Systematic review and network meta-analysis of cryptoglandular complex anal fistula treatment: evaluation of surgical strategies.

IF 2.4 3区医学 Q2 SURGERY

Updates in Surgery Pub Date : 2025-05-29 DOI:10.1007/s13304-025-02270-6

Isabel Sierra Fernández, Zutoia Balciscueta Coltell, Natalia Uribe Quintana

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引用次数: 0

Abstract

Background: Several surgical approaches are available for managing complex cryptoglandular perianal fistulas. However, a gold standard surgical technique has not yet been established. This network meta-analysis aims to assess and compare postoperative failure and anal incontinence pooled rates for different available surgical techniques for complex cryptoglandular anal fistulas.

Methods: Systematic searches were carried out on Pubmed, Ovid, the Cochrane Library database and ClinicalTrials.gov up to June 2023. All randomized comparative trials of nine surgical techniques for cryptoglandular complex perianal fistulas in adult patients were included. A systematic review and network meta-analysis was conducted using the PRISMA-NMA methodology. The endorectal advancement flap was used as the control technique, and the odds ratios (ORs) were calculated through pairwise and network meta-analysis with random effects.

Results: 16 randomized trials were included in this study. Network meta-analysis was conducted for each outcome. Techniques, such as cutting seton, fistulotomy with sphincter reconstruction, LIFT, and VAAFT, obtained similar results in terms of technique failure to the transanal advancement flap with no statistically significant differences. PLUG (OR = 3.6 [95%CI 1.1-11.5]), fibrin glue (OR = 7.5 [95%CI 2.2-25], and platelet-rich plasma (PRP) (OR = 11.5[95%CI 1.3-99]) demonstrated a statistically significant increase in the pooled failure rate. For anal incontinence, only the cutting seton technique exhibited a higher risk of postoperative incontinence (OR = 8.6 [95%CI 1-72.5]).

Conclusion: Our research highlights effective therapeutic approaches for complex anal fistulas, stressing the need to customize treatment based on location, anatomy, patient characteristics, and preferences. However, it advises against using plugs, fibrin glue, PRP therapy due to lower healing rates, and the seton technique because of its potential impact on anal continence. PROSPERO number CRD42022304345.

查看原文本刊更多论文

隐腺复杂性肛瘘治疗的系统回顾和网络荟萃分析：手术策略的评价。

背景：有几种手术方法可用于治疗复杂的隐腺肛周瘘管。然而，黄金标准的手术技术尚未建立。本网络荟萃分析旨在评估和比较不同可用手术技术治疗复杂隐腺肛瘘的术后失败率和肛门失禁合计率。方法：系统检索Pubmed、Ovid、Cochrane Library数据库和ClinicalTrials.gov，检索截止至2023年6月。九种手术技术治疗成人隐腺复杂性肛周瘘管的所有随机比较试验被纳入。采用PRISMA-NMA方法进行系统评价和网络荟萃分析。以直肠内推进瓣作为对照技术，通过随机效应的两两及网络meta分析计算优势比（ORs）。结果：本研究纳入16项随机试验。对每个结果进行网络荟萃分析。切开术、造瘘联合括约肌重建术、LIFT、VAAFT等技术在技术失败方面与经肛前进皮瓣相似，无统计学差异。PLUG （OR = 3.6 [95%CI 1.1-11.5]）、纤维蛋白胶（OR = 7.5 [95%CI 2.2-25]）和富血小板血浆（PRP）（OR = 11.5[95%CI 1.3-99]）的合并失败率有统计学意义的增加。对于肛门失禁，只有割肛术表现出更高的术后失禁风险（OR = 8.6 [95%CI 1-72.5]）。结论：我们的研究强调了复杂肛瘘的有效治疗方法，强调需要根据位置，解剖结构，患者特征和偏好定制治疗。然而，它建议不要使用塞、纤维蛋白胶、PRP疗法，因为治愈率较低，也不要使用塞顿技术，因为它可能对肛门失禁产生影响。普洛斯普洛斯号码CRD42022304345。

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来源期刊

Updates in Surgery Medicine-Surgery

CiteScore

4.50

自引率

7.70%

发文量

208

期刊介绍： Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future. Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts. Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.