Failure rates and complications of four sphincter-sparing techniques for the treatment of fistula-in-ano : a systematic review and network meta-analysis
Fuschillo, Giacomo (Università degli Studi della Campania "Luigi Vanvitelli)
Pata, Francesco (University of Calabria)
D'Ambrosio, M. (Università degli Studi della Campania "Luigi Vanvitelli")
Selvaggi, Lucio (Università degli Studi della Campania "Luigi Vanvitelli")
Pescatori, Mario (Coloproctology Units of Parioli and Cobellis Clinics)
Selvaggi, Francesco (Università degli Studi della Campania "Luigi Vanvitelli")
Pellino, Gianluca (Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona

Data:	2025
Resum:	Background: Several techniques are available to reduce the risk of sphincter injury when treating anal fistula, such as ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula laser closure (FiLaC) and endoanal flap (EAF). The aim of this meta-analysis is to provide data on the safety, complications and failure of these techniques. Methods: Studies published after 2017, with patients undergoing at least one among LIFT, VAAFT, FiLaC and EAF for perianal fistula and providing data regarding failure, were retrieved from PubMed and EMBASE. Primary outcome was failure; other outcomes included continence disturbance and complications. Results: Forty-nine articles with 3520 patients were included. The failure rates were 28. 6% (range 3. 8-75) for LIFT, 22. 3% (6. 2-65. 2) for VAAFT, 43. 9% (11. 1-80) for FiLaC and 25. 9% (4. 7-100) for EAF, with a mean follow-up of 35. 4 (6-80. 4), 32. 4 (6-48), 31. 6(6. 3-60) and 42. 4 (12-155) months. The available network meta-analysis on failure showed RD of -0. 08 (95% CI - 0. 58 to 0. 42) comparing LIFT vs VAAFT and 0. 30 (95% CI 0. 03 to 0. 58) comparing LIFT vs EAF. No patients undergoing VAAFT or FiLaC reported worsening continence, while for LIFT and EAF, the continence disturbance rate was 1. 5% and 7. 3%, respectively. No major complications were observed. The most common minor complications were pain (1. 4%), bleeding (1. 1%) and wound infection (1. 2%). Overall, minor complication rates were 4. 3% for LIFT, 7. 2% for VAAFT, 10. 2% for FiLaC and 6. 2% for EAF. Crohn's disease was associated with a higher failure rate (39. 5% vs 31. 4%). Conclusions: FiLaC, VAAFT, LIFT and EAF may represent a valid option in the treatment of anal fistula. VAAFT showed the lowest rate of failure but with no differences from network metanalysis. Wider homogeneous studies with long-term follow-up are necessary to obtain more robust data. PROSPERO number: CRD42022375600.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	LIFT ; VAAFT ; FILAC ; Endoanal flap ; Anal fistula ; Complications ; Recurrence
Publicat a:	Techniques in coloproctology, Vol. 29 Núm. 1 (december 2025) , p. 116, ISSN 1128-045X

DOI: 10.1007/s10151-025-03152-0
PMID: 40392371

49 p, 1.7 MB

El registre apareix a les col·leccions:
Articles > Articles de recerca
Articles > Articles publicats