Spectrally Resolved Exciton Polarizability for Understanding Charge Generation in Organic Bulk Hetero-Junction Diodes.

Despite decades of research, the dominant charge generation mechanism in organic bulk heterojunction (BHJ) devices is not completely understood. While the local dielectric environments of the photoexcited molecules are important for exciton dissociation, conventional characterizations cannot separately measure the polarizability of electron-donor and electron-acceptor, respectively, in their blends, making it difficult to decipher the spectrally different charge generation efficiencies in organic BHJ devices. Here, by spectrally resolved electroabsorption spectroscopy, we report extraction of the excited state polarizability for individual donors and acceptors in a series of organic blend films. Regardless of the donor and acceptor, we discovered that larger exciton polarizability is linked to larger π-π coherence length and faster charge transfer across the heterojunction, which fundamentally explains the origin of the higher charge generation efficiency near 100% in the BHJ photodiodes. We also show that the molecular packing of the donor and acceptor influence each other, resulting in a synergetic enhancement in the exciton polarizability.

Novel Polymer-Based Organic/c-Si Monolithic Tandem Solar Cell: Enhanced Efficiency using Interlayer and Transparent Top Electrode Engineering.

Tandem solar cells which are electrically connected with various photoactive materials have the potential to solve the current challenges by exceeding the theoretically limited efficiency of single junction solar cells. Here the first monolithic organic/silicon tandem cell is reported based on a semitransparent polymer on a crystalline silicon (c-Si) substrate. Herein, experimental results are presented for four-terminal (4-T) and monolithic two-terminal (2-T) organic/c-Si tandem cells using organic cells with an inverted n-i-p structure and c-Si cells with an n-type TOPCon structure with detailed analysis. The best 4-T tandem cell efficiency is 15.22%, and 2-T results show that the top (organic) and bottom (c-Si) cells are electrically connected by an open-circuit voltage over 1.4 V. Further, a simulated efficiency of over 20% using the organic/c-Si tandem is achieved, implying the tandem efficiency can be enhanced through further improvement of electric and optical characteristics with the optimization.

Enhancement of the photovoltaic performance of CH3NH3PbI3 perovskite solar cells through a dichlorobenzene-functionalized hole-transporting material.

A dichlorobenzene-functionalized hole-transporting material (HTM) is developed for a CH3NH3PbI3-based perovskite solar cell. Notwithstanding the similarity of the frontier molecular orbital energy levels, optical properties, and hole mobility between the functionalized HTM [a polymer composed of 2'-butyloctyl-4,6-dibromo-3-fluorothieno[3,4-b]thiophene-2-carboxylate (TT-BO), 3',4'-dichlorobenzyl-4,6-dibromo-3-fluorothieno[3,4-b]thiophene-2-carboxylate (TT-DCB), and 2,6-bis(trimethyltin)-4,8-bis(2-ethylhexyloxy)benzo[1,2-b:4,5-b']dithiophene (BDT-EH), denoted PTB-DCB21] and the nonfunctionalized polymer [a polymer composed of thieno[3,4-b]thiophene (TT) and benzo[1,2-b:4,5-b']dithiophene (BDT), denoted PTB-BO], a higher power conversion efficiency for PTB-DCB21 (8.7%) than that for PTB-BO (7.4%) is achieved because of a higher photocurrent and voltage. The high efficiency is even obtained without including additives, such as lithium bis(trifluoromethanesulfonyl)imide and/or 4-tert-butylpyridine, that are commonly used to improve the conductivity of the HTM. Transient photocurrent-voltage studies show that the PTB-DCB21-based device exhibits faster electron transport and slower charge recombination; this might be related to better interfacial contact through intermolecular chemical interactions between the perovskite and the 3,4-dichlorobenzyl group in PTB-DCB21.

Improving FAPbBr3 Perovskite Crystal Quality via Additive Engineering for High Voltage Solar Cell over 1.5 V.

