Efficacy of different surgical treatments for management of anal fistula: a network meta-analysis

Abstract

Purpose Currently, the anal fistula treatment which optimises healing and preserves bowel continence remains unclear. The aim of our study was to compare the relative efficacy of different surgical treatments for AF through a network meta-analysis. Methods Systematic searches of MEDLINE, EMBASE and CENTRAL databases up to October 2022 identified randomised controlled trials (RCTs) comparing surgical treatments for anal fistulae. Fistulae were classified as simple (inter-sphincteric or low trans-sphincteric fistulae crossing less than 30% of the external anal sphincter (EAS)) and complex (high trans-sphincteric fistulae involving more than 30% of the EAS). Treatments evaluated in only one trial were excluded from the primary analyses to minimise bias. The primary outcomes were rates of success in achieving AF healing and bowel incontinence. Results Fifty-two RCTs were included. Of the 14 treatments considered, there were no significant differences regarding short-term (6 months or less postoperatively) and long-term (more than 6 months postoperatively) success rates between any of the treatments in patients with both simple and complex anal fistula. Ligation of the inter-sphincteric fistula tract (LIFT) ranked best for minimising bowel incontinence in simple (99.1% of comparisons; 3 trials, n = 70 patients) and complex anal fistula (86.2% of comparisons; 3 trials, n = 102 patients). Conclusions There is insufficient evidence in existing RCTs to recommend one treatment over another regarding their short and long-term efficacy in successfully facilitating healing of both simple and complex anal fistulae. However, LIFT appears to be associated with the least impairment of bowel continence, irrespective of AF classification.

Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence

“…Among them is the ligation of intersphincteric fistula tract (LIFT) procedure, introduced by Rojanasakul in 2007, which stands out for its positive outcomes and reduced morbidity rates 2 – 4 . A recent network meta-analysis highlighted LIFT’s comparable success rates to other surgical techniques, with the added advantage of superior bowel continence preservation 5 . However, these findings come from limited trials, encompassing only a total of 172 patients and varied follow-up durations.…”

A commentary on ‘High ligation of the anal fistula tract by lateral approach: A prospective cohort study on a modification of the ligation of the intersphincteric fistula tract technique’

“…The ligation of the intersphincteric fistula tract (LIFT) technique mainly ligates and cuts the fistula between the sphincters, scrapes the infected tissue of the fistula wall, and tightens the fistula tract with ligation, which is an effective and low-cost sphincter-sparing technique with a success rate of 94.4% and the absence of continence failures 1 , 2 . Kang et al .…”