Techniques in Coloproctology最新文献

{"title":"Outcomes of laparoscopic ventral mesh rectopexy versus trans-vaginal repair in management of anterior rectocele, a randomized controlled trial.","authors":"A Sanad, A Sakr, H Elfeki, W Omar, W Thabet, E Fouda, E Abdallah, S A Elbaz","doi":"10.1007/s10151-025-03145-z","DOIUrl":"10.1007/s10151-025-03145-z","url":null,"abstract":"<p><strong>Background: </strong>Anterior rectocele is one of the most common colorectal problems with symptoms of obstructed defecation or rectal emptying difficulties. The aim of this study is to compare the outcomes of laparoscopic ventral mesh rectopexy (LVMR) and transvaginal repair (TVR) for symptomatic anterior rectocele.</p><p><strong>Methods: </strong>This is a prospective randomized controlled trial conducted with 40 women. Patients were randomized into two groups. LVMR was done in the first group, whereas the second group underwent TVR. Patient outcomes were compared regarding improvement in constipation using the Cleveland Clinic Constipation (CCC) score and sexual-related quality of life score using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) at 6- and 12-month follow-up.</p><p><strong>Results: </strong>Forty females were enrolled in this trial. Each group comprised 20 patients. Preoperatively, the CCC score was 17 ± 2.8 in the LVMR group vs. 17.3 ± 2 in the TVR group (P = 0.278). A significant decrease in the constipation score was recorded in each group at 6 and 12 months after surgery. Regarding sexual function, the mean PISQ-12 score at 6 months was 32 ± 3.9 for LVMR vs. 35 ± 1.4 for TVR, P < 0.001), while at 12 months no difference was noted between the two groups. However, each group showed significant improvement in the PISQ-12 score at 6- and 12-month follow-up.</p><p><strong>Conclusion: </strong>Comparable results were noted for LVMR and TVR in management of anterior rectocele. Obstructive defecation symptoms and sexual function showed significant improvement after 1 year of follow-up. Nevertheless, long-term follow-up is needed.</p><p><strong>Clinical trial registration: </strong>The study was registered in the clinical trials registry with registration number NCT06633172.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"125"},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissection of giant bulky colorectal lesions with muscle retracting sign (MRS+). Strategic management of gravitational traction during ESD might be the solution.","authors":"P Zormpas, K Dimopoulou, M Spinou, Y Komeda, A Papathanasis, E Nakou, E Voulgari, D Dimitriadis, G Tribonias","doi":"10.1007/s10151-025-03151-1","DOIUrl":"10.1007/s10151-025-03151-1","url":null,"abstract":"<p><strong>Background: </strong>Large polyps have a higher risk of muscle retracting sign (MRS) positivity and display higher incomplete resection rates by endoscopic submucosal dissection (ESD). Techniques used are pocket creation methods and circumferential excision with traction application. This is a pilot study aiming to explore the efficacy and safety of a new ESD technique for MRS+ lesions.</p><p><strong>Methods: </strong>First, a 5-cm-long tunnel is created distally from the lesion, stabilizing the scope and enabling a deeper, flatter dissection plane. As the resection nears the lesion's center with suspected MRS, a local pocket is made for circular access to the muscle retraction tip. Effective gravity management is key for procedure success. Initially working against gravity (or opposite to the direction of gravity) allows better submucosal exposure. Subsequently, patient position is adjusted to allow the specimen to be pulled by gravity towards the dissection line. As a result, the altered position loosens the muscle layer, thereby reducing the tension at the MRS site and ultimately the perforation risk. Finally, a circumferential \"360° dissection\" is performed, with prophylactic coagulation applied at the muscle retraction tip to minimize bleeding from large feeding vessels.</p><p><strong>Results: </strong>Our cases series consists of 18 patients who underwent ESD for MRS+ colonic (3/18) and rectal (15/18) giant (> 4 cm) lesions, with en bloc and R0 resection documented in 16/18(89%) cases. Two patients were referred to surgery because of massive MRS+ and high risk of severe intraprocedural bleeding.