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

Baseline Fistula manegment score → Pre-op disease severity Post-op Fm-score at 1, 3, 6 months → Objective clinical healing Where Total score = Pain + Discharge + Continence + QOL with Range = 0-16 Pain (0-4) 0 No pain

• Mild, occasional pain, no analgesics needed
• Moderate pain occasional analgesics
• Severe pain regular analgesics
• Constant, severe pain interfering with daily activities Discharge (0-4)

0 No discharge

1 Occasional spotting, no pad required 2 Daily discharge, small amount, 1 pad/day 3 Moderate discharge requiring >1 pad/day 4 Persistent heavy discharge; soaking pads; malodorous Continence (0-4) 0 Full continence

1 Gas incontinence only 2 Occasional soiling or minor liquid incontinence 3 Frequent soiling; liquid stool incontinence 4 Solid stool incontinence Quality of Life (QoL) 0 No impact on life

• Mild limitation
• Moderate impact
• Significant impact
• Severe impairment Interpretation of healing 0-3 Minimal 4-7 Mild disease

8 - 11 moderate 12 - 17 severe

Baseline Fistula manegment score → Pre-op disease severity Post-op Fm-score at 12 months → Objective clinical non healing Where Total score = Pain + Discharge + Continence + QOL with Range = 0-16 Pain (0-4) 0 No pain

• Mild, occasional pain, no analgesics needed
• Moderate pain occasional analgesics
• Severe pain regular analgesics
• Constant, severe pain interfering with daily activities Discharge (0-4)

0 No discharge

1 Occasional spotting, no pad required 2 Daily discharge, small amount, 1 pad/day 3 Moderate discharge requiring >1 pad/day 4 Persistent heavy discharge; soaking pads; malodorous Continence (0-4) 0 Full continence

1 Gas incontinence only 2 Occasional soiling 3 Frequent soiling 4 Solid stool incontinence Quality of Life (QoL) 0 No impact on life

• Mild limitation
• Moderate impact
• Significant impact
• Severe impairment Interpretation of healing 0-3 Minimal 4-7 Mild disease

8 - 11 moderate 12 - 17 severe Score above 7 consider non healing

Wexner score is clinical tool used to quantify the severity of fecal incontinence. five specific components, and each component is scored from 0 to 4. The total score ranges from 0 to 20, where 0 represents perfect continence and 20 represents complete incontinence.

Incontinence to solid stool:

0 means this never occurs.

• means it happens rarely (> once a month).
• indicates it occurs sometimes (> once a week).
• means it happens usually (< once a week).
• reflects constant or daily incontinence.

Incontinence to liquid stool:

Scored in the same way as solids, from 0 (never) to 4 (always).

Incontinence to gas:

scored from 0 to 4 using the same frequency scale.

Use of pads for protection:

Scored from 0 (no need for pads) to 4 (pads required all the time). 5. Lifestyle alteration due to incontinence: 0 means no effect on lifesty and 4 sever effect 0: Perfect continence 1-5: Mild incontinence 6-10: Moderate 11-20 severe