A randomized controlled trial of a new procedure for the treatment of perianal abscesses, the Trans-intersphincteric Double Seton (TRISDS)

A randomized controlled trial of a new procedure for the treatment of perianal abscesses, the Trans-intersphincteric Double Seton (TRISDS) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A randomized controlled trial of a new procedure for the treatment of perianal abscesses, the Trans-intersphincteric Double Seton (TRISDS) Leichang Zhang, Xiao Yuan, Pan Shen, Wei Ge, Wu Liao, Chen Wang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4253961/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract OBJECTIVE To study the clinical efficacy and safety of a novel procedure,Trans-intersphincteric Double Seton, for the treatment of perianal abscesses in the sciorectal hiatus. METHODS The study population consisted of patients with perianal abscess in the sciorectal space who underwent Trans-intersphincteric Double Seton (TRISDS) and perianal abscess Incision and Drainage (I&D) from September 2020 to September 2023 at the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine. The cure rate, hospitalization time, wound healing time, and Wexner score of anal function were observed in both groups after treatment. RESULTS 100 patients with perianal abscess received surgical treatment, of which 50 patients (male/female: 41/9, mean age: 32.98 years old) received Trans-intersphincteric Double Seton as the observation group, and the other 50 patients (male/female: 38/12, mean age: 32.76 years old) received Incision and Drainage of perianal abscess as the control group, and the differences in the basic data of the patients of the two groups were not significant in comparison (P>0.05) and they are comparable. The cure rate of the observation group 86%, higher than the control group 42%, (p 0.05) are not statistically significant.the healing time of the observation group (33.26 ± 3.81) d is shoeter than that of the control group (37.68 ± 6.24) d, (p < 0.05) the two groups (p < 0.05) are comparable. ) d, (p < 0.05) the difference was statistically significant. Evaluation of anal function: Wexner score comparison between the two groups of patients, no anal incontinence, preoperative and postoperative 42 days comparison (p > 0.05), there is no statistical significance, 21 days after the operation, the observation group (1.82 ± 1.32) is higher than the control group (1.28 ± 1.20), the two groups (p < 0.05),the difference is statistically significant; CONCLUSION For the treatment of perianal abscess in the sciorectal space, transsphincteric double-hanging suture does not lead to anal incontinence as does incision and drainage, but transsphincteric double-hanging suture is safer and more effective, with a higher rate of healing, shorter healing time, and good protection of anal function, which is of clinical promotion value. transsphincteric intersphenoidal double-hanging wire perianal abscess incision and drainage randomized controlled Figures Figure 1 Background Perianal abscess is an acute suppurative infection that occurs around the anal canal and rectum and their interstitial spaces. About 90% of idiopathic perianal abscesses are due to anal gland infections [ 1 ][ 2 ] , and most occur in the sphincter space where the anal glands are located [ 3 ] . In recent years, the prevalence of perianal abscess has gradually increased with social development and changes in dietary structure. In China, perianal abscess mainly occurs in men aged 20–40 years old, with a prevalence of about 2%, accounting for 8%-25% of perianal diseases [ 4 ] . The onset of perianal abscess is characterized by rapid deterioration of the condition. If not treated in time, the infection may spread to the surrounding tissue space, forming a horseshoe-shaped abscess, or even progressing to necrotizing fasciitis, which can be life-threatening for the patient. Therefore, once diagnosed with perianal abscess, surgical treatment should be performed as soon as possible. The Italian Society of Colrectal Surgery (ISCR) recommends immediate Incision and Drainage (I&D) for perianal abscesses [ 5 ] . However, some clinical practices by many scholars have shown that I&D is deficient in the management of primary foci of infection, with healing fistula rates as high as 9%-66% [ 6 ] . In contrast, a one-time radical procedure is more effective in addressing perianal abscesses, but requires incision of part of the sphincter, creating a larger and deeper incision. While this procedure improves the cure rate of perianal abscesses, radical surgery for perianal abscesses may be considered excessive surgical treatment if it is used only to prevent fistula formation or abscess recurrence, as some patients do not form fistulas after abscess drainage, as well as increasing the risk of fecal incontinence and significantly decreasing the patient's postoperative quality of life [ 7 ][ 8 ][ 9 ][ 10 ][ 11 ] . In order to effectively treat this disease and to better protect the anal function, we have proposed a new method of treating perianal abscess based on the theory of adenogenous infection in its pathogenesis, and based on the innovation of the modified Parks loose thread technique, i.e., Trans-intersphincteric Double Seton (TRISDS). This method of trans-intersphincteric approach to the internal and external sphincter is innovative in that it protects the sphincter and prevents fecal incontinence while destroying the primary foci of infection as well as removing the pus located between the sphincters and maintaining adequate drainage, thus achieving the goal of healing and reducing the recurrence of abscesses and the occurrence of fistulas. The risk of fecal incontinence is considered minimal as the internal and external sphincters are not incised or damaged, which is important in balancing the relationship between cure rate and sphincter preservation in perianal abscesses. The efficacy of this treatment is clear, with postoperative follow-up showing a low incontinence rate and a high cure rate. To systematically evaluate the efficacy and safety of this procedure, we designed a randomized controlled, single-blind prospective clinical trial comparing two procedures, TRISDS and I&D, in order to provide more options for clinical decision-making. Patients and methods Ethical Statement: This protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Jiangxi Traditional Chinese Medicine (JZFYKYLL20200420007) and informed consent was obtained from the patients. General information In this clinical trial, a randomized parallel controlled single-blind trial design method was adopted. The enrolled patients who met the study requirements were numbered according to the order of consultation, and the SPSS26.0 software random number sorting method was used to group 50 cases in each group. The trial was terminated when the number of observed cases met 100 cases. Following the principles of respecting subjects' privacy and voluntary participation, we selected 100 cases of perianal abscess patients who met the criteria and were seen in the Department of Anus and Intestines of the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from September 2020 to September 2023 as the study subjects, which were divided into the observation group (n=50, using TRISDS ) and the control group (n=50, using I&D). The study showed that there was no statistically significant difference between the patients in the observation and control groups in terms of gender, age, duration of disease and BMI (P > 0.05), as shown in Table 1, which is comparable. Table 1 : Comparison of baseline data between the two groups (`x±s) groups number of examples Age/years Sex (m/f) Duration of illness/day BMI score TRISDS 50 32.98±9.71 41/9 5.28±1.54 22.51±2.50 I&D 50 32.76±8.97 38/12 5.52±2.4 23.17±3.15 Inclusion and exclusion criteria Inclusion criteria: ① patients who meet the diagnostic criteria of perianal abscess, combined with perianal MRI diagnosed as unilateral sciatico-rectal fossa abscess and patients with adenogenic infection; ② age between 18-65 years old, gender is not limited; ③ signed informed consent. Exclusion criteria: ① those who have already received the corresponding disease treatment will have an impact on the observation index; ② accompanied by other physiological or pathological conditions that affect the observation index or judgment; ③ patients with severe heart, liver, kidney damage; ④ patients with mental disorders or psychiatric disorders. Research design Considering the practical feasibility of blinding, the surgical operator may not be blinded, and to ensure the objectivity of the assessment, the patients were blinded in this study. Over the next 3 months, patients were followed up weekly by the same attending physician, through a combination of clinical observation, outpatient review, and telephone follow-up, and then the patient's data were recorded in a data sheet. Surgical Technique Preoperative preparation: All patients underwent detailed local examination under lumbar anesthesia by a senior attending physician preoperatively and intraoperatively to determine and evaluate the relationship between the endostyle and sphincter; preoperative MRI was performed on all patients to provide accurate imaging localization and to clarify the endostyle. Drink and food fasting and preoperative enema were prohibited for 6 hours before surgery. Method: Observation group: after successful lumbar anesthesia, the patient was placed in the lateral position, and a radial incision was made at the most obvious place of fluctuating abscess in the lateral sphincter of the sciorectal fossa for adequate drainage; curved hemostatic forceps probed from inside the incision, and a curved incision of about 1.5-2 cm was made in the sphincter intersphenoidal groove corresponding to the inner opening (judged after preoperative evaluation), cutting the skin and subcutaneous tissue, entering the sphincter intersphenoidal groove, up to the primary infected foci of intersphenoidal muscles, and adequately scraping the intersphenoidal muscles to make drainage smooth. Inflammatory granulation tissue, so that the drainage is smooth, from the intersphincter to the inner mouth of the silk thread loose hanging line drainage, from the intersphincter to the outer sphincter radial incision to the rubber band loose hanging line drainage, trimming the trauma so t；-hat the drainage is smooth; after thorough hemostasis, the petroleum jelly gauze tamponade was given. Control group: I&D was adopted by the clinical researcher according to the location of the abscess, i.e., a radial incision was made at the most obvious place of abscess fluctuation to drain the pus; both groups of patients were given anti-infective treatment for 5 days after the operation, preventing bleeding for 2 days, and were given fumigation by sitz bath in the morning after defecation, once a day; specialist dressing change was done once a day, and the wires at the internal sphincter in the observation group were removed in about 3 days, and those at the external sphincter were removed in about 7 days. The observation group was removed at the inner sphincter in about 3 days and the outer sphincter in about 7 days. Fig.1 (a). Surgical diagram of TRISDS. Yellow arrow: intersphincter incision, Blue arrow: Loose seton from Intersphincter to the internal opening, Red arrow: Loose seton from Intersphincter to Ischiorectal fossa. (b). Postoperative healing photograph. Observation indicators: (1) Clinical efficacy: The clinical efficacy of the two groups was evaluated at 3 months after the operation and categorized into cured and not cured. Cured refers to the complete disappearance of positive signs and symptoms and no recurrence within 3 months. (ii) Failure to cure refers to the patients' postoperative wounds not healing, or the formation of anal fistula or abscess at the primary site within 3 months. Total effective ratio of treatment = number of cured/total number of patients. (2) Traumatic pain score: Traumatic pain was evaluated on the 1st, 7th and 14th postoperative days according to the visual analogue scale (VAS) of pain in both groups. The scale was 0-10 points, with 0 being no pain and 10 being unbearable pain, and the higher the score, the deeper the pain. (3) Wound exudate score: on the 1st, 7th and 14th postoperative days, the wound penetrated the gauze, and the score was from 0 to 3, with 0 being no obvious secretion, 1 being secretion but not penetrating a piece of gauze, 2 being secretion penetrating a piece of gauze but not the second piece, and 3 being secretion penetrating two pieces of gauze and above, and the higher the score was, the more the exudate was. (4) Granulation growth: observe the granulation growth of postoperative wound on the 1st, 7th and 14th day after operation, score 0~3, 0 is good granulation growth, 1 is bright red granulation, easy to bleed by rubbing, 2 is light red granulation, not easy to bleed by rubbing, 3 is less granulation and light grayish-white granulation, not easy to bleed by rubbing, the higher the score, the worse the growth of the granulation is. (5) Traumatic edema score: The postoperative traumatic edema was observed on the 1st, 7th and 14th days after the operation, and the score ranged from 0 to 3, with 0 being no edema at the edge of the trauma, 1 being slight edema at the edge of the trauma, 2 being redness and swelling of the trauma, which slightly affected the evacuation of feces, and 3 being extensive edema at the edge of the trauma, which seriously affected the evacuation of feces and daily life, and the higher the score was, the more serious was the degree of edema. (6) Hospitalization time and wound healing time: hospitalization time is calculated from the first day of admission to the day of discharge; wound healing time is expressed as the number of days from the first postoperative day to the day when the wound is completely covered by skin. (7) Anal incontinence was evaluated by Wexner anal incontinence scoring index, which was evaluated from gas, liquid, solid, liner and lifestyle changes, with a total of 5 items, and a five-level scoring method (never, occasionally, sometimes, often, always) was used to evaluate the score for each item, with the score of the item ranging from 0 to 4, and the total score ranging from 0 to 20, and the score of 10 was used as the cut-off value for the severity of incontinence, and the higher the score, the more serious the incontinence was. The higher the patient's score, the more serious the incontinence, 0 is normal, 20 is total incontinence, and the higher the score, the more serious the anal incontinence. Statistical Methods: It was analyzed by using SPSS 26.0 statistical software, and the measurement information was expressed as ( xˉ± s ), and the comparison between groups was made by using independent samples t-test, and the counting information was expressed as ( n ), and the difference was considered statistically significant with P<0.05. Follow-up Methods Clinical and Anal Manometry Assessments Upon discharge, patients receive weekly follow-up appointments in the outpatient clinic until their wounds are fully healed, followed by a follow-up appointment in the third month after surgery. Patients are questioned about anal control in a targeted manner. For recurrent abscesses and fistulae that form, we perform drainage and fistulotomy as needed. Results Comparison of postoperative trauma scores between the two groups: Comparison of trabecular exudate scores: the difference in postoperative trabecular exudate scores between the two groups on the 1st, 7th and 14th days was not statistically significant (p>0.05), and trabecular exudate scores were decreasing on the 1st, 7th and 14th days after surgery, and trabecular exudate of the I&D group was lower than that of the TRISDS group after the 1st, 7th and 14th days. See Table 2. Table 2: Comparison of traumatic exudate scores between the two groups (`x±s) wound exudate TRISDS I&D P D1 2.68±0.65 2.54±0.64 0.284 D7 1.72±0.90 1.56±0.73 0.333 D14 1.08±0.69 0.80±0.92 0.09 Comparison of trabecular granulation scores: trabecular granulation growth was not statistically significant on postoperative days 1, 7, and 14 (p>0.05), but trabecular granulation scores in both groups were lower on postoperative days 7 and 14 compared with day 1, and the scores in the TRISDS group were better than those in the I&D group; see Table 3. Table 3: Comparison of trabecular granulation growth scores between the two groups (`x±s) bud growth TRISDS I&D P D1 2.64±0.48 2.76±0.43 0.194 D7 1.62±0.66 1.78±0.54 0.192 D14 1.06±0.79 1.30±0.88 0.157 Comparison of the degree of trabecular edema: there was no statistically significant difference in the degree of trabecular edema between the two groups on the 1st, 7th and 14th postoperative days (p>0.05), but the scores of the TRISDS group were lower than those of the I&D group on the 1st, 7th and 14th postoperative days. The degree of trabecular edema was lower in both groups on postoperative days 7 and 14 compared to day 1. See Table 4. Table 4: Comparison of trauma edema scores between the two groups (`x±s) traumatic edema TRISDS I&D p D1 0.52±0.67 0.66±0.77 0.338 D7 0.48±0.57 0.6±0.67 0.341 D14 0.4±0.53 0.48±0.54 0.46 Comparison of traumatic pain scores : On the 7th and 14th postoperative days, there was no statistically significant difference in the comparison of traumatic pain scores between the two groups (P>0.05); the traumatic pain scores of both groups were lower than that on the 1st postoperative day, and I&D was lower than that of TRISDS, and the difference was statistically significant on the 1st postoperative day (both P<0.05). See Table 5. Table 5: Comparison of traumatic pain scores between the two groups (`x±s) TRISDS I&D P D1 7.50±0.95 6.86±1.04 0.002* D7 3.64±1.15 3.38±0.98 0.23 D14 1.36±0.59 1.58±0.90 0.115 *: p<0.05 compared to TRISDS group Comparison of clinical outcomes between the two groups: 86% cure rate and 14% failure rate in the TRISDS group (cured/failed to cure: 43/7, n=50); 42% cure rate and 58% failure rate in the I&D group (cured/failed to cure: 21/29, n=50); the fistula rate was 10% and 36%, respectively; see Table 6. Table 6: Clinical outcome and fistula rate (%) of patients in both groups groups number of examples curable untreated fistula formation fistula rate Recurrence of abscesses overall effectiveness rate failure rate TRISDS 50 43 7 5 10%# 2 86%# 14% I&D 50 21 29 18 36% 11 42% 58% #: p<0.05 vs. I&D group Comparison of trauma healing and hospitalization time between the two groups of patients: the hospitalization time of the two groups of patients is compared: the hospitalization time of TRISDS group is shorter, but there is no statistical significance between the two groups (p>0.05); comparison of trauma healing time: the time of TRISDS group's trauma healing group is shorter than that of the I&D group, and the comparison of the two groups (p<0.05) is statistically significant. See Table 7. Table 7: Wound healing and duration of hospitalization in both groups (`x ± s) groups Wound healing time Length of hospitalization TRISDS 33.96±4.13 # 7.02±1.63 I&D 37.68±6.24 7.36±1.64 P 0.001 # 0.276 #: p0.05), the difference is not statistically significant; 21 days after the operation, the scores of I&D group were higher than those of TRISDS group, and the difference between the two groups was statistically significant; 42 days after the operation, the scores of TRISDS group were lower than those of I&D group, but the difference was not statistically significant (p>0.05), the difference was not statistically significant. 