G Fuschillo, F Pata, M D'Ambrosio, L Selvaggi, M Pescatori, F Selvaggi, G Pellino
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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. 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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. 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引用次数: 0
摘要
背景：在治疗肛瘘时，有几种技术可以降低括约肌损伤的风险，如括约肌间瘘管束结扎（LIFT）、视频辅助肛瘘治疗（VAAFT）、瘘管激光闭合（FiLaC）和肛管内皮瓣（EAF）。本荟萃分析的目的是提供这些技术的安全性、并发症和失败的数据。方法：从PubMed和EMBASE检索2017年以后发表的研究，这些研究中，患者接受了LIFT、VAAFT、FiLaC和EAF中的至少一种治疗肛周瘘，并提供了失败的数据。主要结局是失败；其他结果包括失禁障碍和并发症。结果：纳入49篇文献，共3520例患者。LIFT的失败率为28.6%（范围3.8-75），VAAFT为22.3% (6.2-65.2)，FiLaC为43.9% (11.1-80)，EAF为25.9%(4.7-100)，平均随访时间为35.4（6-80.4）个月，32.4（6-48）个月，31.6（6.3-60）个月和42.4（12-155）个月。现有的网络荟萃分析显示，LIFT与VAAFT的RD为-0.08 (95% CI - 0.58至0.42)，LIFT与EAF的RD为0.30 （95% CI 0.03至0.58）。接受VAAFT或FiLaC治疗的患者没有出现尿失禁恶化的报告，而LIFT和EAF患者的尿失禁障碍率分别为1.5%和7.3%。无重大并发症。最常见的轻微并发症是疼痛（1.4%）、出血（1.1%）和伤口感染（1.2%）。总的来说，LIFT的轻微并发症发生率为4.3%，VAAFT为7.2%，FiLaC为10.2%，EAF为6.2%。克罗恩病与更高的失败率相关（39.5% vs 31.4%）。结论：FiLaC、VAAFT、LIFT和EAF可能是治疗肛瘘的有效选择。VAAFT的失败率最低，但与网络元分析没有差异。为了获得更可靠的数据，需要更广泛的长期随访的同质研究。普洛斯彼罗号码：CRD42022375600。
Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano: a systematic review and network meta-analysis.
Background: 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.
Methods: 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.
Results: 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%).
Conclusions: 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.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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