</p><p><strong>Conclusions: </strong>This case series demonstrates the efficacy of the aforementioned technique, yielding satisfactory results in the majority of cases-even those without curative resection. The application of this technique not only in giant rectal polyps but also in colonic protruding lesions amplifies the significance of the proposal.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"124"},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to classify: a narrative and scoping review of the old and the new classifications of perianal Crohn's disease.","authors":"T Pelly, E Anand, L Hanna, E Shakweh, S Joshi, P Lung, A Hart, P Tozer","doi":"10.1007/s10151-025-03161-z","DOIUrl":"10.1007/s10151-025-03161-z","url":null,"abstract":"<p><p>Perianal Crohn's disease (pCD) is a complex manifestation of Crohn's disease. Classifying this patient cohort for both clinical purposes and for inclusion into research trials is challenging but crucial in order to improve outcomes. This review provides an overview of historical classifications of both fistulising and non-fistulising pCD, including the Park's, Cardiff-Hughes and American Gastroenterological Association (AGA) classifications, as well as recent advances including the Treatment Optimisation and CLASSification of perianal Crohn's disease (TOpClass) classification of fistulising pCD. Secondly, this article provides a scoping review of recent trials in pCD and describes how the cohorts in these trials relate to the TOpClass classification. Of the 19 studies relating to pCD that were identified, four could be confidently classified as class 2a. Seven could be classified as class 2a or 2b, but it was not possible to subdivide further, and seven to class 2a, 2b or 2c, but it was not possible to subdivide further. One study population was classified as class 2a or 2c. In eight studies, it was not specified whether patients with a defunctioning stoma were included or excluded. This review demonstrates the heterogeneous nature of some patient cohorts in previous clinical trials, and how the TOpClass classification may be used to group patients more accurately for clinical use and inclusion in research trials.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"123"},"PeriodicalIF":2.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 5-year outcomes and predictors of healing in chronic anal fissure treated with botulinum toxin: a retrospective analysis of 199 cases.","authors":"C Arslan, Y Yildirim, M Kocak, T Bisgin, I Erenler Bayraktar, O Bayraktar","doi":"10.1007/s10151-025-03162-y","DOIUrl":"10.1007/s10151-025-03162-y","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin (BT) is a nonsurgical alternative to lateral internal sphincterotomy (LIS). While there are promising results, there is still a gap in knowledge regarding long-term outcomes and the predictors for healing after BT.</p><p><strong>Methods: </strong>Chronic anal fissure (CAF) patients treated with 100 IU BT with a minimum 5-year follow-up were analyzed retrospectively. Patients with persistent or recurrent fissures after their first BT injection were offered either a second BT injection or LIS. Healing was defined as complete symptom resolution with fissure epithelization. The primary outcome measure was recurrence-free healing rate with BT at 5 years. Predictors of healing were assessed by logistic regression analysis.</p><p><strong>Results: </strong>The mean age was 33.8 ± 10 years, and 139 (69.5%) patients were female. The complete healing rate at 5 years was 73.8% and 26.2% for the patients that underwent LIS. Multivariate analysis for LIS likelihood revealed that female gender (odds ratio, OR: 0.48, 95% confidence intervals, CI 0.25-0.92, p = 0.028), absence of chronic constipation (OR: 0.09, 95% CI 0.03-0.25, p = < 0.0001), and shorter constipation duration (OR: 1.10, 95% CI 1.06-1.13, p = < 0.0001) were predictors for recurrent-free healing after BT at 5-years. A cutoff value of 10 months of constipation yielded an accuracy of 88% for predicting nonhealing with BT (AUC: 0.881). BT-related incontinence was mild and resolved within 2 months, while LIS resulted in 19.2% permanent incontinence at 5 years.