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Meta-Analysis
. 2019 Jan 21;3(3):231-241.
doi: 10.1002/bjs5.50129. eCollection 2019 Jun.

Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

M E Stellingwerf  1 , E M van Praag  1 , P J Tozer  2 , W A Bemelman  1 , C J Buskens  1
Affiliations
Meta-Analysis

Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas

M E Stellingwerf et al. BJS Open. .

Erratum in

Abstract

Background: High perianal fistulas require sphincter-preserving surgery because of the risk of faecal incontinence. The ligation of the intersphincteric fistula tract (LIFT) procedure preserves anal sphincter function and is an alternative to the endorectal advancement flap (AF). The aim of this study was to evaluate outcomes of these procedures in patients with cryptoglandular and Crohn's perianal fistulas.

Methods: A systematic literature search was performed using MEDLINE, Embase and the Cochrane Library. All RCTs, cohort studies and case series (more than 5 patients) describing one or both techniques were included. Main outcomes were overall success rate, recurrence and incontinence following either technique. A proportional meta-analysis was performed using a random-effects model.

Results: Some 30 studies comprising 1295 patients were included (AF, 797; LIFT, 498). For cryptoglandular fistula (1098 patients), there was no significant difference between AF and LIFT for weighted overall success (74·6 (95 per cent c.i. 65·6 to 83·7) versus 69·1 (53·9 to 84·3) per cent respectively) and recurrence (25·6 (4·7 to 46·4) versus 21·9 (14·8 to 29·0) per cent) rates. For Crohn's perianal fistula (64 patients), no significant differences were observed between AF and LIFT for overall success rate (61 (45 to 76) versus 53 per cent respectively), but data on recurrence were limited. Incontinence rates were significantly higher after AF compared with LIFT (7·8 (3·3 to 12·4) versus 1·6 (0·4 to 2·8) per cent).

Conclusion: Overall success and recurrence rates were not significantly different between the AF and LIFT procedure, but continence was better preserved after LIFT.

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Figures

Figure 1
Figure 1
PRISMA flow chart for the review. HIV, human immunodeficiency virus
Figure 2
Figure 2
Forest plots of overall success of the two procedures in cryptoglandular and Crohn's fistula. a Advancement flap (AF) procedure in cryptoglandular fistula, b AF procedure in Crohn's disease and c ligation of intersphincteric fistula tract (LIFT) procedure in cryptoglandular fistula. A random‐effects model was used for meta‐analysis. Proportions are shown with 95 per cent confidence intervals
Figure 3
Figure 3
Forest plots of recurrence after the two procedures in cryptoglandular and Crohn's fistula. a Recurrence after advancement flap (AF) procedure in cryptoglandular fistula, b recurrence after AF procedure in Crohn's disease, c trans‐sphincteric and intersphincteric recurrence after ligation of intersphincteric fistula tract (LIFT) procedure in cryptoglandular fistula and d trans‐sphincteric recurrence after LIFT procedure in cryptoglandular fistula. A random‐effects model was used for meta‐analysis. Proportions are shown with 95 per cent confidence intervals
Figure 4
Figure 4
Forest plots of incontinence after the two procedures in cryptoglandular and Crohn's fistula combined. a Incontinence after advancement flap (AF) procedure and b incontinence after ligation of intersphincteric fistula tract (LIFT). A random‐effects model was used for meta‐analysis. Proportions are shown with 95 per cent confidence intervals
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