_CR40","doi-asserted-by":"publisher","unstructured":"Jord\u00e1n J, Roig JV, Garc\u00eda-Armengol J, Garc\u00eda-Granero E, Solana A, Lled\u00f3 S. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Disease. 2010;12(3):254\u201360.https:\/\/doi.org\/10.1111\/j.1463-1318.2009.01806.x","DOI":"10.1111\/j.1463-1318.2009.01806.x"},{"key":"4846_CR41","doi-asserted-by":"publisher","unstructured":"Rashid R, Sohrabi C, Kerwan A, Franchi T, Mathew G, Nicola M, et al. The STROCSS 2024 guideline: strengthening the reporting of cohort, cross-sectional, and case\u2013control studies in surgery. International Journal of Surgery. 2024;110(6).https:\/\/doi.org\/10.1097\/JS9.0000000000001268","DOI":"10.1097\/JS9.0000000000001268"},{"issue":"1","key":"4846_CR42","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1007\/s10350-003-0015-8","volume":"47","author":"A Navarro-Luna","year":"2004","unstructured":"Navarro-Luna A, Garc\u00eda-Domingo MI, Rius-Mac\u00edas J, Marco-Molina C (2004) Ultrasound study of anal fistulas with hydrogen peroxide enhancement. Dis Colon Rectum 47(1):108\u2013114. https:\/\/doi.org\/10.1007\/s10350-003-0015-8","journal-title":"Dis Colon Rectum"},{"key":"4846_CR43","doi-asserted-by":"publisher","unstructured":"Williams G, Williams A, Tozer P, Phillips R, Ahmad A, Jayne D, et al. The treatment of anal fistula: second ACPGBI Position Statement \u2013 2018. Colorectal Disease. 2018;20(S3):5\u201331.https:\/\/doi.org\/10.1111\/codi.14054","DOI":"10.1111\/codi.14054"},{"issue":"8","key":"4846_CR44","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1007\/s00384-013-1706-9","volume":"28","author":"Y Li","year":"2013","unstructured":"Li Y, Yang X, Xu C, Zhang Y, Zhang X (2013) Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects. Int J Colorectal Dis 28(8):1161\u20131168. https:\/\/doi.org\/10.1007\/s00384-013-1706-9","journal-title":"Int J Colorectal Dis"},{"issue":"5","key":"4846_CR45","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s10151-022-02592-2","volume":"26","author":"S Garcia-Botello","year":"2022","unstructured":"Garcia-Botello S, Mart\u00edn-Ar\u00e9valo J, Mart\u00ed-Fern\u00e1ndez R, Moro-Valdezate D, Pla-Mart\u00ed V, Esp\u00ed-Mac\u00edas A (2022) Three-dimensional endoanal ultrasound to assess the validity of Goodsall\u2019s rule and the midline rule in predicting the path of perianal fistula-in-ano and the location of the internal opening. Tech Coloproctol 26(5):351\u2013361. https:\/\/doi.org\/10.1007\/s10151-022-02592-2","journal-title":"Tech Coloproctol"},{"key":"4846_CR46","doi-asserted-by":"publisher","unstructured":"Jorge MJN, Wexner SD. Etiology and management of fecal incontinence. Diseases of the Colon & Rectum. 1993;36(1).https:\/\/doi.org\/10.1007\/BF02050307","DOI":"10.1007\/BF02050307"},{"issue":"2","key":"4846_CR47","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205\u2013213. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","journal-title":"Ann Surg"},{"issue":"3","key":"4846_CR48","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1007\/s10151-009-0522-2","volume":"13","author":"A Rojanasakul","year":"2009","unstructured":"Rojanasakul A (2009) LIFT procedure: a simplified technique for fistula-in-ano. Tech Coloproctol 13(3):237\u2013240. https:\/\/doi.org\/10.1007\/s10151-009-0522-2","journal-title":"Tech Coloproctol"},{"issue":"1","key":"4846_CR49","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1111\/codi.14417","volume":"21","author":"G Bessi","year":"2019","unstructured":"Bessi G, Siproudhis L, Merlini I\u2019H\u00e9ritier A, Wallenhorst T, Le Balc\u2019h E, Bouguen G et al (2019) Advancement flap procedure in Crohn and non-Crohn perineal fistulas: a simple surgical approach. Colorectal Dis 21(1):66\u201372. https:\/\/doi.org\/10.1111\/codi.14417","journal-title":"Colorectal Dis"},{"key":"4846_CR50","doi-asserted-by":"publisher","unstructured":"Zimmerman DDE, Gosselink MP, Hop WCJ, Darby M, Briel JW, Schouten RW (2003) Impact of two different types of anal retractor on fecal continence after fistula repair: a prospective, randomized, clinical trial. Dis Colon Rectum 