Fistulotomy is the best surgical technique to treat a simple anal fistula with success in more than 95% of the cases and minor damage of anal continence. Complex anal fistula is a challenging problem due to higher recurrence rates and incontinence associated to surgical procedures. New methods have been developed for the management of complex anal fistula and some of them include complex procedure and/or the use of sophisticated instruments. Relapses are caused by reactivation of the infection at the internal fistula orifice. This is left untreated by some technique including LIFT, a promising conservative technique that has shown success rates between 20% to 86%. We analyze the probably causes of the failure of LIFT and some variations proposed, including the alternative techniques of intersphinc-teric approach plus treatment of the pathological anal glands with immediate section of the internal sphincter. In the experience of the author over 15 years, the intersphincteric approach to the fistulous tract, the treatment of the internal fistula orifice with a loose seton and a small cutaneous drainage is the safest technique to cure the complex fistula anal with no damage to anal continence. The benefits of conservative techniques like LIFT must be counterbalanced with the relative high recurrence rates. The quality of current evidence is not good enough to consider LIFT as the gold standard in the treatment of complex anal fistula.