</p><p><strong>Conclusions: </strong>BT is an effective and safe treatment for CAF, with acceptable long-term outcomes and minimal incontinence risk. Constipation duration and gender are key predictors of healing, aiding patient selection. Male patients with prolonged constipation may benefit from earlier consideration of LIS.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"122"},"PeriodicalIF":2.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left colectomy for diverticular disease: systematic review and meta-analysis comparing robotic and laparoscopic resections.","authors":"H A Eltyeb, A Y Y Mohamedahmed, G A Mills, J Khan","doi":"10.1007/s10151-025-03155-x","DOIUrl":"10.1007/s10151-025-03155-x","url":null,"abstract":"<p><strong>Background: </strong>Around 50% of people aged 60 years and above are affected by diverticular disease, and 25% of these individuals will require surgical intervention. Our objective is to compare the results of left colonic resection for sigmoid diverticular disease using both robotic and laparoscopic approaches. Our primary aim is to conduct a meta-analysis while investigating the rates of conversion to open surgery, stoma and complications between the two methods.</p><p><strong>Methodology: </strong>A systematic review was conducted following the PRISMA guidelines. A meta-analysis was performed using RevMan Version 5.4 software. The random-effect model was employed to pool dichotomous outcomes and estimate risk and odds ratios (OR).</p><p><strong>Results: </strong>Eight studies were thought to fulfil the eligibility criteria: 1892 patients (49.2%) had robotic surgery, and 1952 patients (50.84%) underwent a laparoscopic approach. There were fewer conversions to open surgery in the robotic group when compared to the laparoscopic group (P < 0.00001), a lower rate of postoperative ileus (P = 0.005), shorter length of stay (mean difference (MD) 0.18 P = 0.003) and fewer morbidities (P = 0.002). There were similar rates of stoma formation (4.7%, P = 1.00), anastomotic leak (2.6%, P = 0.85) and mortality (0.3% vs 0.2%, P = 0.59). The operative time was shorter in the robotic approach, although the difference was not significant (P = 0.47).</p><p><strong>Conclusion: </strong>Robotic surgery is feasible for diverticular disease compared to laparoscopic left colectomy. Our study observed a reduction in the conversion to open rate, reduced morbidity, and less ileus while demonstrating similar rates of stoma formation, anastomotic leak, and mortality. However, more high-quality research needs to be conducted to investigate this further. The study is registered in Prospero (reg # CRD42023440509).</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"121"},"PeriodicalIF":2.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of laparoscopic two-team transanal beyond total mesorectal excision for advanced and recurrent rectal cancer with invasion: a retrospective study compared with conventional laparoscopic approach.","authors":"Ikuma Shioi, Takuya Shiraishi, Yutaro Shimizu, Kosei Uehara, Takahiro Seki, Nobuhiro Hosoi, Kouhei Tateno, Mizuki Endo, Shintaro Uchida, Arisa Yamaguchi, Chika Katayama, Yuta Shibasaki, Chika Komine, Katsuya Osone, Takuhisa Okada, Akiharu Kimura, Akihiko Sano, Makoto Sakai, Ken Shirabe, Hiroshi Saeki","doi":"10.1007/s10151-025-03158-8","DOIUrl":"10.1007/s10151-025-03158-8","url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical approach for advanced or recurrent rectal cancer with invasion of adjacent structures remains controversial. This study aimed to clarify the feasibility of laparoscopic two-team transanal beyond total mesorectal excision in patients with advanced and recurrent rectal cancer with invasion.</p><p><strong>Methods: </strong>This single-center retrospective study was conducted in a single educational hospital in Japan from January 2014 to March 2024. Patients with advanced or recurrent rectal cancer who underwent laparoscopic or two-team transanal total mesorectal excision with the resection of adjacent structures were included in the analysis. Short-term outcomes were compared between the laparoscopic and transanal approaches. The burden of medical resources was assessed using a new index, Staff Time Consumed (STC = median number of participating staff members × operation time).