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Techniques in Coloproctology

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Open Access 17-07-2023 | Review

Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis

Authors: S. Bhat, W. Xu, C. Varghese, N. Dubey, C. I. Wells, C. Harmston, G. O’Grady, I. P. Bissett, A. Y. Lin

Published in: Techniques in Coloproctology | Issue 10/2023

Abstract

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.

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Title: Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis
Authors: S. Bhat
W. Xu
C. Varghese
N. Dubey
C. I. Wells
C. Harmston
G. O’Grady
I. P. Bissett
A. Y. Lin
Publication date: 17-07-2023
Publisher: Springer International Publishing
Published in: Techniques in Coloproctology / Issue 10/2023
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-023-02845-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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