Outcomes in High Perianal Fistula Repair Using Video-Assisted Anal Fistula Treatment Compared With Seton Use: A Randomized Controlled Trial

Siddique, Sumera; Changazi, Shabbar Hussain; Bhatti, Samiullah; Afzal, Barza; Hyidar, Zulqarnain; Rehman, Aveena; Ahmad, Qamar; Ayyaz, Mahmood

doi:10.7759/cureus.22166

Cited by 6 publications

(12 citation statements)

References 13 publications

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“… 47 concords with the study conducted by Siddique et al . 12 that there was no incidence of anal incontinence in the Seton method. Wang et al .…”

Section: Discussionmentioning

confidence: 70%

“…Therefore, the outcomes of long-term VAAFT are still expected 31 . Seton is a conventional surgical method in that the silk 1/0 suture was tightened, running through the internal and external openings until the sphincter was slowly cut 12 . Likewise, Andreou et al .…”

Section: Discussionmentioning

confidence: 99%

“…Considering the difficulty of the treatment of CAF, there are various kinds of surgical techniques in the clinical work, such as ligation of intersphincteric fistula tract (LIFT) 9 , endoanal advancement flap repair (EAFR) 10 , video-assisted anal fistule treatment(VAAFT) 11 , seton 12 , fistulectomy 13 , fistulotomy 14 , anal fistula plug (AFP) 15 , fistulotomy plus seton (FPS) or incision thread drawing 16 , LIFT-plug 17 , fistulotomy with sphincter reconstruction (FSR) 18 , video-assisted modified ligation of the intersphincteric fistula tract (VAMLIFT) 11 , tunnel-like fistulectomy plus draining seton combined with incision of the internal opening of anal fistula (TFSIA) 16 , and LIFT+ EAFR. However, none of these surgical methods are ideal.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis

An,

Gao,

et al. 2023

International Journal of Surgery

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Background: Considering the difficulty of treating complex anal fistula (CAF), various surgical techniques exist in clinical work. However, none are ideal. Evidence on the efficacy and safety of different surgical treatments is scarce. We aimed to compare the outcomes of the 13 surgical techniques and tried to find the best surgical method for treating CAF. Materials and Methods: We searched worldwide databases, including Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed, from inception to March 2023. All randomized controlled trials (RCTs) comparing the outcomes of 13 surgical techniques were included according to the PICO principles. The indicators of the cure rate, the recurrence rate, the complication rate, the operating time, the postoperative pain on day 1 (VAS), and the postoperative incontinence in month 1 (Wexner) were extracted and analyzed using STATA software 15.1, Review Manager 5.4, and GeMTC14.3. Results: Twenty-eight RCTS with a total of 2274 patients were included in the network meta-analysis. There was no statistically significant difference in the comparison among any surgical interventions in terms of the cure rate (P>0.05 Table 2) and recurrence rate (P>0.05 Table 3). However, in terms of complication rate, fistulectomy was lower than FPS (Median: 0.14; 95% CI: 0.02, 0.70) or fistulotomy (Median: 0.09; 95% CI: 0.01, 0.55), and fistulotomy was lower than EAFR (Median: 0.24; 95% CI: 0.05, 0.84), LIFT (Median: 0.17; 95% CI: 0.02, 0.66) or LIFT-EAFR(Median: 0.11; 95% CI: 0.01, 0.69) (P>0.05 Table 4). The surface estimated the advantages and disadvantages under the cumulative ranking (SUCRA). The ranking results indicated that fistulectomy might have the lowest complication rate (SUCRA=7.9%). Because the network results of the operating time, the postoperative pain, and the postoperative incontinence contained no closed loops, the results of their probability ranking could only be referenced, demonstrating that fistulectomy might have the shortest operating time (SUCRA=23.4%), VAMLIFT might have the lowest postoperative pain on day 1 (VAS) (SUCRA=0.4%) and LIFT might have the lowest postoperative incontinence in month 1(Wexner) (SUCRA=16.2%). Conclusion: Fistulectomy might have the lowest complication rate, which might be the relatively superior surgical technique for treating CAF.

