Background:Following the formation of an abscess, the development of an anal fistula often ensues, typically attributed to a crypto-glandular infection. This study aimed to assess the impact of closing the inter-sphincteric fistula tract on the overall outcome of trans-sphincteric fistula surgery.Methods:In this prospective cohort study, patients diagnosed with perianal trans-sphincteric fistulas were subjected to ligation of the inter-sphincteric fistula tract (LIFT). All participants received the same anesthetic approach, and the study involved a two-year follow-up period after the LIFT procedure.Results:The length of the fistulous tract significantly influenced the outcome, while the presence of piles alongside the fistula in the studied patients did not impact the results. The average operative time was 30.2 minutes, and postoperative pain was generally mild for most patients. The concurrent presence of anal fissure or piles did not affect the final outcome of the LIFT procedure. The average time for wound healing was four weeks. Among the patients, 6 had hidradenitis suppurativa, and no unusual histopathological findings were observed in the excised parts.Conclusion:Ligation of the inter-sphincteric fistula tract (LIFT) emerged as an effective and uncomplicated sphincter-preserving technique for the treatment of straightforward trans-sphincteric anal fistulas, showcasing excellent long-term control. However, further studies with a larger patient cohort are necessary to comprehensively evaluate the efficacy of this surgical approach for trans-sphincteric fistulas.