0.05),the difference was not statistically significant. See Table 8 Table 8: Comparison of Wexner score between two groups of patients (`x±s) TRISDS I&D Wexner Rating preoperative Postoperative D21 Postoperative D42 preoperative Postoperative D21 Postoperative D42 0.32±0.51 1.82±1.32 0.50±0.54 0.36±0.52 1.28±1.20* 0.64±0.66 *: p<0.05 compared to TRISDS group Discussion Perianal abscess is a common infectious disease in the perianal area that can develop and spread along the perianal space. Once this disease appears, it often cannot be self-healed or cannot be eradicated by medication. For perianal abscess, surgical treatment is currently preferred, and the commonly used surgical procedures in the clinic are I&D or radical surgery for perianal abscess. However, after I&D, about 9%-66% of patients can develop anal fistula. In order to reduce the rate of fistula, some scholars resected the suspected fistula during drainage, which is called "radical perianal abscess surgery". However, in the acute abscess stage, the surrounding tissues are severely inflamed and edematous, and it is difficult to determine the location of the internal orifice, and blind exploration may cause a false pathway, which may cause more damage and may result in postoperative anal defect or increased risk of incontinence. The risk of incontinence increases [12] . In addition, some patients do not form an anal fistula after I&D, so there is no theoretical basis for performing sphincterotomy in all patients with perianal abscess. More than 90% of perianal abscesses are caused by infection of the anal glands based on the pathogenesis of the "glandular theory of infection" [1] . The primary focus of infection is located between the sphincters and can spread downward to the anal verge, upward to the rectal wall or outward through the external sphincter to the sciorectal fossa. An intersphincteric infection is similar to an abscess in a closed space; this closed space needs to be adequately drained and kept open in order to eradicate the infection and allow the abscess to heal properly. Failure to remove the intersphincteric infection may lead to the formation of an anal fistula. Therefore, removal of the primary site of infection, clarification of the location of the abscess, and thorough drainage are critical steps in treatment. In order to effectively treat perianal abscesses and better protect anal function, we have innovated on the basis of the modified Parks Loose Hanging String Technique by adopting TRISDS for the treatment of perianal abscesses according to the pathophysiologic mechanism of its pathogenesis. In our study, TRISDS for the treatment of perianal abscesses significantly reduced the risk of fistula compared to I&D alone. In I&D, the fistula rate was 36%, whereas the TRISDS treatment group had a significantly lower fistula rate. We consider the TRISDS group hanging the inner sphincter silk thread from the intersphincter access can destroy the intermuscular primary infection foci, the friction of the silk thread can also further promote the drainage of the intermuscular foci and remove the potentially infected anal gland ducts, which reduces the rate of fistula, at the same time, one hanging from the intermuscular to the internal opening of the silk thread, retaining the sphincter's integrity and facilitating the drainage of the second hanging of the external sphincter rubber strips are also on the intermuscular and extra-muscular sciatico-rectal fossa The second hanging of the external sphincter also exerted adequate drainage of the intermuscular and extra-muscular sciatico-rectal fossa pus while preserving the integrity of the external sphincter. In contrast, the I&D group did not destroy the primary infection foci, and drainage was not yet adequate, thus increasing the fistula rate. The results of this study show that TRISDS in the treatment of perianal abscess has achieved significant efficacy and less damage in anal function, but there are some patients who formed anal fistula after surgery, this procedure we will remove the thread of TRISDS on the 7th day after surgery in our previous cases, and in this study to summarize the reasons for fistula after TRISDS surgery, we consider that it is related to the timing of the removal of the thread, which is related to the timing of the removal of the thread. Early removal of the thread will lead to incomplete drainage of the wound, resulting in the failure of the wound to heal completely, forming a false healing, leading to anal fistula, and in the further clinical application, we gradually remove the thread according to the patient's trauma, to achieve complete drainage, and to further improve the healing rate. TRISDS did not ultimately result in increased functional damage to the anal sphincter, and when TRISDS is used for perianal abscesses, the filaments pass through the intermuscular groove of the internal and external sphincter muscles, and the resulting functional damage is very minimal compared with the more extensive one-time radical procedure. We selected 21 days postoperatively to measure anal function when the trauma had not yet completely healed, and we could find a statistically significant difference in anal function Wexner scores at 21 days postoperatively for I&D versus TRISDS (p<0.05), and we considered the hanging of the wire in the early postoperative period as well as the intermuscular formation of the incision in the early trauma at 21 days postoperatively when the trauma had not healed yet. When the wound is not yet healed, part of the wound margin is involutional and shortened, forming a defect, at this time the seal is poor, that is, it will be accompanied by a slight incontinence, and also selected for measurement when the wound is basically healed at 42 days postoperatively, it can be found that there is no statistical significance, and we consider that with the wound healing, the notch is closed, the defect formed is filled, and the anal function is also close to normal. This confirms that TRISDS is effective in protecting the patient's postoperative anal function by achieving a better healing rate while also being essentially non-invasive to the anal sphincter. In this clinical study, we chose sciorectal space abscess for observation, but in clinical application, we found that TRISDS can also be taken for different types of abscesses.If the abscess is located in the intersphincter, only a curved incision can be made in the intersphincter, and only the inner sphincter can be hooked up, while the outer sphincter portion does not need to be hooked up. If the high interosseous abscess spreads to the pelvic rectal space but does not break through the external sphincter or anorectal muscle, the internal sphincter can be hooked up at the same time combined with the placement of a tube to flush the pus cavity to prevent pus residue; for the sciatic rectal fossa abscess with an unclear internal opening, it is not forced to pass through the anus for the internal sphincter to be hooked up but only hooked up to the external sphincter to avoid the formation of pseudo-endopenings to form a fistula of medical origin. Therefore, TRISDS is diverse in terms of future applications, and we also plan to consider its application to other types of abscesses and anal fistulas (e.g., horseshoe abscess, Crohn's-type anal fistula). Summarize In this study, considering the insufficient sample size, we did not make a direct comparison with one-time radical surgery. As a means of treating perianal abscesses, disposable radical surgery shows obvious advantages in terms of cure rate, but its impact on anal function should not be ignored. The aim of this study was to explore a more meticulous and protective treatment strategy to optimize the therapeutic effect and minimize the adverse effects on anal function. In a follow-up study, we also plan to investigate the differences in treatment outcomes between TRISDS and radical surgery in a multicenter comparison, and to analyze the differences in cure rates between this procedure and radical surgery, with the aim of further improving the procedure. Based on these findings, further large-sample clinical studies and widespread dissemination of the application are urgent. This initiative will help to evaluate the superiority and feasibility of TRISDS more comprehensively and objectively, while deepening its application in clinical practice. Through a wide range of studies, we are expected to further recognize the application potential of TRISDS, provide safer and more effective treatment options for patients with perianal abscesses, and maximize the protection of the functional integrity of the anus. Such systematic and in-depth research and continued promotional efforts will provide clinicians and patients with more viable treatment strategies, leading to more superior treatment outcomes and improved quality of life. Declarations Competing interests：The authors declare no competing interests Funding Open Access Fund provided by the National Natural Science Foundation of China (82260938) Jiangxi Provincial Department of Education Innovation Project Grant (YC2021-S516) Jiangxi Provincial Department of Education Science and Technology Tackling Project (190682) References EISENHAMMER S (1956) The internal anal sphincter and the anorectal abscess[J]. Surg Gynecol Obstet 103(4):501–506 PARKS A G, GORDON P H, HARDCASTLE J D. (1976) A classification of fistula-in-ano[J/OL]. Br J Surg 63(1):1–12. https://doi.org/10.1002/bjs.1800630102 Perianal abscess/fistula disease - PubMed[EB/OL]. [2024-02-04]. https://pubmed.ncbi.nlm.nih.gov/20011384/ SKOVGAARDS D M, PERREGAARD H, HAGEN K B et al (2020) [Treatment of anal abscesses][J]. 