Edizsoy A, Tahirli N, Tanyeri A, Tunçyürek P. Timing of ligation of the intersphincteric fistula tract after loose seton drainage in complex anal fistulas. World J Gastrointest Surg 2026; 18(10): 123763 [DOI: 10.4240/wjgs.123763]
Corresponding Author of This Article
Akay Edizsoy, MD, Assistant Professor, Department of General Surgery/Surgical Oncology, Aydın Adnan Menderes University, Zafer Mahallesi, Efeler 09100, Aydın, Türkiye. akayedizsoy@yahoo.com
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Surgery
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Edizsoy A, Tahirli N, Tanyeri A, Tunçyürek P. Timing of ligation of the intersphincteric fistula tract after loose seton drainage in complex anal fistulas. World J Gastrointest Surg 2026; 18(10): 123763 [DOI: 10.4240/wjgs.123763]
World J Gastrointest Surg. Oct 27, 2026; 18(10): 123763 Published online Oct 27, 2026. doi: 10.4240/wjgs.123763
Timing of ligation of the intersphincteric fistula tract after loose seton drainage in complex anal fistulas
Akay Edizsoy, Narmin Tahirli, Ahmet Tanyeri, Pars Tunçyürek
Akay Edizsoy, Department of General Surgery/Surgical Oncology, Aydın Adnan Menderes University, Efeler 09100, Aydın, Türkiye
Narmin Tahirli, Pars Tunçyürek, Department of General Surgery, Aydın Adnan Menderes University, Efeler 09100, Aydın, Türkiye
Ahmet Tanyeri, Department of Radiology, Aydın Adnan Menderes University, Efeler 09100, Aydın, Türkiye
Author contributions: Edizsoy A and Tunçyürek P designed the study; Edizsoy A, Tahirli N, and Tanyeri A collected the data; Edizsoy A, Tanyeri A, and Tunçyürek P performed the analyses; Edizsoy A drafted and wrote the manuscript; Tunçyürek P critically revised the manuscript. All authors approved the final version.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Institutional review board statement: This retrospective study was approved by the Institutional Ethics Committee of Aydın Adnan Menderes University, No. 2025/348.
Informed consent statement: Written informed consent was obtained from each patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: Akay Edizsoy, MD, Assistant Professor, Department of General Surgery/Surgical Oncology, Aydın Adnan Menderes University, Zafer Mahallesi, Efeler 09100, Aydın, Türkiye. akayedizsoy@yahoo.com
Received: May 28, 2026 Revised: June 30, 2026 Accepted: July 16, 2026 Published online: October 27, 2026 Processing time: 134 Days and 9 Hours
Abstract
BACKGROUND
The ligation of intersphincteric fistula tract (LIFT) is a well-established technique for complex anal fistulas; however, recurrence remains a concern, particularly when performed before complete resolution of residual infection.
AIM
To evaluate the role of interval magnetic resonance imaging (MRI) in determining definitive LIFT timing after loose seton drainage for complex anal fistulas.
METHODS
Between 2023 and 2025, 48 patients with anal fistulas were studied retrospectively to evaluate bridging loose seton placement followed by LIFT. Preoperative MRI was performed in all patients, while interval MRI was selectively used to assess residual abscess cavities and guide surgical timing. Patient demographics, comorbidities, fistula characteristics, and postoperative outcomes were analyzed. Functional outcomes were assessed using the Wexner incontinence score before and 2 months after LIFT.
RESULTS
Primary healing after LIFT was achieved in 91.7% of patients, while 8.3% (4 patients) experienced recurrence. In 9 patients with persistent abscess cavities, MRI was used to support surgical timing decisions and document regression of inflammatory findings. Recurrence occurred in 1 patient out of the 9 patients (11.1%) who underwent delayed LIFT after interval MRI and in 3 patients out of the 39 patients (7.7%) who underwent LIFT at the planned 8-week interval. Given the small sample size and baseline differences, these findings should be interpreted descriptively. No new continence disturbances occurred, and Wexner scores showed no significant change. Diabetes and cardiovascular disease were numerically more frequent among patients with recurrence but without statistical significance.
CONCLUSION
Interval MRI may assist definitive LIFT timing in selected patients with persistent inflammatory cavities after loose seton drainage. Prospective studies are needed to validate this approach.
Core Tip: This study suggests that timing of the ligation of intersphincteric fistula tract surgical procedure after loose seton drainage may be clinically relevant in selected patients with complex anal fistulas. Interval magnetic resonance imaging may help identify persistent inflammatory cavities that warrant postponement of definitive surgery. However, due to the overall small sample size and baseline differences observed between the groups evaluated in this study, no conclusions can be drawn regarding the superiority of delayed vs standard-timing ligation of intersphincteric fistula tract.
