Prospective observation study of incision and drainage vs drainage and initial fistula management for perianal abscesses

BACKGROUND: Perianal abscess is a common anorectal emergency, and simple incision and drainage (I&D) remains the standard initial treatment. However, failure to address an underlying fistulous tract at the primary surgery may result in high rates of abscess recurrence and subsequent fistula formation. The role of drainage with concurrent initial fistula management remains debated due to concerns regarding anal continence. AIM: To compare outcomes of simple incision and drainage versus drainage with initial fistula management in patients with acute perianal abscess, with special reference to abscess recurrence. METHODS: This Prospective observation studies was conducted in the Department of General Surgery at SRM Medical College Hospital and Research Centre from march 2025 to December 2025. A total of 142 patients with acute perianal abscess were randomized into two groups: Group A underwent simple I&D (n = 71) and Group B underwent I&D with primary fistula management (n = 71). Patients were followed for 10 months. Primary outcomes included abscess recurrence and fistula formation. Secondary outcomes included anal incontinence assessed using the Fecal Incontinence Severity Index (FISI), postoperative pain, wound healing time, and hospital stay. Statistical analysis was performed using SPSS v25.0 with p < 0.05 considered significant. RESULTS: Abscess recurrence was significantly higher in the simple drainage group (23.9%) compared to the drainage with fistula management group (4.2%) (p = 0.001). Fistula formation occurred exclusively in the simple drainage group (25.4%) (p < 0.001). Mean FISI scores were higher following simple drainage (5.10 ± 3.15) than drainage with fistula management (3.30 ± 2.13) (p < 0.001). Hospital stay was significantly shorter in the combined procedure group (p < 0.001), while postoperative pain scores were comparable. CONCLUSION: Drainage with initial fistula management significantly reduces abscess recurrence and fistula formation without increasing postoperative pain, and is associated with better continence outcomes and shorter hospital stay compared to simple drainage alone.