46(12). https:\/\/doi.org\/10.1007\/BF02660774","DOI":"10.1007\/BF02660774"},{"issue":"3","key":"4846_CR51","doi-asserted-by":"publisher","first-page":"189","DOI":"10.3393\/ac.2024.00304.0043","volume":"40","author":"SY Park","year":"2024","unstructured":"Park SY (2024) Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption. Ann Coloproctology 40(3):189\u2013190. https:\/\/doi.org\/10.3393\/ac.2024.00304.0043","journal-title":"Ann Coloproctology"},{"issue":"5","key":"4846_CR52","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1007\/s00384-014-2104-7","volume":"30","author":"F Cadeddu","year":"2015","unstructured":"Cadeddu F, Salis F, Lisi G, Ciangola I, Milito G (2015) Complex anal fistula remains a challenge for colorectal surgeon. Int J Colorectal Dis 30(5):595\u2013603. https:\/\/doi.org\/10.1007\/s00384-014-2104-7","journal-title":"Int J Colorectal Dis"},{"key":"4846_CR53","doi-asserted-by":"publisher","unstructured":"Buchanan GN, Bartram CI, Phillips RKS, Gould SWT, Halligan S, Rockall TA et al (2003) Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum 46(9). https:\/\/doi.org\/10.1007\/s10350-004-6708-9","DOI":"10.1007\/s10350-004-6708-9"},{"issue":"4","key":"4846_CR54","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3393\/ac.2017.33.6.254","volume":"32","author":"M Shalaby","year":"2016","unstructured":"Shalaby M, Di Lorenzo N, Franceschilli L, Perrone F, Angelucci GP, Quareisma S et al (2016) Outcome of colorectal surgery in elderly populations. Ann Coloproctology 32(4):139\u2013143. https:\/\/doi.org\/10.3393\/ac.2017.33.6.254","journal-title":"Ann Coloproctology"},{"issue":"5","key":"4846_CR55","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00384-014-2091-8","volume":"30","author":"KWA G\u00f6ttgens","year":"2015","unstructured":"G\u00f6ttgens KWA, Smeets RR, Stassen LPS, Beets G, Breukink SO (2015) Systematic review and meta-analysis of surgical interventions for high cryptoglandular perianal fistula. Int J Colorectal Dis 30(5):583\u2013593. https:\/\/doi.org\/10.1007\/s00384-014-2091-8","journal-title":"Int J Colorectal Dis"},{"issue":"3","key":"4846_CR56","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1002\/bjs5.50129","volume":"3","author":"ME Stellingwerf","year":"2019","unstructured":"Stellingwerf ME, van Praag EM, Tozer PJ, Bemelman WA, Buskens CJ (2019) Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn\u2019s high perianal fistulas. BJS Open 3(3):231\u2013241. https:\/\/doi.org\/10.1002\/bjs5.50129","journal-title":"BJS Open"},{"issue":"40","key":"4846_CR57","doi-asserted-by":"publisher","first-page":"6805","DOI":"10.3748\/wjg.v19.i40.6805","volume":"19","author":"O Vergara-Fernandez","year":"2013","unstructured":"Vergara-Fernandez O, Espino-Urbina LA (2013) Ligation of intersphincteric fistula tract: what is the evidence in a review? World J Gastroenterol 19(40):6805\u20136813. https:\/\/doi.org\/10.3748\/wjg.v19.i40.6805","journal-title":"World J Gastroenterol"},{"issue":"1","key":"4846_CR58","doi-asserted-by":"publisher","first-page":"3152424","DOI":"10.1155\/2017\/3152424","volume":"2017","author":"Y Xu","year":"2017","unstructured":"Xu Y, Tang W (2017) Ligation of intersphincteric fistula tract is suitable for recurrent anal fistulas from follow-up of 16 months. BioMed Res Int 2017(1):3152424. https:\/\/doi.org\/10.1155\/2017\/3152424","journal-title":"BioMed Res Int"},{"issue":"5","key":"4846_CR59","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1111\/codi.13330","volume":"18","author":"C Kontovounisios","year":"2016","unstructured":"Kontovounisios C, Tekkis P, Tan E, Rasheed S, Darzi A, Wexner SD (2016) Adoption and success rates of perineal procedures for fistula-in-ano: a systematic review. Colorectal Dis 18(5):441\u2013458. https:\/\/doi.org\/10.1111\/codi.13330","journal-title":"Colorectal Dis"},{"key":"4846_CR60","doi-asserted-by":"publisher","unstructured":"Bleier JIS, Moloo H, Goldberg SM (2010) Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum 53(1). https:\/\/doi.org\/10.1007\/DCR.0b013e3181bb869f","DOI":"10.1007\/DCR.0b013e3181bb869f"},{"issue":"3","key":"4846_CR61","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s00384-015-2144-7","volume":"30","author":"M