Surgical intervention for anorectal fistula

Abstract

BACKGROUND: Surgery for anorectal fistula may result in recurrence, or impairment of continence. The ideal treatment for anorectal fistulae should be associated with low recurrence rates, minimal incontinence and good quality of life.OBJECTIVE: To assess the efficacy and morbidity of operative procedures for chronic anal fistula, primary outcomes being recurrence and incontinence. SELECTION CRITERIA: Randomised controlled trials comparing operative procedures for anorectal fistulae were considered. Non randomised trials and cohort studies were examined where data on recurrence and function were available. CRITERIA FOR CONSIDERING STUDIES FOR THIS RE-DATA COLLECTION AND ANALYSIS: Two reviewers (TJ and BP) independently selected the trials for inclusion in the review. Disagreements were solved by discussion. Where disagreement persisted and published results made data extraction difficult, we obtained clarification from the authors. REVMAN 5 was used for statistical analysis. Quality of the trials were assessed and allowances made for subgroup analysis and prevention of publication bias, using funnel plots if needed.MAIN RESULTS: Ten randomized controlled trials were available for analysis. The quality of included studies was adequate, though in some trials the numbers were small and they were inadequately powered for equivalence or to detect significant differences. Comparisons were made between various modalities of treatments. There were no significant difference in recurrence rates or incontinence rates in any of the studied comparisons except in the case of advancement flaps. There were more recurrences in the glue plus flap group, a significant difference that favoured the flap only technique. It was also noted that Fibrin glue and advancement flap procedures report low incontinence rates. In the review of literature of non-randomized trials, most trials on fibrin glue indicate good healing in simple fistulae with low incontinence rates. AUTHORS' CONCLUSIONS:There are very few randomized controlled trials comparing the various modalities of surgery for fistula in ano. While post operative pain, time to healing and discharge

The treatment of anal fistula: second ACPGBI Position Statement – 2018

“…The glues are applied to fill the fistula track and provide a bridge for fibroblasts and stromo‐vascular cell in‐growth to produce healing. Their ease of use, minimal risk to continence and repeatability make them an attractive option, especially in patients at high risk of sphincter dysfunction .…”

Unexpected complication after radical (inguinal) orchidectomy: trans-sphincteric anoscrotal fistula

“…For these patients, options include mucosal advancement flaps, ligation of the internal fistula tract, anal fistula plugs and an increasing number of novel techniques 2 4 9 10…”

A young woman with recurrent perianal sepsis

“…If a fistula tract is identified during detailed clinical examination a variety of treatment options are available, although none is universally accepted or without risk. 18 A seton is a thread that is placed through the fistula track to form a continuous ring between the internal and external openings. In the acute setting a draining seton can be used to maintain patency of the track, allow drainage, and reduce inflammation and sepsis.…”