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Surgical intervention for anorectal fistula
Tarun J Jacob1, Benjamin Perakath, Michael R B Keighley
1Department of Surgery, Christian Medical College, Ida Scudder road, Vellore, Tamil Nadu, India, 632004.
The Cochrane Database of Systematic Reviews
|May 14, 2010
Summary
Surgery for anal fistulas has varying recurrence and incontinence rates. Fibrin glue and advancement flaps show promise for low incontinence, but more research is needed.
Area of Science:
- Gastroenterology and Surgical Innovation
- Anorectal Disease Management
Background:
- Anorectal fistula surgery can lead to recurrence and incontinence.
- Ideal fistula treatment balances low recurrence, minimal incontinence, and quality of life.
Purpose of the Study:
- To evaluate the efficacy and morbidity of surgical procedures for chronic anal fistulas.
- Primary outcomes assessed were recurrence and incontinence rates.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and non-randomized studies.
- Searched EMBASE, Medline, Cochrane Central Register, and IndMed databases.
- Two independent reviewers selected trials; REVMAN 5 used for statistical analysis.
Main Results:
- Ten RCTs were analyzed; study quality was adequate but often underpowered.
- No significant differences in recurrence or incontinence were found between most techniques.
- Advancement flaps showed higher recurrence when used with glue; flap-only technique favored.
- Fibrin glue and advancement flaps reported low incontinence rates.
- Non-randomized trials suggest fibrin glue is effective for simple fistulas with low incontinence.
Conclusions:
- Limited high-quality RCTs exist for comparing fistula surgery modalities.
- Recurrence rates appear similar across various techniques.
- Fibrin glue and advancement flaps are associated with low incontinence.
- Well-powered RCTs are needed to evaluate treatments, including newer procedures like anal fistula plug and LIFT.
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