A Comparison of Different Surgical Treatments for Complex Anal Fistula: A Systematic Review

Abstract

Fistula-in-ano is a common proctological condition that primarily affects younger people and leads to chronic morbidity. An anal fistula is divided into simple and complex fistulas. A complex fistula is a challenging problem due to higher recurrence rates and incontinence associated with surgery. Many new methods have been developed for the closure of complex fistula-in-ano, but there is no single best method. The aim of this study is to identify a superior surgical technique for treating complex/high cryptoglandular perianal fistulas (HCPFs). A literature search was done using PubMed and Google Scholar for the period of 2012-2021. Articles that contain surgical treatment for complex anal fistula in the English language published in the last 10 years were included. The types of studies included were randomized controlled trials (RCTs), meta-analyses, systematic reviews, cohort studies, and traditional reviews. Articles excluded were those done more than 10 years ago, in other languages, and containing simple fistula management only. Nine studies were included in the review; a systematic review and meta-analysis concluded that no single method is effective. The ligation of the intersphincteric fistula tract (LIFT) procedure seems to be a promising and effective technique as it has a low rate of fecal incontinence as compared to other methods. Biological techniques give variable success rates so does fistula plug (FP). Mucosal advancement flap (MAF) and rerouting seton give good results according to one study. Fistula plug gives variable results and is not a preferred method.Ligation of the intersphincteric fistula tract (LIFT) seems to be a promising new technique for complex anal fistulas, but the data available is not enough to determine the best method. More randomized trials are required to compare traditional techniques and emerging new biological methods to see the best technique available.

Optimum management for complex anal fistula: A network meta-analysis of randomized controlled trials

“…This method had the lowest failure and fecal incontinence complication rates. This result was comparable to that of a systematic review by Zahra et al (2022) [ 28 ], which found that closure of the intersphincteric fistula tract was a novel and potentially effective treatment for complex anal fistulas. However, the authors of this review could not recommend those findings because of insufficient data.…”

Perineal hernia as a sequela of anal reconstruction surgeries in perianal Crohn's disease

“…Although contrast-enhanced CT can help establish the diagnosis, MRI with enterography may have more clinical utility in pCD patients due to its ability to assess for pCD treatment response and detect concurrent active pCD and fistulas [10] . Patients with pCD may undergo surgeries such as LIFT and endorectal flap advancement surgeries for complex anal fistula treatment [11] . The risk of developing a perineal hernia as a long-term outcome of these procedures is unclear.…”

Biomedical Application of Decellularized Scaffolds

“…In recent years, decellularized dermal matrix tamponades have been widely used in the treatment of anal fistula. In addition, with the continuous development of 3D bioprinting technology and the application of biological scaffold materials, new ideas have been opened for the treatment of anal fistula by tissue engineering. − …”