Comparison of Incision and Drainage Procedure with Drainage and Ligation of the Intersphincteric Fistula Tract in the Treatment of Deep Perianal Abscess

Background 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. Methods This retrospective cohort study included 111 patients divided into two groups: Group I (incision and drainage) and Group II (incision and drainage combined with the LIFT procedure). Data on comorbidities, anal MRI imaging, Wexner incontinence scores, McGill pain scores, and complications were collected. Logistic regression and log-rank analyses were performed to assess outcomes. Results In Group I, the number of patients with persistent fistula at the 3rd month was 16 (28.1%), while in Group II, it was 3 patients (5.7%) (p = .001). At the 6th month, the number of patients with persistent fistula was 21 (38.2%) in Group I and 3 (3.7%) in Group II, which was statistically significant (p = .000). In logistic regression analysis, the pain score on the 14th day was found to be a significant independent predictor that increased the likelihood of not developing a fistula at the 6th month. Log-rank analysis revealed that the application of LIFT along with drainage significantly reduced the likelihood of fistula development compared to drainage alone. Conclusions The LIFT procedure, combined with incision and drainage, effectively treats transsphincteric fistulas and deep perianal abscesses, reducing recurrence rates without significantly increasing incontinence.