Related Experiment Videos
Systematic review of surgical interventions for Crohn's anal fistula
M J Lee1, N Heywood2, S Adegbola3
1Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK.
Background:
Anal fistula occurs in approximately one in three patients with Crohn's disease and is typically managed through a multimodal approach. The optimal surgical therapy is not yet clear. The aim of this systematic review was to identify and assess the literature on surgical treatments of Crohn's anal fistula.
Methods:
A systematic review was conducted that analysed studies relating to surgical treatment of Crohn's anal fistula published on MEDLINE, Embase and Cochrane databases between January 1995 and March 2016. Studies reporting specific outcomes of patients treated for Crohn's anal fistula were included. The primary outcome was fistula healing rate. Bias was assessed using the Cochrane ROBINS-I and ROB tool as appropriate.
Results:
A total of 1628 citations were reviewed. Sixty-three studies comprising 1584 patients were ultimately selected in the analyses. There was extensive reporting on the use of setons, advancement flaps and fistula plugs. Randomized trials were available only for stem cells and fistula plugs. There was inconsistency in outcome measures across studies, and a high degree of bias was noted.
Conclusion:
Data describing surgical intervention for Crohn's anal fistula are heterogeneous with a high degree of bias. There is a clear need for standardization of outcomes and description of study cohorts for better understanding of treatment options.
Insights
Surgical treatments for Crohn's anal fistula lack clear optimal methods due to heterogeneous data and bias. Further research needs standardized outcomes and cohort descriptions for better understanding of fistula healing rates.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Inflammatory Bowel Disease Research
Background:
- Anal fistula affects one in three Crohn's disease patients.
- Management involves a multimodal approach, but optimal surgical therapy remains unclear.
- Crohn's anal fistula requires effective treatment strategies.
Purpose of the Study:
- To systematically review and assess the literature on surgical treatments for Crohn's anal fistula.
- Identify and evaluate existing surgical interventions.
- Determine the current state of evidence for managing this condition.
Main Methods:
- Systematic review of MEDLINE, Embase, and Cochrane databases (January 1995 - March 2016).
- Inclusion of studies reporting specific outcomes for Crohn's anal fistula patients.
- Primary outcome: fistula healing rate. Bias assessed using Cochrane tools.
Main Results:
- 1628 citations reviewed; 63 studies (1584 patients) selected.
- Extensive reporting on setons, advancement flaps, and fistula plugs.
- Limited randomized trials (stem cells, fistula plugs); inconsistent outcome measures and high bias noted.
Conclusions:
- Surgical intervention data for Crohn's anal fistula are heterogeneous and biased.
- A significant need exists for standardized outcomes and study cohort descriptions.
- Improved data quality is crucial for understanding treatment effectiveness.