Sirany Anne-Marie E, Nygaard Rachel M, Morken Jeffrey J
Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota.
Dis Colon Rectum. 2015 Jun;58(6):604-12. doi: 10.1097/DCR.0000000000000374.
The ligation of the intersphincteric fistula tract procedure, a sphincter-preserving technique, aims to obtain complete, durable healing, while preserving fecal continence in the treatment of transsphincteric anal fistulas.
This was a systematic review to evaluate the outcomes of the originally described (classic) ligation of the intersphincteric fistula tract procedure and the identified technical variations of the procedure.
PubMed, Web of Science, and the archive of Diseases of the Colon & Rectum were searched with the terms "ligation of intersphincteric fistula" and "ligation of intersphincteric fistula tract."
Original, English-language studies reporting the primary healing rate for each technical variation of the ligation of the intersphincteric fistula tract procedure were included. Studies were excluded when the technique used was unclear or when primary healing rate was reported in a pooled manner including outcomes from multiple technical variations of the ligation of the intersphincteric fistula tract procedure.
Outcomes associated with all of the technical variations of the ligation of the intersphincteric fistula tract procedure were investigated.
The main outcome measured was primary healing rate. Secondary outcome measures included time to healing, changes in continence, and risk factors for failure.
In all, 26 studies met criteria for review, including 1 randomized controlled trial and 25 cohort/case series. Seven technical variations of the ligation of the intersphincteric fistula tract procedure were identified and classified according to the surgical technique. Primary healing rates ranged from 47% to 95%.
The levels of evidence available in the published works are relatively low, as indicated by the Oxford Center for Evidence-Based Medicine evidence levels.
The ligation of the intersphincteric fistula tract procedure is a promising treatment option for transsphincteric fistulas, with reasonable success rates and minimal impact on continence. The true efficacy of the procedure is unknown because of the number of technical variations and the pooled results reported in the literature.
括约肌间瘘管结扎术是一种保留括约肌的技术，旨在实现完全、持久的愈合，同时在治疗经括约肌肛瘘时保留大便失禁功能。
本系统评价旨在评估最初描述的（经典）括约肌间瘘管结扎术的疗效以及该手术已确定的技术变体。
使用“括约肌间瘘管结扎术”和“括约肌间瘘管结扎”等术语检索了PubMed、科学网以及《结肠与直肠疾病》存档库。
纳入报告括约肌间瘘管结扎术各技术变体主要愈合率的原始英文研究。当所用技术不明确或主要愈合率以汇总方式报告（包括括约肌间瘘管结扎术多种技术变体的结果）时，排除相关研究。
研究括约肌间瘘管结扎术所有技术变体相关的结果。
主要测量结局为主要愈合率。次要结局指标包括愈合时间、大便失禁变化以及失败的危险因素。
共有26项研究符合纳入标准，包括1项随机对照试验和25项队列/病例系列研究。根据手术技术确定并分类了括约肌间瘘管结扎术的7种技术变体。主要愈合率在47%至95%之间。
如牛津循证医学中心证据水平所示，已发表研究中的证据水平相对较低。
括约肌间瘘管结扎术是治疗经括约肌肛瘘的一种有前景的治疗选择，成功率合理且对大便失禁影响最小。由于技术变体数量以及文献中报告的汇总结果，该手术的真正疗效尚不清楚。
