Where does the evidence conflict on long‑term recurrence and continence outcomes after LIFT in patients with CD

What is known

- The only earlier Crohn's-specific LIFT series reported a clinical success rate of ~53%, with continence better preserved after LIFT than after advancement flap. ¹ - A prospective Crohn's LIFT cohort showed 60% healing at 2 months and 67% at 12-month follow-up, with no patient developing fecal incontinence. ² - Network meta-analysis found LIFT had a ~1.5% continence-disturbance rate versus 7.3% for endorectal advancement flap, though failure was ~37% and confounded by biologic therapy and timing. ³

What is unknown / caveats

- Healing/recurrence rates conflict (~53% success ¹ vs 60-67% ² vs ~37% failure ³), largely from undefined recurrence and differing follow-up - Continence is consistently reported as well-preserved across sources, so the conflict is in durable healing, not continence - Evidence is small retrospective/prospective cohorts plus mixed cryptoglandular+Crohn's meta-analyses; recurrence often undefined and follow-up short and inconsistent - Healing is confounded by concurrent biologic therapy and whether LIFT was done during vs after induction, rarely extractable from studies ³ - Colonic CD involvement predicts higher LIFT failure than small-bowel CD ⁴, not accounted for uniformly - No head-to-head trial isolates LIFT durability in Crohn's with standardized recurrence definitions and long follow-up.

## References

1. van Praag EM, Stellingwerf ME, van der Bilt JDW, Bemelman WA, Gecse KB, Buskens CJ. Ligation of the Intersphincteric Fistula Tract and Endorectal Advancement Flap for High Perianal Fistulas in Crohn's Disease: A Retrospective Cohort Study. J Crohns Colitis. 2020;14(6):757-763. PMID: 31696918.

2. Gingold DS, Murrell ZA, Fleshner PR. A prospective evaluation of the ligation of the intersphincteric tract procedure for complex anal fistula in patients with Crohn's disease. Ann Surg. 2014;260(6):1057-61. PMID: 24374520.

3. Fuschillo G, Pata F, D'Ambrosio M, Selvaggi L, Pescatori M, Selvaggi F, Pellino G. Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano: a systematic review and network meta-analysis. Tech Coloproctol. 2025;29(1):116. PMID: 40392371.

4. Kamiński JP, Zaghiyan K, Fleshner P. Increasing experience of ligation of the intersphincteric fistula tract for patients with Crohn's disease: what have we learned?. Colorectal Dis. 2017;19(8):750-755. PMID: 28371062.

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_Draft — generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._