ArticleScientific reports2026
Comparison of incision and drainage procedure with drainage and ligation of the intersphincteric fistula tract in the treatment of deep perianal abscess.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Patients with deep perianal abscess (DPA) and transsphincteric fistula typically require incision and drainage as emergency treatment. However, recurrent abscesses and fistulas are common. This study aimed to evaluate the impact of simultaneous ligation of the intersphincteric fistula tract (LIFT) on abscess recurrence, incontinence, and fistula healing. This study is a retrospective analysis of an institutional protocol and includes 111 patients divided into two groups: Group I (incision and drainage alone, n = 57) and Group II (incision and drainage combined with the LIFT procedure, n = 54). The primary endpoint was persistent fistula at 6 months, confirmed by clinical examination and magnetic resonance imaging (MRI). Secondary endpoints included abscess recurrence, Wexner incontinence score changes, and complications. Firth's penalized logistic regression, inverse probability of treatment weighting (IPTW), and log-rank analyses were performed to assess outcomes. At the 3rd month, the number of patients with persistent fistula was 16 (28.1%) in Group I, while it was 3 patients (5.6%) in Group II (P = 0.002). At the 6th month, persistent fistula was observed in 21 of 55 patients (38.2%) in Group I and 3 of 53 patients (5.7%) in Group II (P < 0.001). Firth's penalized logistic regression showed that the LIFT procedure was significantly associated with reduced fistula persistence (OR = 0.079, 95% CI 0.019-0.327, P < 0.001). A sensitivity analysis restricted to patients with MRI-confirmed transsphincteric fistula (Group I: n = 34; Group II: n = 54) confirmed these findings (59.4% vs. 5.7%, P < 0.001). IPTW-adjusted analysis yielded consistent results (weighted OR = 0.063). This study demonstrates that the LIFT procedure, when applied together with drainage, reduces the incidence of persistent fistula and shows a non-significant reduction in abscess recurrence in patients with DPA and complex anal fistula. These findings should be interpreted with caution due to the non-randomized design and require confirmation through prospective randomized controlled trials.
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