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[2024-02-04]. https://pubmed.ncbi.nlm.nih.gov/20614450/ OLIVER I, LACUEVA F J, PÉREZ VICENTE F et al (2003) Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment[J/OL]. Int J Colorectal Dis 18(2):107–110. https://doi.org/10.1007/s00384-002-0429-0 PIGOT F (2015) Treatment of anal fistula and abscess[J/OL]. J Visc Surg 152(2 Suppl). https://doi.org/10.1016/j.jviscsurg.2014.07.008 . S23-29 HE Z, DU J, WU K et al (2020) Formation rate of secondary anal fistula after incision and drainage of perianal Sepsis and analysis of risk factors[J/OL]. BMC Surg 20(1):94. https://doi.org/10.1186/s12893-020-00762-3 VOGEL JD, JOHNSON E K, MORRIS A M, Fistula [ et al (2016) J/OL] Dis Colon Rectum 59(12):1117–1133. https://doi.org/10.1097/DCR.0000000000000733 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4253961","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":298281583,"identity":"4044d8e9-3a0c-4f75-b1b1-7b384f53f988","order_by":0,"name":"Leichang Zhang","email":"","orcid":"","institution":"Department of Proctology Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Leichang","middleName":"","lastName":"Zhang","suffix":""},{"id":298281584,"identity":"e127085c-32c9-4b2c-98d9-f06464d23188","order_by":1,"name":"Xiao Yuan","email":"","orcid":"","institution":"Graduate School of Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Yuan","suffix":""},{"id":298281585,"identity":"d4cb5303-2f6d-429c-914d-475d534a953c","order_by":2,"name":"Pan Shen","email":"","orcid":"","institution":"Graduate School of Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Pan","middleName":"","lastName":"Shen","suffix":""},{"id":298281586,"identity":"e2263156-d21b-4945-9ba7-5f7a0afcb9a2","order_by":3,"name":"Wei Ge","email":"","orcid":"","institution":"Department of Proctology Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Ge","suffix":""},{"id":298281588,"identity":"984434a0-8b70-4cce-9949-bccb503b27d0","order_by":4,"name":"Wu Liao","email":"","orcid":"","institution":"Department of Proctology Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wu","middleName":"","lastName":"Liao","suffix":""},{"id":298281590,"identity":"4cff4e40-ce52-4002-bf29-6f7e599d39ed","order_by":5,"name":"Chen Wang","email":"","orcid":"","institution":"Department of Proctology,Longhua Hospitai,Shanghai University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Wang","suffix":""},{"id":298281593,"identity":"a4efb738-1ac2-4895-9c31-f7868252b92e","order_by":6,"name":"Xiaonan Zhang","email":"","orcid":"","institution":"Graduate School of Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xiaonan","middleName":"","lastName":"Zhang","suffix":""},{"id":298281596,"identity":"086a218d-a55c-4570-95db-9a1c97209883","order_by":7,"name":"Chaofeng Li","email":"","orcid":"","institution":"Department of Proctology Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chaofeng","middleName":"","lastName":"Li","suffix":""},{"id":298281600,"identity":"f4812d1d-bc72-4848-acba-c3bed10906a4","order_by":8,"name":"Lu Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYBACA2Yg8YBBgoeNvbHx4QeitSQwWMjw8RxuNpYgSgsDWEuFjZxEepsAD1Fa2NkvPkhsAzpM8mEbgwSDnZxuA0GH8RQbgLVIJ7Y9KGBINjY7QFhLmgRUS7uBBMOBxG1EaEn/AXHYQSBJnBb2YwxgLRKMRGvhYZZIOAfUwpMIDGQDIvxi33/84YcPZXX28u3HHz78UGEnR1ALAwOPAbKlBJWDAPsDopSNglEwCkbBCAYAMTM38gflPcUAAAAASUVORK5CYII=","orcid":"","institution":"Department of Proctology Jiangxi University of Traditional Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Lu","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2024-04-11 18:17:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4253961/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4253961/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56122921,"identity":"ae4aca53-761d-45e2-ad37-422a2aaccec9","added_by":"auto","created_at":"2024-05-08 20:41:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":286217,"visible":true,"origin":"","legend":"\u003cp\u003e(a). Surgical diagram of TRISDS. Yellow arrow: intersphincter incision, Blue arrow: Loose seton from Intersphincter to the internal opening, Red arrow: Loose seton from Intersphincter to Ischiorectal fossa. (b). Postoperative healing photograph.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4253961/v1/635e2b9389e7bb6db16a6554.png"},{"id":57578686,"identity":"00eada5c-1f3a-4198-8f4f-cae26912a046","added_by":"auto","created_at":"2024-06-02 22:46:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":888428,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4253961/v1/9fdf1871-f70f-4cc4-9097-eda2462e5b67.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A randomized controlled trial of a new procedure for the treatment of perianal abscesses, the Trans-intersphincteric Double Seton (TRISDS)","fulltext":[{"header":"Background","content":"\u003cp\u003ePerianal abscess is an acute suppurative infection that occurs around the anal canal and rectum and their interstitial spaces. About 90% of idiopathic perianal abscesses are due to anal gland infections\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e][\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, and most occur in the sphincter space where the anal glands are located\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e \u003cp\u003eIn recent years, the prevalence of perianal abscess has gradually increased with social development and changes in dietary structure. In China, perianal abscess mainly occurs in men aged 20\u0026ndash;40 years old, with a prevalence of about 2%, accounting for 8%-25% of perianal diseases\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The onset of perianal abscess is characterized by rapid deterioration of the condition. If not treated in time, the infection may spread to the surrounding tissue space, forming a horseshoe-shaped abscess, or even progressing to necrotizing fasciitis, which can be life-threatening for the patient. Therefore, once diagnosed with perianal abscess, surgical treatment should be performed as soon as possible.\u003c/p\u003e \u003cp\u003eThe Italian Society of Colrectal Surgery (ISCR) recommends immediate Incision and Drainage (I\u0026amp;D) for perianal abscesses\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. However, some clinical practices by many scholars have shown that I\u0026amp;D is deficient in the management of primary foci of infection, with healing fistula rates as high as 9%-66%\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. In contrast, a one-time radical procedure is more effective in addressing perianal abscesses, but requires incision of part of the sphincter, creating a larger and deeper incision. While this procedure improves the cure rate of perianal abscesses, radical surgery for perianal abscesses may be considered excessive surgical treatment if it is used only to prevent fistula formation or abscess recurrence, as some patients do not form fistulas after abscess drainage, as well as increasing the risk of fecal incontinence and significantly decreasing the patient's postoperative quality of life\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e][\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e][\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn order to effectively treat this disease and to better protect the anal function, we have proposed a new method of treating perianal abscess based on the theory of adenogenous infection in its pathogenesis, and based on the innovation of the modified Parks loose thread technique, i.e., Trans-intersphincteric Double Seton (TRISDS). This method of trans-intersphincteric approach to the internal and external sphincter is innovative in that it protects the sphincter and prevents fecal incontinence while destroying the primary foci of infection as well as removing the pus located between the sphincters and maintaining adequate drainage, thus achieving the goal of healing and reducing the recurrence of abscesses and the occurrence of fistulas. The risk of fecal incontinence is considered minimal as the internal and external sphincters are not incised or damaged, which is important in balancing the relationship between cure rate and sphincter preservation in perianal abscesses. The efficacy of this treatment is clear, with postoperative follow-up showing a low incontinence rate and a high cure rate.\u003c/p\u003e \u003cp\u003eTo systematically evaluate the efficacy and safety of this procedure, we designed a randomized controlled, single-blind prospective clinical trial comparing two procedures, TRISDS and I\u0026amp;D, in order to provide more options for clinical decision-making.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cp\u003eEthical Statement:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis protocol was approved by the Medical Ethics Committee of the Affiliated Hospital of Jiangxi Traditional Chinese Medicine (JZFYKYLL20200420007) and informed consent was obtained from the patients.\u003c/p\u003e\n\u003cp\u003eGeneral information\u003c/p\u003e\n\u003cp\u003eIn this clinical trial, a randomized parallel controlled single-blind trial design method was adopted. The enrolled patients who met the study requirements were numbered according to the order of consultation, and the SPSS26.0 software random number sorting method was used to group 50 cases in each group. The trial was terminated when the number of observed cases met 100 cases. Following the principles of respecting subjects\u0026apos; privacy and voluntary participation, we selected 100 cases of perianal abscess patients who met the criteria and were seen in the Department of Anus and Intestines of the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from September 2020 to September 2023 as the study subjects, which were divided into the observation group (n=50, using TRISDS ) and the control group (n=50, using I\u0026amp;D). The study showed that there was no statistically significant difference between the patients in the observation and control groups in terms of gender, age, duration of disease and BMI (P \u0026gt; 0.05), as shown in Table 1, which is comparable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Comparison of baseline data between the two groups (`x\u0026plusmn;s)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003enumber of examples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003eAge/years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003eSex (m/f)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\" valign=\"top\"\u003e\n \u003cp\u003eDuration of illness/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003eBMI score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003e32.98\u0026plusmn;9.