Goos","year":"2015","unstructured":"Goos M, Manegold P, Gr\u00fcneberger M, Thomusch O, Ruf G (2015) Long-term results after endoanal advancement flap repair for fistulas-in-ano. How important is the aetiology? Int J Colorectal Dis 30(3):413\u2013419. https:\/\/doi.org\/10.1007\/s00384-015-2144-7","journal-title":"Int J Colorectal Dis"},{"key":"4846_CR62","doi-asserted-by":"publisher","unstructured":"Ellis CN (2010) Sphincter-preserving fistula management: what patients want. Dis Colon Rectum 53(12). https:\/\/doi.org\/10.1007\/DCR.0b013e3181f2e9cd","DOI":"10.1007\/DCR.0b013e3181f2e9cd"},{"issue":"12","key":"4846_CR63","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1007\/s10151-018-1885-z","volume":"22","author":"A Lauretta","year":"2018","unstructured":"Lauretta A, Falco N, Stocco E, Bellomo R, Infantino A (2018) Anal fistula laser closure: the length of fistula is the Achilles\u2019 heel. Tech Coloproctol 22(12):933\u2013939. https:\/\/doi.org\/10.1007\/s10151-018-1885-z","journal-title":"Tech Coloproctol"},{"key":"4846_CR64","doi-asserted-by":"publisher","unstructured":"Liu WY, Aboulian A, Kaji AH, Kumar RR (2013) Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum 56(3). https:\/\/doi.org\/10.1097\/DCR.0b013e318278164c","DOI":"10.1097\/DCR.0b013e318278164c"},{"key":"4846_CR65","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.ijsu.2019.08.003","volume":"69","author":"Z Mei","year":"2019","unstructured":"Mei Z, Wang Q, Zhang Y, Liu P, Ge M, Du P et al (2019) Risk factors for recurrence after anal fistula surgery: a meta-analysis. Int J Surg 69:153\u2013164. https:\/\/doi.org\/10.1016\/j.ijsu.2019.08.003","journal-title":"Int J Surg"},{"issue":"1, Supplement 1","key":"4846_CR66","doi-asserted-by":"publisher","first-page":"S22","DOI":"10.1016\/0002-9343(92)90623-J","volume":"93","author":"P Silverstein","year":"1992","unstructured":"Silverstein P (1992) Smoking and wound healing. Am J Med 93(1, Supplement 1):S22\u2013S4. https:\/\/doi.org\/10.1016\/0002-9343(92)90623-J","journal-title":"Am J Med"},{"key":"4846_CR67","doi-asserted-by":"publisher","unstructured":"Zimmerman DDE, Gosselink MP, Mitalas LE, Delemarre JBVM, Hop WJC, Briel JW et al (2005) Smoking impairs rectal mucosal bloodflow\u2014a pilot study: possible implications for transanal advancement flap repair. Dis Colon Rectum 48(6). https:\/\/doi.org\/10.1007\/s10350-004-0943-y","DOI":"10.1007\/s10350-004-0943-y"},{"issue":"1","key":"4846_CR68","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/codi.16741","volume":"26","author":"L Reza","year":"2024","unstructured":"Reza L, Gottgens K, Kleijnen J, Breukink S, Ambe PC, Aigner F et al (2024) European Society of Coloproctology: guidelines for diagnosis and treatment of cryptoglandular anal fistula. Colorectal Disease. 26(1):145\u2013196. https:\/\/doi.org\/10.1111\/codi.16741","journal-title":"Colorectal Disease."}],"container-title":["International Journal of Colorectal Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-025-04846-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00384-025-04846-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00384-025-04846-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T16:03:11Z","timestamp":1741795391000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00384-025-04846-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,12]]},"references-count":68,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4846"],"URL":"https:\/\/doi.org\/10.1007\/s00384-025-04846-5","relation":{},"ISSN":["1432-1262"],"issn-type":[{"value":"1432-1262","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,12]]},"assertion":[{"value":"18 February 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Research Ethics Board validated the protocol (697\/5) and followed the World Medical Association\u2019s Declaration of Helsinki 2013.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Preoperative consent for the intervention was done for all patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"61"}}