Systematic review of surgical interventions for Crohn's anal fistula

Lee, Matthew J.; Heywood, Nick; Adegbola, S; Tozer, P; Sahnan, Kapil; Fearnhead, Nicola; Brown, S. R.

doi:10.1002/bjs5.13

Cited by 32 publications

(38 citation statements)

References 80 publications

(180 reference statements)

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“…Item generation for the survey was undertaken with reference to four sources: themes identified from qualitative interviews [9], additional lay input (patient with experience of the condition), expert clinical input (from colorectal surgeons and gastroenterologists with an interest in IBD) including reference to the relevant literature addressing clinical outcomes, and existing patient-facing information sources including online decision aids and videos [2,4,10,11].…”

Section: Item Selection and Generationmentioning

confidence: 99%

“…Whilst medical therapies are usually the mainstay of care [2], a range of surgical procedures may be offered to aid fistula healing [3]. No surgical treatment has been shown to be clearly superior in terms of efficacy, and all have different characteristics and outcomes [4]. This may mean that choices about the ‘best’ operation to offer are subject to patient preference, as well as the severity or impact of their disease.…”

Section: Introductionmentioning

confidence: 99%

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Survey to define informational needs of patients undergoing surgery for Crohn’s anal fistula

et al. 2020

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Aim There are many surgical treatments used in Crohn's anal fistula, although none is perfect. Decisions about surgery in this condition may be preference sensitive. The aim of this study was to identify what information patients would like in order to make treatment decisions and to explore experiences of making decisions in this setting. Method A survey was designed based upon qualitative interviews and input from patients and clinicians. It included a long list of informational items to be ranked on a scale of importance, a control preference scale, the decision regret scale, and items exploring preferred information formats. This was distributed through 10 English hospitals to patients with recent surgical treatment for Crohn's anal fistula. Results were analysed using principal component analysis, to identify key informational needs, and other appropriate descriptive statistics. Results In total 92 questionnaires were returned (response rate 41.8%); 48 (52.5%) respondents were women and 54 (58.7%) had undergone seton insertion. Principal component analysis identified three information needs: wound and aftercare, effect on perianal symptoms, severity of surgery. Decision‐making preferences showed a desire to participate in decision‐making. Median decision regret score was 25/100 (i.e., low). The preferred format for sharing information to support decision‐making was from the surgeon, 80/92 (87.0%), and from a booklet, 58/92 (63.0%). Conclusion Key informational needs in this condition are wound and after care, effect on perianal symptoms, and severity of surgery. Patients would like this information to help engage in shared decision‐making.

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Section: Item Selection and Generationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survey to define informational needs of patients undergoing surgery for Crohn’s anal fistula

et al. 2020

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“…There are a range of potential surgical techniques currently in use [ 3 ]. However, there is no clear front running intervention to achieve the ‘Holy Grail’ of fistula closure [ 4 ]. There are three main components within a study which assesses a surgical intervention; the population who were studied, the intervention or treatment(s) compared, and the outcomes reported.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the quality of reporting of interventions in the surgical treatment of Crohn’s anal fistula: an assessment using the TIDiER and Blencowe frameworks

et al. 2021

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Background Crohn’s anal fistula is a challenging condition, and may require multiple surgical procedures. To replicate successful procedures, these must be adequately reported in the literature. The aim of this study was to review the quality of reporting of components of surgical interventions for Crohn’s anal fistula. Methods A systematic review was conducted. It was registered with PROSPERO (CRD:42019135157). The Medline and EMBASE databases were searched for studies reporting interventions intended to close fistula in patients with Crohn’s disease, published between 1999 and August 2019. Abstracts and full texts were screened for inclusion by two reviewers. Dual extraction of data was performed to compare reporting to the TIDiER and Blencowe frameworks for reporting of interventions. Results Initial searches identified 207 unique studies; 38 full texts were screened for inclusion and 33 were included. The most common study design was retrospective cohort (17/33), and the most frequently reported interventions were anal fistula plug (n = 8) and fibrin glue (n = 6). No studies showed coverage of all domains of TIDieR. Reporting was poor among domains related to who provided an intervention, where it was provided, and how it was tailored. Reporting of domains in the Blencowe framework was poor; the majority of studies did not report the component steps of procedures or efforts to standardise them. Conclusions This study demonstrates that reporting on technical aspects of interventions for Crohn’s anal fistula is poor. Surgeons should aim to improve reporting to allow accurate reproduction of techniques both in clinical practice and in clinical trials.

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“…Since there is little evidence on healing rates after advancement ap in CD 18,[24][25][26] , our aim was to analyze potential risk factors for healing failure in this particular group of patients.…”

Section: Discussionmentioning

confidence: 99%

Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

Seifarth

Lehmann

Holmer

et al. 2021

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Background Surgical closure of anal fistulas with rectal advancement flap is an established standard method, but in some cases, it has a high degree of healing failure. There are few studies in literature with a small number of cases examining differences between patients with and without Crohn's disease (CD). The aim of this study was to identify risk factors for anal fistula healing failure after advancement flap between patients with cryptoglandular fistulas and patients with CD. Methods From January 2010 to October 2020, 155 rectal advancement flaps (CD patients = 55, non-CD patients = 100) were performed. Patients were entered into a prospective database and retrospectively analyzed for healing rates. Results Median follow up was 189 days (95 % CI: 109–269). Overall complication rate was 5.8 %. Total healing rate for all rectal advanced flaps was 56 %. CD patients were younger (33 vs. 43 years, p < 0.001), more often female (76 vs. 30 %, p < 0.001), had more immunosuppressant medication (65 vs. 5 %, p < 0.001), more vaginal fistulas (29 vs. 8 %, p = 0.001) and more protective stomas (49 vs. 2 %, p < 0.001) than patients without CD. However, there was no difference in the healing rate of patients with or without CD (47 % vs. 60 %, p = 0.088). Conclusions Patients with anal fistulas without and with Crohn’s disease have the same healing rate. Although patients with CD differ in their patient-specific characteristics, no independent factors for the occurrence of anal fistula healing failure could be determined. Trial registration: Not applicable due to the retrospective study design.

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Systematic review of surgical interventions for Crohn's anal fistula

Cited by 32 publications

References 80 publications

Survey to define informational needs of patients undergoing surgery for Crohn’s anal fistula

Survey to define informational needs of patients undergoing surgery for Crohn’s anal fistula

A systematic review of the quality of reporting of interventions in the surgical treatment of Crohn’s anal fistula: an assessment using the TIDiER and Blencowe frameworks

Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

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