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e41/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\" valign=\"top\"\u003e\n \u003cp\u003e5.28\u0026plusmn;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003e22.51\u0026plusmn;2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.232323232323232%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003e32.76\u0026plusmn;8.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e38/12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.252525252525253%\" valign=\"top\"\u003e\n \u003cp\u003e5.52\u0026plusmn;2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.141414141414142%\"\u003e\n \u003cp\u003e23.17\u0026plusmn;3.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e ① patients who meet the diagnostic criteria of perianal abscess, combined with perianal MRI diagnosed as unilateral sciatico-rectal fossa abscess and patients with adenogenic infection; ② age between 18-65 years old, gender is not limited; ③ signed informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e ① those who have already received the corresponding disease treatment will have an impact on the observation index; ② accompanied by other physiological or pathological conditions that affect the observation index or judgment; ③ patients with severe heart, liver, kidney damage; ④ patients with mental disorders or psychiatric disorders.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Research design\u003c/p\u003e\n\u003cp\u003eConsidering the practical feasibility of blinding, the surgical operator may not be blinded, and to ensure the objectivity of the assessment, the patients were blinded in this study. Over the next 3 months, patients were followed up weekly by the same attending physician, through a combination of clinical observation, outpatient review, and telephone follow-up, and then the patient\u0026apos;s data were recorded in a data sheet.\u003c/p\u003e"},{"header":"Surgical Technique","content":"\u003cp\u003ePreoperative preparation:\u003c/p\u003e\n\u003cp\u003eAll patients underwent detailed local examination under lumbar anesthesia by a senior attending physician preoperatively and intraoperatively to determine and evaluate the relationship between the endostyle and sphincter; preoperative MRI was performed on all patients to provide accurate imaging localization and to clarify the endostyle. Drink and food fasting and preoperative enema were prohibited for 6 hours before surgery.\u003c/p\u003e\n\u003cp\u003eMethod:\u003c/p\u003e\n\u003cp\u003eObservation group: after successful lumbar anesthesia, the patient was placed in the lateral position, and a radial incision was made at the most obvious place of fluctuating abscess in the lateral sphincter of the sciorectal fossa for adequate drainage; curved hemostatic forceps probed from inside the incision, and a curved incision of about 1.5-2 cm was made in the sphincter intersphenoidal groove corresponding to the inner opening (judged after preoperative evaluation), cutting the skin and subcutaneous tissue, entering the sphincter intersphenoidal groove, up to the primary infected foci of intersphenoidal muscles, and adequately scraping the intersphenoidal muscles to make drainage smooth. Inflammatory granulation tissue, so that the drainage is smooth, from the intersphincter to the inner mouth of the silk thread loose hanging line drainage, from the intersphincter to the outer sphincter radial incision to the rubber band loose hanging line drainage, trimming the trauma so t；-hat the drainage is smooth; after thorough hemostasis, the petroleum jelly gauze tamponade was given. Control group: I\u0026amp;D was adopted by the clinical researcher according to the location of the abscess, i.e., a radial incision was made at the most obvious place of abscess fluctuation to drain the pus; both groups of patients were given anti-infective treatment for 5 days after the operation, preventing bleeding for 2 days, and were given fumigation by sitz bath in the morning after defecation, once a day; specialist dressing change was done once a day, and the wires at the internal sphincter in the observation group were removed in about 3 days, and those at the external sphincter were removed in about 7 days. The observation group was removed at the inner sphincter in about 3 days and the outer sphincter in about 7 days.\u003c/p\u003e\n\u003cp\u003eFig.1 (a). Surgical diagram of TRISDS. Yellow arrow: intersphincter incision, Blue arrow: Loose seton from Intersphincter to the internal opening, Red arrow: Loose seton from Intersphincter to Ischiorectal fossa. (b). Postoperative healing photograph.\u003c/p\u003e\n\u003cp\u003eObservation indicators:\u003c/p\u003e\n\u003cp\u003e(1) Clinical efficacy: The clinical efficacy of the two groups was evaluated at 3 months after the operation and categorized into cured and not cured. Cured refers to the complete disappearance of positive signs and symptoms and no recurrence within 3 months. (ii) Failure to cure refers to the patients\u0026apos; postoperative wounds not healing, or the formation of anal fistula or abscess at the primary site within 3 months. Total effective ratio of treatment = number of cured/total number of patients.\u003c/p\u003e\n\u003cp\u003e(2) Traumatic pain score: Traumatic pain was evaluated on the 1st, 7th and 14th postoperative days according to the visual analogue scale (VAS) of pain in both groups. The scale was 0-10 points, with 0 being no pain and 10 being unbearable pain, and the higher the score, the deeper the pain.\u003c/p\u003e\n\u003cp\u003e(3) Wound exudate score: on the 1st, 7th and 14th postoperative days, the wound penetrated the gauze, and the score was from 0 to 3, with 0 being no obvious secretion, 1 being secretion but not penetrating a piece of gauze, 2 being secretion penetrating a piece of gauze but not the second piece, and 3 being secretion penetrating two pieces of gauze and above, and the higher the score was, the more the exudate was.\u003c/p\u003e\n\u003cp\u003e(4) Granulation growth: observe the granulation growth of postoperative wound on the 1st, 7th and 14th day after operation, score 0~3, 0 is good granulation growth, 1 is bright red granulation, easy to bleed by rubbing, 2 is light red granulation, not easy to bleed by rubbing, 3 is less granulation and light grayish-white granulation, not easy to bleed by rubbing, the higher the score, the worse the growth of the granulation is.\u003c/p\u003e\n\u003cp\u003e(5) Traumatic edema score: The postoperative traumatic edema was observed on the 1st, 7th and 14th days after the operation, and the score ranged from 0 to 3, with 0 being no edema at the edge of the trauma, 1 being slight edema at the edge of the trauma, 2 being redness and swelling of the trauma, which slightly affected the evacuation of feces, and 3 being extensive edema at the edge of the trauma, which seriously affected the evacuation of feces and daily life, and the higher the score was, the more serious was the degree of edema.\u003c/p\u003e\n\u003cp\u003e(6) Hospitalization time and wound healing time: hospitalization time is calculated from the first day of admission to the day of discharge; wound healing time is expressed as the number of days from the first postoperative day to the day when the wound is completely covered by skin.\u003c/p\u003e\n\u003cp\u003e(7) Anal incontinence was evaluated by Wexner anal incontinence scoring index, which was evaluated from gas, liquid, solid, liner and lifestyle changes, with a total of 5 items, and a five-level scoring method (never, occasionally, sometimes, often, always) was used to evaluate the score for each item, with the score of the item ranging from 0 to 4, and the total score ranging from 0 to 20, and the score of 10 was used as the cut-off value for the severity of incontinence, and the higher the score, the more serious the incontinence was. The higher the patient\u0026apos;s score, the more serious the incontinence, 0 is normal, 20 is total incontinence, and the higher the score, the more serious the anal incontinence.