Lead bromide-based perovskites are promising materials as the top cells of tandem solar cells and for application in various fields requiring high voltages owing to their wide band gaps and excellent environmental resistances. However, several factors, such as the formation of bulk and surface defects, impede the performances of corresponding devices, thereby limiting the efficiencies of these devices as single-junction devices. To reduce the number of defect sites, urea is added to the formamidinium lead bromide (FAPbBr3) perovskite material to increase its grain size. Nevertheless, urea undesirably reacts with lead(II) bromide (PbBr2) in the perovskite structure, creating unfavorable impurities in the device. To solve this problem, herein, in addition to urea, we introduced formamidinium chloride (FACl) into FAPbBr3. Owing to the synergistic effect of urea and FACl, the FAPbBr3 film quality effectively improved due to suppression of the generation of impurities and stabilization of film crystallinity. Consequently, the FAPbBr3 single-junction solar cell constructed using FACl and urea as additives demonstrated a power conversion efficiency of 9.6% and an open-circuit voltage of 1.516 V with negligible hysteresis. This study provides new insights into the use of additive engineering for overcoming the energy losses caused by defects in perovskite films.

Preoperative plasma hyperfibrinogenemia is predictive of poor prognosis in patients with nonmetastatic colon cancer.

BACKGROUND: The outcomes of colorectal cancer are determined by host factors, including systemic inflammation. The purpose of this study was to evaluate the prognostic significance of fibrinogen and inflammation-based scores, as markers of the inflammatory response, in colon cancer. METHODS: We retrospectively reviewed the medical records of patients with nonmetastatic colon cancer who underwent curative resection between January 2005 and December 2007. Fibrinogen, albumin, C-reactive protein, neutrophil, lymphocyte, and platelet counts were measured at the time of diagnosis. Correlations between preoperative plasma fibrinogen levels and clinicopathologic characteristics were analyzed. Univariate and multivariate survival analyses were performed to identify factors associated with disease-free and overall survival. RESULTS: A total of 624 patients who underwent curative resection for colon cancer were eligible for this study. Mean preoperative plasma fibrinogen levels were 325.24±88.19 mg/dl. Higher preoperative plasma fibrinogen levels were associated with sex (male), old age, poorly/mucinous differentiated tumor, advanced tumor stage, elevated carcinoembryonic antigen (CEA) levels, higher modified Glasgow Prognostic Score, and higher neutrophil:lymphocyte and platelet:lymphocyte ratios. In multivariate analysis, elevated plasma fibrinogen level [disease-free survival: hazard ratio (HR) 1.999, 95% confidence interval (95% CI) 1.081-3.695, P=.027; overall survival: HR 3.138, 95% CI 1.077-9.139, P=.036], advanced tumor stage, and higher CEA levels were independently associated with worse disease-free survival and overall survival. None of the inflammation-based scores were significantly associated with survival. CONCLUSIONS: Fibrinogen as one of inflammatory markers may be considered a possible prognostic marker in colon cancer.

Factors associated with complete local excision of small rectal carcinoid tumor.

PURPOSE: Although small rectal carcinoid tumors can be treated using local excision, complete resection can be difficult because tumors are located in the submucosal layer. We evaluate the factors associated with pathologically complete local resection of rectal carcinoid tumors. METHODS: Data were analyzed of 161 patients with 166 rectal carcinoid tumors who underwent local excision with curative intent from January 2001 to December 2010. A pathologically complete resection (P-CR) was defined as an en bloc resection with tumor-free lateral and deep margins. The study classified treatments into three categories for analysis: conventional polypectomy (including strip biopsy, snare polypectomy, and hot biopsy), advanced endoscopic techniques (including endoscopic mucosal resection with cap and endoscopic submucosal dissection), and surgical local excision (including transanal excision and transanal endoscopic microsurgery). We evaluated the P-CR rate according to treatment method, tumor size, initial endoscopic impression and the use of endoscopic ultrasound (EUS) or transrectal ultrasound (TRUS). RESULTS: The mean tumor size was 5.51 ± 2.43 mm (range 2-18 mm) and all lesions were confined to the submucosal layer. The P-CR rates were 30.9, 72.0, and 81.8 % for conventional polypectomy, advanced endoscopic techniques, and surgical local excision, respectively. Univariate analysis showed that P-CR was associated with treatment method, use of EUS or TRUS, and initial endoscopic impression. Multivariate analysis showed that only treatment method was associated with P-CR. CONCLUSION: Pathologically complete resection of small rectal carcinoid tumors was more likely to be achieved when using advanced endoscopic techniques or surgical local excision rather than conventional polypectomy.

Cost-comparison of laparoscopic and open surgery for mid or low rectal cancer after preoperative chemoradiotherapy: data from a randomized controlled trial.