</p><p><strong>Results: </strong>In total, 35 patients were included. More patients underwent preoperative treatment and lateral lymph-node dissection using the transanal approach. However, the operative time (539 and 339 min in the laparoscopic and transanal groups, respectively; p < 0.001) and total blood loss (274 and 70 mL, respectively; p = 0.008) were lower in the transanal group. Additionally, the positive resection margin was lower in the transanal group than in the laparoscopic group (28% and 0%, p = 0.021); STC was comparable between groups. There was no increase in postoperative mortality or morbidity. Patients with surgical difficulties had shorter operative times in the transanal group, and comparable STC.</p><p><strong>Conclusions: </strong>Laparoscopic two-team transanal approach offers better short-term outcomes than the conventional approach in highly selected patients.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"120"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity score-matched analysis of risk factors for prolonged postoperative ileus after TME in rectal cancer.","authors":"X Zhang, C Wang, G Li, X Qiu, W Chen, J Lu, L Xu, B Wu, Y Xiao, G Lin","doi":"10.1007/s10151-025-03163-x","DOIUrl":"10.1007/s10151-025-03163-x","url":null,"abstract":"<p><strong>Background: </strong>Prolonged postoperative ileus (PPOI) is a common complication following total mesorectal excision. Early detection and prompt intervention are crucial for the treatment of rectal cancer.</p><p><strong>Methods: </strong>We conducted a retrospective study. After applying propensity score matching, we collected and compared the clinical characteristics of 164 patients in both the PPOI group and the non-PPOI group using univariate analysis. Significant factors identified were then evaluated in a multivariable logistic regression analysis. Moreover, we analyzed the clinical features and treatment strategies.</p><p><strong>Results: </strong>The incidence of PPOI after laparoscopic TME was 18.3% in our trial. Univariate analysis revealed significant differences in several factors between the two groups, including prophylactic anaerobic antibiotic therapy (p < 0.001), preoperative bowel obstruction (p = 0.006), preoperative nutritional support therapy (p < 0.001), and the type of stoma (p < 0.001). However, further multivariable logistic regression analysis indicated that prophylactic anaerobic antibiotic therapy was not an independent risk factor for PPOI. Among the patients who experienced PPOI, the majority, 135 patients (82.3%), presented with Clavien-Dindo grades I-II. Overall, 81.7% and 85.4% of patients received oral probiotics and vancomycin treatment, respectively. Only 48 patients (29.3%) required gastric tube insertion, while 27 patients (16.5%) needed a transnasal ileus tube due to ineffective drug treatment.</p><p><strong>Conclusions: </strong>Our study suggests that selecting the appropriate preoperative nutritional support strategy and type of stoma is crucial in reducing the incidence of PPOI. When PPOI occurs, a multi-stage treatment protocol may be beneficial for recovery.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"119"},"PeriodicalIF":2.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of chronic anal fissures: should fissurectomy be performed with botulinum toxin injection?","authors":"R Quinn, J Ellis-Clark, S Albayati","doi":"10.1007/s10151-025-03153-z","DOIUrl":"10.1007/s10151-025-03153-z","url":null,"abstract":"<p><strong>Background: </strong>Despite the superior success rate of lateral internal sphincterotomy for managing chronic anal fissure (CAF), there is a trend towards sphincter-preserving treatment due to the increased risk of incontinence. Botulinum toxin (BT) and fissurectomy are two sphincter-preserving options for CAF. We aim to assess if combining fissurectomy with botox treatment is superior to botulinum toxin alone in the management of CAF.