Comparing Three Surgical Techniques for the Treatment of Transsphincteric Perianal Fistula: (1) Traditional Fistulotomy (Lay Open), (2) Ligation of the Intersphincteric Tract (LIFT) With Adjunctive Endo Fistula Laser Ablation, and (3) Open LIFT Procedure Followed by LASER

NCT ID: NCT07236047

Last Updated: 2025-11-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-20

Study Completion Date

2027-09-01

Brief Summary

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\>This randomized clinical trial compares three different surgical techniques for the treatment of transsphincteric perianal fistula: (1) traditional fistulotomy (lay open), (2) ligation of the intersphincteric tract (LIFT) with adjunctive endofistula laser ablation, and (3) open LIFT procedure followed by direct laser ablation of the tract under vision. The aim is to determine which approach offers the highest healing rate, lowest recurrence, and best postoperative outcomes with minimal impact on continence.

Detailed Description

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\> Transsphincteric perianal fistula presents a surgical challenge due to the need to balance fistula eradication with continence preservation. While fistulotomy is associated with high healing rates, it carries a risk of sphincter damage. Ligation of the intersphincteric tract (LIFT) offers a sphincter-sparing alternative, and the use of endofistula laser ablation (FiLaC or diode laser) has shown promise in enhancing outcomes.

This study will enroll 90 patients with confirmed transsphincteric cryptoglandular perianal fistula and randomize them equally into three arms:

Group A: Conventional fistulotomy (lay open).

Group B: LIFT procedure with endofistula laser ablation using a radial laser fiber.

Group C: Open LIFT with direct laser ablation of the tract under vision.

The primary endpoint is complete clinical healing at 6 months. Secondary outcomes include recurrence rates at 12 months, pain scores (VAS), continence outcomes (Wexner score), return to daily activities, and patient satisfaction. The study aims to determine the optimal balance between healing efficacy and preservation of continence.

Conditions

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Perianal Fistula

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Title:

Randomized Controlled Trial Comparing Fistulotomy vs LIFT with Laser Ablation vs Open LIFT plus Laser in the Treatment of Transsphincteric Perianal Fistula

Objective:

To compare healing rate, recurrence, pain, and functional outcomes among three surgical techniques for transsphincteric fistula.

Design:

Single-center, prospective, randomized controlled trial

Three parallel arms

90 participants total (30 per group)

Inclusion Criteria:

Adults aged 18-65

Confirmed diagnosis of transsphincteric cryptoglandular perianal fistula

Primary (first-time) surgery

Able to provide informed consent

Exclusion Criteria:

Crohn's disease or other inflammatory bowel disease

Suprasphincteric, extrasphincteric, or horseshoe fistulas

Previous fistula surgery

Active perianal abscess

Current immunosuppression

Pregnant or breastfeeding women

Primary Outcome:

Clinical healing (no discharge, closure of opening) at 6 months

Secondary Outcomes:

Recurrence at 12 months

Postoperative
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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lay open

fistula lay open of the tract

Group Type ACTIVE_COMPARATOR

fistula lay open

Intervention Type PROCEDURE

lay open of fistula tract

LIFT plus LASER

ligation of inters-sphincteric tract plus laser for the outer tract

Group Type ACTIVE_COMPARATOR

LIFT plus LASER

Intervention Type PROCEDURE

ligation of inter-sphincteric tract plus LASER of tract

open LIFT plus LASER

cutting internal sphincter and ligation of tract plus LASER to outer part

Group Type ACTIVE_COMPARATOR

open LIFT plus LASER

Intervention Type PROCEDURE

cutting of internal anal sphincter plus ligation of inter-sphincteric tract plus LASER

Interventions

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fistula lay open

lay open of fistula tract

Intervention Type PROCEDURE

LIFT plus LASER

ligation of inter-sphincteric tract plus LASER of tract

Intervention Type PROCEDURE

open LIFT plus LASER

cutting of internal anal sphincter plus ligation of inter-sphincteric tract plus LASER

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adults aged 18-65
* Confirmed diagnosis of transsphincteric cryptoglandular perianal fistula
* Primary (first-time) surgery
* Able to provide informed consent

Exclusion Criteria

* Crohn's disease or other inflammatory bowel disease
* Suprasphincteric, extrasphincteric, or horseshoe fistulas
* Previous fistula surgery
* Active perianal abscess
* Current immunosuppression
* Pregnant or breastfeeding women
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Alexandria University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Walid GALAL Elshazly, Prof

Role: PRINCIPAL_INVESTIGATOR

University of Alexandria

Central Contacts

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Walid galal Elshazly, PROF

Role: CONTACT

+201221100756

omar walid ELShazly, GP

Role: CONTACT

+201110711943

Other Identifiers

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0307609

Identifier Type: -

Identifier Source: org_study_id

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