BACKGROUND: The purpose of the present study was to compare the direct costs of laparoscopic surgery (LS) and open surgery (OS) in the treatment of mid or low rectal cancer after preoperative chemoradiotherapy in patients in Korea. METHODS AND RESULTS: The records of 130 LS patients and 125 OS patients were reviewed. Hospital stay after surgery and overall complication rates within three months of surgery were not significantly different. The LS group had significantly higher median costs than the OS group ($7,467.30 vs. $5,667.00; P < 0.001). The median hospital costs during hospitalization for surgery were higher in the LS group ($7,436.60 vs. $5,626.60; P < 0.001), but hospital costs for management of early postoperative complications were similar. The higher direct costs of LS were mainly due to the more expensive consumables and equipment needed for LS. CONCLUSIONS: Further study is needed to determine whether the higher direct costs of LS for rectal cancer are balanced by advantages of LS over OS, such as better short-term outcomes and cosmetic effect.

Ultrafast intramolecular exciton splitting dynamics in isolated low-band-gap polymers and their implications in photovoltaic materials design.

Record-setting organic photovoltaic cells with PTB polymers have recently achieved ~8% power conversion efficiencies (PCE). A subset of these polymers, the PTBF series, has a common conjugated backbone with alternating thieno[3,4-b]thiophene and benzodithiophene moieties but differs by the number and position of pendant fluorine atoms attached to the backbone. These electron-withdrawing pendant fluorine atoms fine tune the energetics of the polymers and result in device PCE variations of 2-8%. Using near-IR, ultrafast optical transient absorption (TA) spectroscopy combined with steady-state electrochemical methods we were able to obtain TA signatures not only for the exciton and charge-separated states but also for an intramolecular ("pseudo") charge-transfer state in isolated PTBF polymers in solution, in the absence of the acceptor phenyl-C(61)-butyric acid methyl ester (PCBM) molecules. This led to the discovery of branched pathways for intramolecular, ultrafast exciton splitting to populate (a) the charge-separated states or (b) the intramolecular charge-transfer states on the subpicosecond time scale. Depending on the number and position of the fluorine pendant atoms, the charge-separation/transfer kinetics and their branching ratios vary according to the trend for the electron density distribution in favor of the local charge-separation direction. More importantly, a linear correlation is found between the branching ratio of intramolecular charge transfer and the charge separation of hole-electron pairs in isolated polymers versus the device fill factor and PCE. The origin of this correlation and its implications in materials design and device performance are discussed.

Synthesis of fluorinated polythienothiophene-co-benzodithiophenes and effect of fluorination on the photovoltaic properties.

Herein, we describe the synthesis of fluorinated polythienothiophene-co-benzodithiophenes (PTBFs) and the characterization of their physical properties, especially their performance in solar cells. Fluorination of the polymer backbone lowered both the HOMO and LUMO energy levels and simultaneously widened the energy bandgap of the polymer (0.1-0.2 eV). Incorporation of fluorine into the various positions of the polymer backbone significantly affected the solar cells' power conversion efficiency from 2.3% to 7.2%. Detailed studies revealed that the polymer containing mono-fluorinated thienothiophene gave the best solar cell performance. Perfluorination of the polymer backbone led to poor compatibility with PC(71)BM molecules, thus poor solar energy conversion efficiency. This is possibly due to the enhanced self-organization properties of the polymer chains and the fluorophobicity effect. Furthermore, it was found that perfluorination of the polymer backbone resulted in poor photochemical stability against singlet oxygen attack. Theoretical studies indicated that the internal polarization caused enhancement of the negative charge density on thienothiophene rings, which rendered them vulnerable to [2+4] cycloaddition reaction with singlet oxygen.

Examining the effect of the dipole moment on charge separation in donor-acceptor polymers for organic photovoltaic applications.

