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CC BY 4.0 · Journal of Coloproctology 2025; 45(01): s00451804911
DOI: 10.1055/s-0045-1804911
Original Article

Comparative Evaluation of IFTAK and LAFT Techniques in the Management of Trans-Sphincteric Fistula-in-Ano: A Prospective Study

Awadhesh Kumar Pandey 
1   Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University Varanasi, Uttar Pradesh, India
,
Amol Padole 
2   Department of Shalya Tantra, GAC Nanded, Maharashtra, India
,
Smita Pandey 
1   Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University Varanasi, Uttar Pradesh, India
,
Nasrin Habeeb 
1   Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University Varanasi, Uttar Pradesh, India
,
Aadithyaraj Kunnummal Thilakan 
1   Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University Varanasi, Uttar Pradesh, India
,
Arun Kumar Dwivedi 
1   Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences Banaras Hindu University Varanasi, Uttar Pradesh, India
› Author Affiliations Funding The author(s) received no financial support for the research.
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Abstract

Introduction

Anorectal fistulas are chronic abnormal connections between the anal canal and perianal skin, often resulting from cryptoglandular infections. Despite advancements in surgical techniques, recurrence remains a significant challenge. Traditional methods like fistulotomy and seton placement show variable success rates, while newer sphincter-sparing approaches like IFTAK and LAFT offer promise. This study compares the efficacy of IFTAK and LAFT in managing trans-sphincteric fistulas.

Methods

This prospective study at Sir Sundar Lal Hospital, BHU, compared IFTAK and LAFT for managing trans-sphincteric fistula-in-ano. Forty-four patients were randomized into two groups (22 each). Patients underwent preoperative preparation, postoperative care, and follow-ups at regular intervals. Outcomes, including pain (VAS), healing, and recurrence, were analyzed statistically using SPSS.

Results

Group A (IFTAK) showed significantly lower recurrence rates (0% vs. 27.3%, p = 0.000) and superior healing of the fistulous tract compared to Group B (LAFT). Pain reduction, discharge, inflammation, and induration improved significantly in both groups (p < 0.001). However, Group A demonstrated faster pain reduction and better wound dryness at 45 and 60 days (p < 0.05). Hospital stays were shorter in Group A. Overall, IFTAK exhibited better clinical outcomes and fewer complications.

Conclusion

The study indicates that IFTAK is more effective than LAFT for managing trans-sphincteric fistulas, with no recurrences, better healing, and higher success rates, especially for posterior fistulas. LAFT offers less pain, and shorter hospital stays but has a higher recurrence rate. Combining IFTAK and LAFT may optimize outcomes, warranting further research.

Keywords

trans-sphincteric fistula management - IFTAK - LAFT - sphincter preservation - recurrence rate

Authors' Contribution

AKP: Conceptualization, Validation, Resources, Writing – review & editing, Supervision. AP: Conceptualization, Data curation, Writing – original draft SP: Writing – original draft, Data curation NH: Writing – review & editing, Data curation AKT: Writing – review & editing, Visualization. AKD: Writing – review & editing, Supervision.




Publication History

Received: 06 December 2024

Accepted: 05 February 2025

Article published online:
20 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Awadhesh Kumar Pandey, Amol Padole, Smita Pandey, Nasrin Habeeb, Aadithyaraj Kunnummal Thilakan, Arun Kumar Dwivedi. Comparative Evaluation of IFTAK and LAFT Techniques in the Management of Trans-Sphincteric Fistula-in-Ano: A Prospective Study. Journal of Coloproctology 2025; 45: s00451804911.
DOI: 10.1055/s-0045-1804911
 

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