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“… 47 concords with the study conducted by Siddique et al . 12 that there was no incidence of anal incontinence in the Seton method. Wang et al .…”

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis

An,

Gao,

et al. 2023

International Journal of Surgery

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“…Anorectal fistulas, colloquially referred to as anal fistulas, represent postoperative complications arising from abscess rupture or incision drainage around the anal and rectal regions. These fistulas are categorized based on their position relative to the dentate line into either high or low anal fistulas 3 . High anal fistulas, a common concern in proctological surgery, are primarily characterized by perianal pain, itching, discharge, and at times, systemic symptoms, markedly impacting patients' quality of life and work efficacy 27 .…”

Section: Discussionmentioning

confidence: 99%

“…These fistulas are categorized based on their position relative to the dentate line into either high or low anal fistulas. 3 High anal fistulas, a common concern in proctological surgery, are primarily characterized by perianal pain, itching, discharge, and at times, systemic symptoms, markedly impacting patients' quality of life and work efficacy. 27 Historically, the treatment of high anal fistulas has not been accorded adequate attention, with many patients resorting to conservative therapies such as medication for pain relief.…”

Section: Discussionmentioning

confidence: 99%

Effects of loose combined cutting seton surgery on wound healing and pain in patients with high anal fistula: A meta‐analysis

Xi,

Li,

et al. 2024

International Wound Journal

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A meta‐analysis was conducted to evaluate the effects of loose combined cutting seton surgery on wound healing and pain in patients with high anal fistula, aiming to provide evidence‐based medical evidence for surgical method selection for these patients. A comprehensive computerized search of PubMed, Cochrane Library, EMBASE, Wanfang and China National Knowledge Infrastructure databases was conducted to collect all relevant studies published up to November 2023, evaluating the effects of loose combined cutting seton surgery in treating patients with high anal fistulas. Two researchers independently screened, extracted data, and assessed the quality of the identified studies. RevMan 5.4 software was employed for data analysis. Overall, 16 articles were included, comprising 1124 patients, with 567 undergoing loose combined cutting seton surgery and 557 undergoing simple cutting seton surgery. The analysis revealed patients undergoing loose combined cutting seton surgery had a higher rate of postoperative wound healing (97.44% vs. 81.69%, odds ratio [OR]: 7.49, 95% confidence interval [CI]: 4.29–13.10, p < 0.00001), shorter wound healing time (standardized mean differences [SMD]: −1.48, 95% CI: −1.89 to −1.08, p < 0.00001), lower postoperative wound pain scores (SMD: −2.51, 95% CI: −3.51 to −1.51, p < 0.00001), and a lower rate of postoperative complications (3.43% vs. 20.83%, OR: 0.13, 95% CI: 0.05–0.31, p < 0.00001). The current evidence suggests that compared to simple cutting seton surgery, loose combined cutting seton surgery in treating high anal fistulas can promote postoperative wound healing, shorten wound healing time, alleviate pain, and reduce the incidence of postoperative complications, making it a worthy clinical practice for widespread application.

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Assessing the suitability of video-assisted anal fistula treatment for obese patients compared to conventional surgery: a question worth investigating

Tang,

Xu,

Yang

et al. 2024

Int J Colorectal Dis

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Background and aims Video-assisted anal fistula treatment (VAAFT) is an innovative surgical approach enabling the direct visualization of the fistula tract structure. This study aims to assess the efficacy of VAAFT in comparison with that of traditional surgical methods and explore potential risk factors contributing to fistula recurrence to provide new recommendations for surgical selection. Materials and methods Information was collected from 100 patients with complex anal fistula (CAF) in our hospital who underwent surgical treatment from January 2021 to January 2023. We compared the baseline information and surgical outcomes of two groups, analyzed the risk factors for fistula recurrence by using logistic regression analysis, and conducted further exploration by using the body mass index. Results Equal numbers of patients underwent VAAFT and traditional surgeries, and no significant differences in baseline information were observed. Patients who received VAAFT experienced less intraoperative bleeding (15.5 (14.0–20.0) vs. 32.0 (25.0–36.0)), shorter hospital stays (2.0 (2.0–2.5) vs. 3.0 (3.0–3.5)), reduced postoperative pain and wound discharge, but longer operative times (43.3 ± 6.9 vs. 35.0 (31.5–40.0)) compared with patients who underwent traditional surgeries. No significant differences in recurrence rates were found three and six months after operation (the p-values were 0.790 and 0.806, respectively). However, the Wexner scores of the VAAFT group were significantly low in the first follow-up (0 (0–1.0) vs. 2.0 (1.0–2.0)). Postoperative recurrence of fistulas may be associated with obesity (p-value = 0.040), especially in patients undergoing traditional surgeries (p-value = 0.036). Conclusion VAAFT offers advantages, such as less pain, less trauma, and faster recovery, compared with traditional surgical treatment. Obese patients with CAF are prone to recurrence, and we recommend that they undergo VAAFT treatment rather than traditional surgeries.

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Outcomes in High Perianal Fistula Repair Using Video-Assisted Anal Fistula Treatment Compared With Seton Use: A Randomized Controlled Trial

Cited by 6 publications

References 13 publications

Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis

Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis

Effects of loose combined cutting seton surgery on wound healing and pain in patients with high anal fistula: A meta‐analysis

Assessing the suitability of video-assisted anal fistula treatment for obese patients compared to conventional surgery: a question worth investigating

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