A new low band gap copolymer PBB3 containing [6,6']bi[thieno[3,4-b]thiophenyl]-2,2'-dicarboxylic acid bis-(2-butyloctyl) ester (BTT) and 4,8-bis(2-butyloctyl)benzo[1,2-b:4,5-b']dithiophene (BDT) units was synthesized and tested for solar cell efficiency. PBB3 showed a broad absorbance in the near-IR region with a substantially red-shifted (by more than 100 nm) λ(max) at 790 nm as compared to the PTB series of polymers, which have been previously reported. The PBB3 polymer also showed both a favorable energy level match with PCBM (with a LUMO energy level of -3.29 eV) and a favorable film domain morphology as evidenced by TEM images. Despite these seemingly optimal parameters, a bulk heterojunction (BHJ) photovoltaic device fabricated from a blend of PBB3 and PC(71)BM showed an overall power conversion efficiency (PCE) of only 2.04% under AM 1.5G/100 mW cm(-2). The transient absorption spectra of PBB3 showed the absence of cationic and pseudo charge transfer states that were observed previously in the PTB series polymers, which were also composed of alternating thienothiophene (TT) and BDT units. We compared the spectral features and electronic density distribution of PBB3 with those of PTB2, PTB7, and PTBF2. While PTB2 and PTB7 have substantial charge transfer characteristics and also relatively large local internal dipoles through BDT to TT moieties, PTBF2 and PBB3 have minimized internal dipole moments due to the presence of two adjacent TT units (or two opposing fluorine atoms in PTBF2) with opposite orientations or internal dipoles. PBB3 showed a long-lived excitonic state and the slowest electron transfer dynamics of the series of polymers, as well as the fastest recombination rate of the charge-separated (CS) species, indicating that electrons and holes are more tightly bound in these species. Consequently, substantially lower degrees of charge separation were observed in both PBB3 and PTBF2. These results show that not only the energetics but also the internal dipole moment along the polymer chain may be critical in maintaining the pseudocharge transfer characteristics of these systems, which were shown to be partially responsible for the high PCE device made from the PTB series of low band gap copolymers.

Guidelines for accreditation of endoscopy units: quality measures from the Korean Society of Coloproctology.

PURPOSE: Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. METHODS: The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. RESULTS: The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. CONCLUSION: The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.

Simultaneous Enhanced Efficiency and Stability of Perovskite Solar Cells Using Adhesive Fluorinated Polymer Interfacial Material.

For enhancing the performance and long-term stability of perovskite solar cell (PSC) devices, interfacial engineering between the perovskite and hole-transporting material (HTM) is important. We developed a fluorinated conjugated polymer PFPT3 and used it as an interfacial layer between the perovskite and HTM layers in normal-type PSCs. Interaction of perovskite and PFPT3 via Pb-F bonding effectively induces an interfacial dipole moment, which resulted in energy-level bending; this was favorable for charge transfer and hole extraction at the interface. The PSC device achieved an increased efficiency of 22.00% with an open-circuit voltage of 1.13 V, short-circuit current density of 24.34 mA/cm2, and fill factor of 0.80 from a reverse scan and showed an averaged power conversion efficiency of 21.59%, which was averaged from forward and reverse scans. Furthermore, the device with PFPT3 showed much improved stability under an 85% RH condition because hydrophobic PFPT3 reduced water permeation into the perovskite layer, and more importantly, the enhanced contact adhesion at the PFPT3-mediated perovskite/HTM interface suppressed surface delamination and retarded water intrusion. The fluorinated conjugated polymeric interfacial material is effective for improving not only the efficiency but also the stability of the PSC devices.

Single-Step Fabrication of Polymeric Composite Membrane via Centrifugal Colloidal Casting for Fuel Cell Applications.

Recent interest in polymer electrolyte membranes (PEMs) for fuel cell systems has spurred the development of infiltration technology by which to insert ionomers into mechanically robust reinforcement structures by solution casting in order to produce a cost effective and highly efficient electrolyte. However, the results of the fabrication process often continue to present challenges related to the structural complexity and self-assembly dynamics between the hydrophobic and hydrophilic parts of the constituents which in turn, necessitates additional processing steps and increases production costs. Here, a single-step process is reported for highly compact polymeric composite membranes (PCMs), fabricated using a centrifugal colloidal casting (C3) method. Combined structural analyses as well as coarse-grained molecular dynamics simulations are employed to determine the micro-/macroscopic structural characteristics of the fabricated PCMs. These findings indicate that the C3 method is capable of forming highly dense ionomer matrix-reinforcement composites consisting of microphase-separated ionomer structures with tailored crystallinity and ionic cluster sizes. An outcome that is very unlikely with the single-step coating steps in conventional methods. These structural attributes ensure PCMs with better proton conductivity, greater strain stability, and lower gas crossover properties compared to commercial pristine membranes, expanding their possible range of applicability to PEMs.

Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula.

PURPOSE: Since the publication of Dialysis Outcomes Quality Initiative (DOQI) guidelines, the use of native veins for the construction of arteriovenous fistulas (AVF) for hemodialysis has been highly recommended rather than prosthetic arteriovenous grafts (AVG). Upper arm basilic vein transposition (BVT) has been accepted widely, with superior patency compared with AVG, but only a few studies have reported outcomes of forearm BVT (FBVT). This study evaluated the efficacy of FBVT compared with direct AVF (DAVF) and AVG in a tertiary referral center. METHODS: From January 2005 to December 2007, 461 patients underwent AV access for hemodialysis in Seoul National University Hospital. We retrospectively reviewed the medical records and dialysis sheets and evaluated the current AVF function in the outpatient clinic or by telephone interviews. Patients were grouped by the operation type: DAVF, FBVT, and AVG. The outcomes compared were primary, assisted-primary and secondary patency rates, maturation failure, and complications. RESULT: The mean age was 59 years (range, 14-92 years), and 280 patients (60.7%) were male. By operation type, the 461 accesses were 389 DAVF (84.4%), 34 FBVT (7.4%), and 38 AVG (8.2%). Mean follow-up duration was 21 months (range, 1-51 months). The primary patency rates for DAVF, FBVT, and AVG were 67.6%, 41.5%, 35% at 12 months and 53.9%, 30.2%, 10.3% at 24 months, respectively. The secondary patency rates were 89.2%, 79.1%, 78.3% at 12 months and 83.8%, 74.4%, 64.9% at 24 months, respectively. Maturation failure occurred in five DAVF patients and in one FBVT patient. The infection rate was 0.3% in DAVF and 12.5% in AVG, but no infection occurred in patients with FBVT. Multivariate analysis revealed that age and history of previous access were associated with lower primary patency. CONCLUSION: Forearm BVT showed an acceptable, high 2-year patency rate and fewer thromboses and infectious complications than AVG. Forearm BVT could be considered before forming an upper arm AVF or forearm AVG, if the basilic vein is available.

Progress in Materials, Solution Processes, and Long-Term Stability for Large-Area Organic Photovoltaics.

Organic solar cells based on bulk heterojunctions (BHJs) are attractive energy-conversion devices that can generate electricity from absorbed sunlight by dissociating excitons and collecting charge carriers. Recent breakthroughs attained by development of nonfullerene acceptors result in significant enhancement in power conversion efficiency (PCEs) exceeding 17%. However, most of researches have focused on pursuing high efficiency of small-area (<1 cm2 ) unit cells fabricated usually with spin coating. For practical application of organic photovoltaics (OPVs) from lab-scale unit cells to industrial products, it is essential to develop efficient technologies that can extend active area of devices with minimized loss of performance and ensured operational stability. In this progress report, an overview of recent advancements in materials and processing technologies is provided for transitioning from small-area laboratory-scale devices to large-area industrial scale modules. First, development of materials that satisfy requirements of high tolerability in active layer thickness and large-area adaptability is introduced. Second, morphology control using various coating techniques in a large active area is discussed. Third, the recent research progress is also underlined for understanding mechanisms of OPV degradation and studies for improving device long-term stability along with reliable evaluation procedures.

Understanding the Performance of Organic Photovoltaics under Indoor and Outdoor Conditions: Effects of Chlorination of Donor Polymers.