\u003c/p\u003e\n\u003cp\u003eStatistical Methods:\u003c/p\u003e\n\u003cp\u003eIt was analyzed by using SPSS 26.0 statistical software, and the measurement information was expressed as (\u003cem\u003exˉ\u0026plusmn; s\u003c/em\u003e), and the comparison between groups was made by using independent samples t-test, and the counting information was expressed as (\u003cem\u003en\u003c/em\u003e), and the difference was considered statistically significant with P\u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003eFollow-up Methods Clinical and Anal Manometry Assessments\u003c/p\u003e\n\u003cp\u003eUpon discharge, patients receive weekly follow-up appointments in the outpatient clinic until their wounds are fully healed, followed by a follow-up appointment in the third month after surgery. Patients are questioned about anal control in a targeted manner. For recurrent abscesses and fistulae that form, we perform drainage and fistulotomy as needed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eComparison of postoperative trauma scores between the two groups:\u003c/p\u003e\n\u003cp\u003eComparison of trabecular exudate scores: the difference in postoperative trabecular exudate scores between the two groups on the 1st, 7th and 14th days was not statistically significant (p\u0026gt;0.05), and trabecular exudate scores were decreasing on the 1st, 7th and 14th days after surgery, and trabecular exudate of the I\u0026amp;D group was lower than that of the TRISDS group after the 1st, 7th and 14th days. See Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Comparison of traumatic exudate scores between the two groups (`x\u0026plusmn;s)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.343434343434346%\" valign=\"top\"\u003e\n \u003cp\u003ewound exudate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.171717171717173%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.343434343434346%\" valign=\"top\"\u003e\n \u003cp\u003eD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003e2.68\u0026plusmn;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003e2.54\u0026plusmn;0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.171717171717173%\" valign=\"top\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.343434343434346%\" valign=\"top\"\u003e\n \u003cp\u003eD7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003e1.72\u0026plusmn;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003e1.56\u0026plusmn;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.171717171717173%\" valign=\"top\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.343434343434346%\" valign=\"top\"\u003e\n \u003cp\u003eD14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003e1.08\u0026plusmn;0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.242424242424242%\" valign=\"top\"\u003e\n \u003cp\u003e0.80\u0026plusmn;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.171717171717173%\" valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of trabecular granulation scores:\u0026nbsp;\u003c/strong\u003etrabecular granulation growth was not statistically significant on postoperative days 1, 7, and 14 (p\u0026gt;0.05), but trabecular granulation scores in both groups were lower on postoperative days 7 and 14 compared with day 1, and the scores in the TRISDS group were better than those in the I\u0026amp;D group; see Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eComparison of trabecular granulation growth scores between the two groups (`x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003ebud growth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003eD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e2.64\u0026plusmn;0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e2.76\u0026plusmn;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003eD7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e1.62\u0026plusmn;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e1.78\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003eD14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e1.06\u0026plusmn;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.510204081632654%\" valign=\"top\"\u003e\n \u003cp\u003e1.30\u0026plusmn;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" valign=\"top\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of the degree of trabecular edema:\u003c/strong\u003e there was no statistically significant difference in the degree of trabecular edema between the two groups on the 1st, 7th and 14th postoperative days (p\u0026gt;0.05), but the scores of the TRISDS group were lower than those of the I\u0026amp;D group on the 1st, 7th and 14th postoperative days. The degree of trabecular edema was lower in both groups on postoperative days 7 and 14 compared to day 1. See Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Comparison of trauma edema scores between the two groups (`x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003etraumatic edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.52\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.66\u0026plusmn;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eD7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.48\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.6\u0026plusmn;0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.416666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eD14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.4\u0026plusmn;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.916666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e0.48\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of traumatic pain scores :\u003c/strong\u003eOn the 7th and 14th postoperative days, there was no statistically significant difference in the comparison of traumatic pain scores between the two groups (P\u0026gt;0.05); the traumatic pain scores of both groups were lower than that on the 1st postoperative day, and I\u0026amp;D was lower than that of TRISDS, and the difference was statistically significant on the 1st postoperative day (both P\u0026lt;0.05). See Table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Comparison of traumatic pain scores between the two groups (`x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eD1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e7.50\u0026plusmn;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e6.86\u0026plusmn;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eD7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.64\u0026plusmn;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e3.38\u0026plusmn;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eD14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1.36\u0026plusmn;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e1.58\u0026plusmn;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*: p\u0026lt;0.05 compared to TRISDS group\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of clinical outcomes between the two groups:\u0026nbsp;\u003c/strong\u003e86% cure rate and 14% failure rate in the TRISDS group (cured/failed to cure: 43/7, n=50); 42% cure rate and 58% failure rate in the I\u0026amp;D group (cured/failed to cure: 21/29, n=50); the fistula rate was 10% and 36%, respectively; see Table 6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6:\u0026nbsp;\u003c/strong\u003eClinical outcome and fistula rate (%) of patients in both groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.913357400722022%\" valign=\"top\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003enumber of examples\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.859205776173285%\" valign=\"top\"\u003e\n \u003cp\u003ecurable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003euntreated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566787003610107%\" valign=\"top\"\u003e\n \u003cp\u003efistula formation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.205776173285198%\" valign=\"top\"\u003e\n \u003cp\u003efistula rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.342960288808664%\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence of abscesses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.967509025270758%\" valign=\"top\"\u003e\n \u003cp\u003eoverall effectiveness rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566787003610107%\" valign=\"top\"\u003e\n \u003cp\u003efailure rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.913357400722022%\" valign=\"top\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.859205776173285%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.649819494584838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.205776173285198%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.205776173285198%\" valign=\"top\"\u003e\n \u003cp\u003e10%#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.342960288808664%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.967509025270758%\" valign=\"top\"\u003e\n \u003cp\u003e86%#\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566787003610107%\" valign=\"top\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.913357400722022%\" valign=\"top\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.288808664259928%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.859205776173285%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.649819494584838%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.205776173285198%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.205776173285198%\" valign=\"top\"\u003e\n \u003cp\u003e36%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.342960288808664%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.967509025270758%\" valign=\"top\"\u003e\n \u003cp\u003e42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.566787003610107%\" valign=\"top\"\u003e\n \u003cp\u003e58%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e#: p\u0026lt;0.05 vs. I\u0026amp;D group\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of trauma healing and hospitalization time between the two groups of patients:\u0026nbsp;\u003c/strong\u003ethe hospitalization time of the\u0026nbsp;two groups of patients is compared: the hospitalization time of TRISDS group is shorter, but there is no statistical significance between the two groups (p\u0026gt;0.05); comparison of trauma healing time: the time of TRISDS group\u0026apos;s trauma healing group is shorter than that of the I\u0026amp;D group, and the comparison of the two groups (p\u0026lt;0.05) is statistically significant. See Table 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7:\u0026nbsp;\u003c/strong\u003eWound healing and duration of hospitalization in both groups (`x \u0026plusmn; s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003egroups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eWound healing time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eLength of hospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e33.96\u0026plusmn;4.13\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e7.02\u0026plusmn;1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e37.68\u0026plusmn;6.