PMID- 37460830
OWN - NLM
STAT- MEDLINE
DCOM- 20230911
LR  - 20231221
IS  - 1128-045X (Electronic)
IS  - 1123-6337 (Print)
IS  - 1123-6337 (Linking)
VI  - 27
IP  - 10
DP  - 2023 Oct
TI  - Efficacy of different surgical treatments for management of anal fistula: a 
      network meta-analysis.
PG  - 827-845
LID - 10.1007/s10151-023-02845-8 [doi]
AB  - PURPOSE: Currently, the anal fistula treatment which optimises healing and 
      preserves bowel continence remains unclear. The aim of our study was to compare 
      the relative efficacy of different surgical treatments for AF through a network 
      meta-analysis. METHODS: Systematic searches of MEDLINE, EMBASE and CENTRAL 
      databases up to October 2022 identified randomised controlled trials (RCTs) 
      comparing surgical treatments for anal fistulae. Fistulae were classified as 
      simple (inter-sphincteric or low trans-sphincteric fistulae crossing less than 
      30% of the external anal sphincter (EAS)) and complex (high trans-sphincteric 
      fistulae involving more than 30% of the EAS). Treatments evaluated in only one 
      trial were excluded from the primary analyses to minimise bias. The primary 
      outcomes were rates of success in achieving AF healing and bowel incontinence. 
      RESULTS: Fifty-two RCTs were included. Of the 14 treatments considered, there 
      were no significant differences regarding short-term (6 months or less 
      postoperatively) and long-term (more than 6 months postoperatively) success rates 
      between any of the treatments in patients with both simple and complex anal 
      fistula. Ligation of the inter-sphincteric fistula tract (LIFT) ranked best for 
      minimising bowel incontinence in simple (99.1% of comparisons; 3 trials, n = 70 
      patients) and complex anal fistula (86.2% of comparisons; 3 trials, n = 102 
      patients). CONCLUSIONS: There is insufficient evidence in existing RCTs to 
      recommend one treatment over another regarding their short and long-term efficacy 
      in successfully facilitating healing of both simple and complex anal fistulae. 
      However, LIFT appears to be associated with the least impairment of bowel 
      continence, irrespective of AF classification.
CI  - (c) 2023. The Author(s).
FAU - Bhat, S
AU  - Bhat S
AUID- ORCID: 0000-0003-3770-8996
AD  - Surgical and Translational Research Centre, Department of Surgery, The University 
      of Auckland, Auckland, New Zealand.
AD  - Department of Surgery, Te Whatu Ora MidCentral, Palmerston North, New Zealand.
FAU - Xu, W
AU  - Xu W
AD  - Surgical and Translational Research Centre, Department of Surgery, The University 
      of Auckland, Auckland, New Zealand.
AD  - Department of Surgery, Te Whatu Ora Te Toka Tumai, Whangarei, New Zealand.
FAU - Varghese, C
AU  - Varghese C
AD  - Surgical and Translational Research Centre, Department of Surgery, The University 
      of Auckland, Auckland, New Zealand.
FAU - Dubey, N
AU  - Dubey N
AD  - Department of General Medicine, Tauranga Hospital, Te Whatu Ora, Tauranga, New 
      Zealand.
FAU - Wells, C I
AU  - Wells CI
AD  - Surgical and Translational Research Centre, Department of Surgery, The University 
      of Auckland, Auckland, New Zealand.
AD  - Department of Surgery, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand.
FAU - Harmston, C
AU  - Harmston C
AD  - Surgical and Translational Research Centre, Department of Surgery, The University 
      of Auckland, Auckland, New Zealand.
AD  - Department of Surgery, Te Whatu Ora Te Toka Tumai, Whangarei, New Zealand.
FAU - O'Grady, G
AU  - O'Grady G
AD  - Surgical and Translational Research Centre, Department of Surgery, The University 
      of Auckland, Auckland, New Zealand.
AD  - Auckland Bioengineering Institute, The University of Auckland, Auckland, New 
      Zealand.
FAU - Bissett, I P
AU  - Bissett IP
AD  - Surgical and Translational Research Centre, Department of Surgery, The University 
      of Auckland, Auckland, New Zealand.
FAU - Lin, A Y
AU  - Lin AY
AD  - Department of Surgery and Anaesthesia, University of Otago, Wellington, New 
      Zealand. tony.lin@otago.ac.nz.
AD  - Department of Surgery, Wellington Regional Hospital, Te Whatu Ora, Wellington, 
      New Zealand. tony.lin@otago.ac.nz.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20230717
PL  - Italy
TA  - Tech Coloproctol
JT  - Techniques in coloproctology
JID - 9613614
SB  - IM
MH  - Humans
MH  - *Fecal Incontinence/etiology/surgery
MH  - Network Meta-Analysis
MH  - Wound Healing
MH  - Anal Canal/surgery
MH  - Ligation/adverse effects
MH  - *Rectal Fistula/surgery/etiology
MH  - Treatment Outcome
PMC - PMC10485107
OTO - NOTNLM
OT  - Complex
OT  - Fistula-in-ano
OT  - Healing
OT  - Incontinence
OT  - Sphincter preserving
COIS- Professor Greg O'Grady and Professor Ian P. Bissett have ownership interests with 
      The Insides Company Ltd (Auckland, New Zealand). Professor O'Grady is an 
      executive director, co-founder, and chief scientific officer. Professor Bissett 
      is a co-founder and chief medical officer. Professor O'Grady is also a co-founder 
      and chief executive officer of Alimetry Ltd (Auckland, New Zealand). The 
      remaining authors have no conflicts of interest to disclose.
EDAT- 2023/07/18 01:09
MHDA- 2023/09/11 06:43
PMCR- 2023/07/17
CRDT- 2023/07/17 23:34
PHST- 2023/05/03 00:00 [received]
PHST- 2023/07/06 00:00 [accepted]
PHST- 2023/09/11 06:43 [medline]
PHST- 2023/07/18 01:09 [pubmed]
PHST- 2023/07/17 23:34 [entrez]
PHST- 2023/07/17 00:00 [pmc-release]
AID - 10.1007/s10151-023-02845-8 [pii]
AID - 2845 [pii]
AID - 10.1007/s10151-023-02845-8 [doi]
PST - ppublish
SO  - Tech Coloproctol. 2023 Oct;27(10):827-845. doi: 10.1007/s10151-023-02845-8. Epub 
      2023 Jul 17.