Understanding the effects of the chemical structures of donor polymers on the photovoltaic properties of their corresponding organic photovoltaic (OPV) devices under various light-intensity conditions is important for improving the performance of these devices. We synthesized a series of copolymers based on poly[(2,6-(4,8-bis(5-(2-thioethylhexyl)thiophen-2-yl)benzo[1,2-b:4,5-b']dithiophene))-alt-(5,5-(1',3'-di-2-thienyl-5',7'-bis(2-ethylhexyl)benzo[1',2'-c:4',5'-c']dithiophene-4,8-dione))] (PBDB-TS) and studied the effects of chlorine substitution of its thiophene-substituted benzodithiophene (BDT-Th) unit on its photovoltaic properties. Chlorination of the polymer resulted in a bulk heterojunction (BHJ) morphology optimized for efficient charge transport with suppressed leakage current and an increased open-circuit voltage of the OPV device; this optimization led to a remarkable enhancement of the OPV device's power conversion efficiency (PCE) not only under the condition of 1 sun illumination but also under a low light intensity mimicking indoor light; the PCE increased from 8.7% for PBDB-TS to ∼13% for the chlorinated polymers, PBDB-TS-3Cl, and PBDB-TS-4Cl under the 1 sun illumination condition and from 5.3% for PBDB-TS to 21.7% for PBDB-TS-4Cl under 500 lx fluorescence illuminance. Interestingly, although the OPV PCEs under 1 sun illumination were independent of the position of chlorine substitution onto the polymer, PBDB-TS-4Cl exhibited better performance under simulated indoor light than its derivative PBDB-TS-3Cl. Our results demonstrate that efficient light absorption and charge-carrier generation play key roles in achieving high OPV efficiency under low-light-intensity conditions.

Development of new semiconducting polymers for high performance solar cells.

A new low band gap semiconducting polymer, PTB1, was synthesized and found promising for solar energy harvesting. Simple polymer solar cells based on PTB1 and methanofullerene [6,6]-phenyl-C(71)-butyric acid methyl esters (PC(71)BM) exhibit a solar conversion efficiency of 5.6%. An external quantum efficiency of 67% and fill-factor of 65% are achieved, both of which are among the highest values reported for a solar cell system based on a low band gap polymer.

3D Printer-Based Encapsulated Origami Electronics for Extreme System Stretchability and High Areal Coverage.

Stretchability and areal coverage of active devices are critical design considerations of stretchable or wearable photovoltaics and photodetections where high areal coverages are required. However, simultaneously maximizing both properties in conventional island-bridge structures through traditional two-dimensional manufacturing processes is difficult due to their inherent trade-offs. Here, a 3D printer-based strategy to achieve extreme system stretchability and high areal coverage through combining fused deposition modeling (FDM) and flexible conductive nanocomposites is reported. Distinguished from typical approaches of using conductive filaments for FDM which have a flexibility dilemma and conductivity trade-offs, the proposed axiomatic approach to embed a two-dimensional silver nanowire percolation network into the surfaces of flexible 3D printed structures offers sufficient conductivity and deformability as well as additional benefits of electrical junction enhancement and encapsulation of silver nanowires. Kirigami/origami-pattern-guided three-dimensional arrangements of encapsulated interconnections provide efficient control over stretchability and areal coverage. The suggested process enables a perovskite solar module with an initial areal coverage of ∼97% to be electrically and mechanically reversible with 400% system stretchability and 25 000% interconnect stretchability under the 1000 cycle test, by folding down or hiding the origami-applied interconnects under the islands. This 3D printing strategy of potentially low cost, large size capabilities, and high speed is promising for highly flexible future energy conversion applications.

High ligation of the anal fistula tract by lateral approach: A prospective cohort study on a modification of the ligation of the intersphincteric fistula tract (LIFT) technique.

BACKGROUND: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving operation for anal fistulas. Although it has advantages in preserving continence after surgery, it is difficult to perform owing to the narrow field of view. We performed a modified surgical procedure based on the LIFT to overcome these drawbacks. MATERIALS AND METHODS: Twenty-eight patients who were scheduled to undergo high ligation of the anal fistula tract by the lateral approach for the treatment of transsphincteric anal fistulas were prospectively studied. Instead of making a new stab incision on the intersphincteric groove, we dissected along the fistula tract from the external opening until the intersphincteric space appeared. The fistula tract was then ligated close to the internal anal sphincter with absorbable sutures, and the distal part of the ligation was cut off. A cored-out wound was left open for drainage. RESULTS: The median follow-up was 16 months (range, 8-27 months). Of the 28 patients, 19 (68%) had simple transsphincteric fistulas and 9 (32%) had complex transsphincteric fistulas. Successful fistula closure was achieved in 21 patients (75%), with a median healing time of 4 weeks (range, 3-7 weeks). None of the patients complained of any incontinence symptoms after the procedure. Of the seven patients (25%) who failed to heal successfully, two (7%) did not heal up to 2 months after surgery and five (18%) experienced recurrence after complete healing. CONCLUSION: High ligation of the anal fistula tract by lateral approach may be a useful sphincter-sparing procedure for transsphincteric anal fistulas.