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e7.36\u0026plusmn;1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.333333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e#: p\u0026lt;0.05 vs. I\u0026amp;D group\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison of Wexner scores of patients in two groups:\u0026nbsp;\u003c/strong\u003epreoperative scores of patients in two groups (p\u0026gt;0.05), the difference is not statistically significant; 21 days after the operation, the scores of I\u0026amp;D group were higher than those of TRISDS group, and the difference between the two groups was statistically significant; 42 days after the operation, the scores of TRISDS group were lower than those of I\u0026amp;D group, but the difference was not statistically significant (p\u0026gt;0.05), the difference was not statistically significant. 0.05),the difference was not statistically significant. See Table 8\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8:\u003c/strong\u003e Comparison of Wexner score between two groups of patients (`x\u0026plusmn;s)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.161616161616163%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"41.41414141414141%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eTRISDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"42.42424242424242%\" colspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eI\u0026amp;D\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"bottom\"\u003e\n \u003cp\u003eWexner Rating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003epreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative D21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative D42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003epreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative D21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative D42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.842105263157894%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.32\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e1.82\u0026plusmn;1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.50\u0026plusmn;0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.36\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\" valign=\"top\"\u003e\n \u003cp\u003e1.28\u0026plusmn;1.20*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.64\u0026plusmn;0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*: p\u0026lt;0.05 compared to TRISDS group\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePerianal abscess is a common infectious disease in the perianal area that can develop and spread along the perianal space. Once this disease appears, it often cannot be self-healed or cannot be eradicated by medication. For perianal abscess, surgical treatment is currently preferred, and the commonly used surgical procedures in the clinic are I\u0026amp;D or radical surgery for perianal abscess. However, after I\u0026amp;D, about 9%-66% of patients can develop anal fistula. In order to reduce the rate of fistula, some scholars resected the suspected fistula during drainage, which is called \u0026quot;radical perianal abscess surgery\u0026quot;. However, in the acute abscess stage, the surrounding tissues are severely inflamed and edematous, and it is difficult to determine the location of the internal orifice, and blind exploration may cause a false pathway, which may cause more damage and may result in postoperative anal defect or increased risk of incontinence. The risk of incontinence increases\u003csup\u003e[12]\u003c/sup\u003e . In addition, some patients do not form an anal fistula after I\u0026amp;D, so there is no theoretical basis for performing sphincterotomy in all patients with perianal abscess.\u003c/p\u003e\n\u003cp\u003eMore than 90% of perianal abscesses are caused by infection of the anal glands based on the pathogenesis of the \u0026quot;glandular theory of infection\u0026quot;\u003csup\u003e[1]\u003c/sup\u003e . The primary focus of infection is located between the sphincters and can spread downward to the anal verge, upward to the rectal wall or outward through the external sphincter to the sciorectal fossa. An intersphincteric infection is similar to an abscess in a closed space; this closed space needs to be adequately drained and kept open in order to eradicate the infection and allow the abscess to heal properly. Failure to remove the intersphincteric infection may lead to the formation of an anal fistula. Therefore, removal of the primary site of infection, clarification of the location of the abscess, and thorough drainage are critical steps in treatment.\u003c/p\u003e\n\u003cp\u003eIn order to effectively treat perianal abscesses and better protect anal function, we have innovated on the basis of the modified Parks Loose Hanging String Technique by adopting TRISDS for the treatment of perianal abscesses according to the pathophysiologic mechanism of its pathogenesis.\u003c/p\u003e\n\u003cp\u003eIn our study, TRISDS for the treatment of perianal abscesses significantly reduced the risk of fistula compared to I\u0026amp;D alone. In I\u0026amp;D, the fistula rate was 36%, whereas the TRISDS treatment group had a significantly lower fistula rate. We consider the TRISDS group hanging the inner sphincter silk thread from the intersphincter access can destroy the intermuscular primary infection foci, the friction of the silk thread can also further promote the drainage of the intermuscular foci and remove the potentially infected anal gland ducts, which reduces the rate of fistula, at the same time, one hanging from the intermuscular to the internal opening of the silk thread, retaining the sphincter\u0026apos;s integrity and facilitating the drainage of the second hanging of the external sphincter rubber strips are also on the intermuscular and extra-muscular sciatico-rectal fossa The second hanging of the external sphincter also exerted adequate drainage of the intermuscular and extra-muscular sciatico-rectal fossa pus while preserving the integrity of the external sphincter. In contrast, the I\u0026amp;D group did not destroy the primary infection foci, and drainage was not yet adequate, thus increasing the fistula rate.\u003c/p\u003e\n\u003cp\u003eThe results of this study show that TRISDS in the treatment of perianal abscess has achieved significant efficacy and less damage in anal function, but there are some patients who formed anal fistula after surgery, this procedure we will remove the thread of TRISDS on the 7th day after surgery in our previous cases, and in this study to summarize the reasons for fistula after TRISDS surgery, we consider that it is related to the timing of the removal of the thread, which is related to the timing of the removal of the thread. Early removal of the thread will lead to incomplete drainage of the wound, resulting in the failure of the wound to heal completely, forming a false healing, leading to anal fistula, and in the further clinical application, we gradually remove the thread according to the patient\u0026apos;s trauma, to achieve complete drainage, and to further improve the healing rate.\u003c/p\u003e\n\u003cp\u003eTRISDS did not ultimately result in increased functional damage to the anal sphincter, and when TRISDS is used for perianal abscesses, the filaments pass through the intermuscular groove of the internal and external sphincter muscles, and the resulting functional damage is very minimal compared with the more extensive one-time radical procedure. We selected 21 days postoperatively to measure anal function when the trauma had not yet completely healed, and we could find a statistically significant difference in anal function Wexner scores at 21 days postoperatively for I\u0026amp;D versus TRISDS (p\u0026lt;0.05), and we considered the hanging of the wire in the early postoperative period as well as the intermuscular formation of the incision in the early trauma at 21 days postoperatively when the trauma had not healed yet. When the wound is not yet healed, part of the wound margin is involutional and shortened, forming a defect, at this time the seal is poor, that is, it will be accompanied by a slight incontinence, and also selected for measurement when the wound is basically healed at 42 days postoperatively, it can be found that there is no statistical significance, and we consider that with the wound healing, the notch is closed, the defect formed is filled, and the anal function is also close to normal. This confirms that TRISDS is effective in protecting the patient\u0026apos;s postoperative anal function by achieving a better healing rate while also being essentially non-invasive to the anal sphincter.\u003c/p\u003e\n\u003cp\u003eIn this clinical study, we chose sciorectal space abscess for observation, but in clinical application, we found that TRISDS can also be taken for different types of abscesses.If the abscess is located in the intersphincter, only a curved incision can be made in the intersphincter, and only the inner sphincter can be hooked up, while the outer sphincter portion does not need to be hooked up. If the high interosseous abscess spreads to the pelvic rectal space but does not break through the external sphincter or anorectal muscle, the internal sphincter can be hooked up at the same time combined with the placement of a tube to flush the pus cavity to prevent pus residue; for the sciatic rectal fossa abscess with an unclear internal opening, it is not forced to pass through the anus for the internal sphincter to be hooked up but only hooked up to the external sphincter to avoid the formation of pseudo-endopenings to form a fistula of medical origin. Therefore, TRISDS is diverse in terms of future applications, and we also plan to consider its application to other types of abscesses and anal fistulas (e.g., horseshoe abscess, Crohn\u0026apos;s-type anal fistula).