# Mucosal Advancement Flap Versus Ligation of the Intersphincteric Fistula Tract for Transsphincteric Fistula-in-Ano: A Comparative Study in a Tertiary Care Hospital

## TL;DR

This study compares two surgical techniques for treating a common anorectal condition and finds both are effective but have different benefits.

## Contribution

A direct comparison of MAF and LIFT procedures for TPAF with short-term outcome data from a prospective study.

## Key findings

- LIFT resulted in significantly lower postoperative pain compared to MAF.
- MAF showed faster wound healing than LIFT.
- Both techniques had no major incontinence or recurrence at one month.

## Abstract

Background and aim

Transsphincteric fistula-in-ano (TPAF) is a common anorectal condition that poses significant surgical challenges due to the involvement of the external anal sphincter and the risk of postoperative incontinence. Sphincter-preserving procedures such as the mucosal advancement flap (MAF) and ligation of the intersphincteric fistula tract (LIFT) have become preferred alternatives; however, their comparative outcomes remain debated. This study aimed to compare postoperative outcomes between the MAF and LIFT procedures in patients with TPAF.

Methods

A prospective comparative study was conducted in the Department of General Surgery, Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh, from June 2025 to September 2025. A total of 14 patients diagnosed with TPAF were randomized into two groups: Group A (MAF, n = 7) and Group B (LIFT, n = 7). Postoperative pain (Visual Analogue Scale (VAS) score), wound infection, time to complete healing, anal continence (Wexner score), and recurrence were assessed during a one-month follow-up.

Results

The mean age of the study population was 46.8 years, with a male-to-female ratio of 3:2. Postoperative pain at 48 hours was significantly lower in the LIFT group (VAS 3.1 ± 0.6) compared to the MAF group (VAS 4.8 ± 0.9, p = 0.02). Complete wound healing occurred faster with MAF (mean 18.6 ± 3.2 days) than with LIFT (21.4 ± 3.9 days, p = 0.05). Minor wound infection occurred in one patient (14.3%) from each group. No major incontinence was reported in either group, and no recurrence was observed at one month.

Conclusions

Both MAF and LIFT are safe and effective sphincter-preserving techniques for managing TPAF. LIFT offers reduced postoperative pain and shorter operative time, while MAF offers faster healing. Larger, multicenter trials with extended follow-up are warranted to establish long-term efficacy.