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted across two Sydney hospitals over 7 years. All patients with a CAF managed with either BT and fissurectomy (group 1) or BT only (group 2) were included. Primary outcome was healing rate defined as resolution or significant improvement of perianal symptoms at initial follow-up. Secondary outcomes were persistence, recurrence, re-intervention and faecal incontinence rate. Follow-up questionnaire was conducted to compare long-term outcomes between the two groups.</p><p><strong>Results: </strong>Fifty-seven patients met the inclusion criteria (group 1, 37; group 2, 20). Mean BT dose and injection location between the groups were similar (p = 0.259 and p = 0.427). There was a 65% response rate to the follow-up questionnaire. Median follow-up was 34.3 months (range 0.4-93). There was no difference in healing (56.7% vs. 50%, p = 0.561), recurrence (37.8% vs. 30%, p = 0.383) or re-intervention rate (13.5% vs. 20%, p = 0.888). Long-term incontinence rate was significantly higher in patients group 2 (0% vs. 10%, p = 0.010), with two patients reporting persistent flatus incontinence. Median overall satisfaction score was 3/4 (range 1-4), in both groups (p = 0.469).</p><p><strong>Conclusion: </strong>Botulinum toxin with or without fissurectomy is a safe sphincter-sparing treatment option for CAF. However, the addition of fissurectomy to BT does not improve healing rates and we therefore recommend BT injection alone as a second-line treatment of CAF in patients who fail topical treatment.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"118"},"PeriodicalIF":2.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative autonomic field block combined with the transversus abdominis plane block: for left-sided colectomies (video forum).","authors":"A Caycedo-Marulanda, A Sánchez, M Ferrara, J Daes","doi":"10.1007/s10151-025-03154-y","DOIUrl":"10.1007/s10151-025-03154-y","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"117"},"PeriodicalIF":2.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano: a systematic review and network meta-analysis.","authors":"G Fuschillo, F Pata, M D'Ambrosio, L Selvaggi, M Pescatori, F Selvaggi, G Pellino","doi":"10.1007/s10151-025-03152-0","DOIUrl":"10.1007/s10151-025-03152-0","url":null,"abstract":"<p><strong>Background: </strong>Several techniques are available to reduce the risk of sphincter injury when treating anal fistula, such as ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula laser closure (FiLaC) and endoanal flap (EAF). The aim of this meta-analysis is to provide data on the safety, complications and failure of these techniques.</p><p><strong>Methods: </strong>Studies published after 2017, with patients undergoing at least one among LIFT, VAAFT, FiLaC and EAF for perianal fistula and providing data regarding failure, were retrieved from PubMed and EMBASE. Primary outcome was failure; other outcomes included continence disturbance and complications.</p><p><strong>Results: </strong>Forty-nine articles with 3520 patients were included. The failure rates were 28.6% (range 3.8-75) for LIFT, 22.3% (6.2-65.2) for VAAFT, 43.9% (11.1-80) for FiLaC and 25.9% (4.7-100) for EAF, with a mean follow-up of 35.4 (6-80.4), 32.4 (6-48), 31.6(6.3-60) and 42.4 (12-155) months. The available network meta-analysis on failure showed RD of -0.08 (95% CI - 0.58 to 0.42) comparing LIFT vs VAAFT and 0.30 (95% CI 0.03 to 0.58) comparing LIFT vs EAF. No patients undergoing VAAFT or FiLaC reported worsening continence, while for LIFT and EAF, the continence disturbance rate was 1.5% and 7.3%, respectively. No major complications were observed. The most common minor complications were pain (1.4%), bleeding (1.1%) and wound infection (1.2%). Overall, minor complication rates were 4.3% for LIFT, 7.2% for VAAFT, 10.2% for FiLaC and 6.2% for EAF. Crohn's disease was associated with a higher failure rate (39.5% vs 31.4%).</p><p><strong>Conclusions: </strong>FiLaC, VAAFT, LIFT and EAF may represent a valid option in the treatment of anal fistula. VAAFT showed the lowest rate of failure but with no differences from network metanalysis. Wider homogeneous studies with long-term follow-up are necessary to obtain more robust data.</p><p><strong>Prospero number: </strong>CRD42022375600.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"116"},"PeriodicalIF":2.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}