# Autologous skin graft intersphincteric implantation in anal fistula treatment (ASGIIFT) – A novel surgical technique in the treatment of complex transsphincteric anal fistulas

## TL;DR

A new surgical technique called ASGIIFT shows promise in healing complex anal fistulas without significant side effects.

## Contribution

The novel ASGIIFT procedure combines autologous skin graft implantation with the LIFT technique for treating transsphincteric anal fistulas.

## Key findings

- 87.5% of patients achieved primary healing within 3–6 weeks postoperatively.
- No patients experienced worsening continence or serious complications.
- Five initially unhealed cases converted to intersphincteric fistulas and were successfully treated with fistulotomy.

## Abstract

This study aimed to evaluate whether implantation of an autologous skin graft in the intersphincteric space, as part of the ASGIIFT procedure, improves the primary healing of complex transsphincteric cryptoglandular anal fistulas.

A prospective observational IDEAL stage 2a study was conducted at a tertiary referral centre for minimally invasive colorectal surgery and proctology in Croatia between September 2021 and January 2023, with an 18‐month follow‐up. Preoperative pelvic MRI was performed in all cases, and 40 adult patients who met the inclusion criteria were included in the study. The primary outcome was the postoperative primary healing rate which was defined clinically. Secondary outcomes included postoperative continence disturbance, postoperative pain, time of healing and other postoperative complications (Wexner score and VAS – Visual Analogue Scale were used). The ASGIIFT procedure includes all standard steps of the LIFT technique (ligation of the intersphincteric fistula tract), with the addition of a pre‐prepared autologous dermal graft placed into the intersphincteric space. The study was approved by the institutional ethics committee.

Primary clinical healing was achieved in 35 patients (87.5%) within a median of 4 weeks postoperatively (range 3–6 weeks). Five initially unhealed patients showed conversion from transsphincteric to intersphincteric fistula during the follow‐up period and were subsequently treated by fistulotomy without complications. No patient experienced worsening continence, and no serious postoperative complications occurred.

ASGIIFT appears to be a safe and feasible technique for treating transsphincteric anal fistulas, showing promising early results in this single‐centre IDEAL 2a study. Further prospective comparative studies are warranted to validate these initial findings.