\u003c/p\u003e"},{"header":"Summarize","content":"\u003cp\u003eIn this study, considering the insufficient sample size, we did not make a direct comparison with one-time radical surgery. As a means of treating perianal abscesses, disposable radical surgery shows obvious advantages in terms of cure rate, but its impact on anal function should not be ignored. The aim of this study was to explore a more meticulous and protective treatment strategy to optimize the therapeutic effect and minimize the adverse effects on anal function. In a follow-up study, we also plan to investigate the differences in treatment outcomes between TRISDS and radical surgery in a multicenter comparison, and to analyze the differences in cure rates between this procedure and radical surgery, with the aim of further improving the procedure. Based on these findings, further large-sample clinical studies and widespread dissemination of the application are urgent. This initiative will help to evaluate the superiority and feasibility of TRISDS more comprehensively and objectively, while deepening its application in clinical practice. Through a wide range of studies, we are expected to further recognize the application potential of TRISDS, provide safer and more effective treatment options for patients with perianal abscesses, and maximize the protection of the functional integrity of the anus. Such systematic and in-depth research and continued promotional efforts will provide clinicians and patients with more viable treatment strategies, leading to more superior treatment outcomes and improved quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompeting interests：The authors declare no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eOpen Access Fund provided by the National Natural Science Foundation of China (82260938) Jiangxi Provincial Department of Education Innovation Project Grant (YC2021-S516) Jiangxi Provincial Department of Education Science and Technology Tackling Project (190682)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEISENHAMMER S (1956) The internal anal sphincter and the anorectal abscess[J]. Surg Gynecol Obstet 103(4):501\u0026ndash;506\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePARKS A G, GORDON P H, HARDCASTLE J D. (1976) A classification of fistula-in-ano[J/OL]. Br J Surg 63(1):1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/bjs.1800630102\u003c/span\u003e\u003cspan address=\"10.1002/bjs.1800630102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerianal abscess/fistula disease - PubMed[EB/OL]. [2024-02-04]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/20011384/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/20011384/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSKOVGAARDS D M, PERREGAARD H, HAGEN K B et al (2020) [Treatment of anal abscesses][J]. Ugeskr Laeger 182(51):V07200506\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAMATO A, BOTTINI C, DE NARDI P et al (2015) Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR)[J/OL]. Tech Coloproctol 19(10):595\u0026ndash;606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10151-015-1365-7\u003c/span\u003e\u003cspan address=\"10.1007/s10151-015-1365-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOMMER A, HEROLD A, BERG E et al (2017) German S3 guidelines: anal abscess and fistula (second revised version)[J/OL]. Langenbeck's Archives Surg 402(2):191\u0026ndash;201. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00423-017-1563-z\u003c/span\u003e\u003cspan address=\"10.1007/s00423-017-1563-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSAHNAN K, ASKARI A, ADEGBOLA S O et al (2017) Natural history of anorectal sepsis[J/OL]. Br J Surg 104(13):1857\u0026ndash;1865. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/bjs.10614\u003c/span\u003e\u003cspan address=\"10.1002/bjs.10614\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIncision and drainage of perianal abscess with or without treatment of anal fistula - PubMed[EB/OL]. [2024-02-04]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/20614450/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/20614450/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOLIVER I, LACUEVA F J, P\u0026Eacute;REZ VICENTE F et al (2003) Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment[J/OL]. Int J Colorectal Dis 18(2):107\u0026ndash;110. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00384-002-0429-0\u003c/span\u003e\u003cspan address=\"10.1007/s00384-002-0429-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePIGOT F (2015) Treatment of anal fistula and abscess[J/OL]. J Visc Surg 152(2 Suppl). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jviscsurg.2014.07.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jviscsurg.2014.07.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. S23-29\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHE Z, DU J, WU K et al (2020) Formation rate of secondary anal fistula after incision and drainage of perianal Sepsis and analysis of risk factors[J/OL]. BMC Surg 20(1):94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12893-020-00762-3\u003c/span\u003e\u003cspan address=\"10.1186/s12893-020-00762-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVOGEL JD, JOHNSON E K, MORRIS A M, Fistula [ et al (2016) J/OL] Dis Colon Rectum 59(12):1117\u0026ndash;1133. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/DCR.0000000000000733\u003c/span\u003e\u003cspan address=\"10.1097/DCR.0000000000000733\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"transsphincteric intersphenoidal double-hanging wire, perianal abscess, incision and drainage, randomized controlled","lastPublishedDoi":"10.21203/rs.3.rs-4253961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4253961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eOBJECTIVE\u003c/h2\u003e \u003cp\u003eTo study the clinical efficacy and safety of a novel procedure,Trans-intersphincteric Double Seton, for the treatment of perianal abscesses in the sciorectal hiatus.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e \u003cp\u003eThe study population consisted of patients with perianal abscess in the sciorectal space who underwent Trans-intersphincteric Double Seton (TRISDS) and perianal abscess Incision and Drainage (I\u0026amp;D) from September 2020 to September 2023 at the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine. The cure rate, hospitalization time, wound healing time, and Wexner score of anal function were observed in both groups after treatment.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e \u003cp\u003e100 patients with perianal abscess received surgical treatment, of which 50 patients (male/female: 41/9, mean age: 32.98 years old) received Trans-intersphincteric Double Seton as the observation group, and the other 50 patients (male/female: 38/12, mean age: 32.76 years old) received Incision and Drainage of perianal abscess as the control group, and the differences in the basic data of the patients of the two groups were not significant in comparison (P\u0026gt;0.05) and they are comparable. The cure rate of the observation group 86%, higher than the control group 42%, (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) the difference is statistically significant.hospitalization time of the observation group (7.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63) d is shorter than that of the control group (7.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64) d, the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) are not statistically significant.the healing time of the observation group (33.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81) d is shoeter than that of the control group (37.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24) d, (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) are comparable. ) d, (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) the difference was statistically significant. Evaluation of anal function: Wexner score comparison between the two groups of patients, no anal incontinence, preoperative and postoperative 42 days comparison (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), there is no statistical significance, 21 days after the operation, the observation group (1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32) is higher than the control group (1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20), the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05),the difference is statistically significant;\u003c/p\u003e\u003ch2\u003eCONCLUSION\u003c/h2\u003e \u003cp\u003eFor the treatment of perianal abscess in the sciorectal space, transsphincteric double-hanging suture does not lead to anal incontinence as does incision and drainage, but transsphincteric double-hanging suture is safer and more effective, with a higher rate of healing, shorter healing time, and good protection of anal function, which is of clinical promotion value.\u003c/p\u003e","manuscriptTitle":"A randomized controlled trial of a new procedure for the treatment of perianal abscesses, the Trans-intersphincteric Double Seton (TRISDS)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-08 20:41:13","doi":"10.21203/rs.3.rs-4253961/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"613f2c79-3d58-447d-84de-1ee584f61fa6","owner":[],"postedDate":"May 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-02T22:38:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-08 20:41:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4253961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4253961","identity":"rs-4253961","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}