Background Treatment of a perianal fistula is difficult due to the risk of fecal incontinence and recurrence. The ligation of intersphincteric tract (LIFT) procedure is a sphincter-saving procedure associated with quite impressive preliminary results with more than 90% of patients achieving complete healing within a mean duration of 4 weeks and without any disturbance of the continence state. The aim of the this review was to prospectively compare the LIFT procedure with fistulotomy as a treatment for trans-sphincteric anal fistulas with respect to healing time, overall healing rate, recurrence, continence, morbidity, and postoperative pain. Methods This study was performed in 30 patients of trans-sphincteric anal fistulas patients who underwent LIFT and fistulotomy between from January 2021 to August 2021 at our Surgery Department of Zagazig University Hospitals in Egypt. All patients were followed up for 6months through regular visits in the outpatient clinic. The primary end point of the study was healing while the secondary outcome measures were recurrence rate, morbidity, postoperative pain, and incontinence rate. Results Postoperative pain scores, patient satisfaction and time taken to return to normal activities were significantly better in the LIFT arm. Highly significant difference in favor of LIFT group in the following complications, haemorrhage (P value= 0.0008**), urinary retention (P value= 0.0001**), delayed wound healing (P value= 0.0004**), persistant pain (P value= 0.0002**) and faecal incontinence (P value= 0.0004**). Healing rate in the LIFT group was 92% vrsus 70% in the fistulotomy group (P value= 0.08). Only a small number of postoperative complications was reported in the fistulotomy group, including a thrombosed external haemorrhoid (n=1), anal fissure (n=2), anal stenosis (n=3) (n=1) and bleeding (n=2). The bleeding did not require re-operation or hospital readmission. Conclusion The LIFT procedure has the advantages of preservation of the anal sphincters, minimal tissue injury, short healing time with no additional costs and relatively easy procedure. Keywords: Fistula-in-ano, Ligation of the intersphincteric fistula tract, intersphincteric plane, anal fistula, transsphincteric fistula, fistulotomy.