Robin Phillips' Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK.
Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, London, UK.
Colorectal Dis. 2021 Dec;23(12):3073-3089. doi: 10.1111/codi.15945. Epub 2021 Oct 22.
This systematic review aimed to assess the outcomes of fistulotomy or fistulectomy and immediate sphincter repair (FISR) in relation to healing, incontinence and sphincter dehiscence both overall and in patients with high anal fistulae.
Medline, Embase and The Cochrane library were searched for studies of patients undergoing FISR for anal fistula. Data regarding healing, continence and sphincter dehiscence were extracted overall and for high anal fistulae. The DerSimonian-Laird random-effects method was used for pooled analysis, heterogeneity between studies was assessed based on the significance of between-study heterogeneity, and on the size of the I value. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa scale.
We identified 21 studies evaluating 1700 patients. Pooled analysis of healing reached 93% (95% CI: 91%-95%, I = 51% p-value for heterogeneity = 0.004), with continence disturbance and worsening continence reaching 11% (95% CI: 6%-18%, I = 87% p < 0.001) and 8% (95% CI: 4%-13%, I = 74% p < 0.001), respectively. Subgroup analysis according to fistula height could only be conducted on limited data. Pooled healing in high anal fistulae was 89% (95% CI: 84%-94%, I = 76% p < 0.001), 16% suffered disturbance of continence (95% CI: 7%-27%, I = 89% p < 0.001), 8% worsening continence from baseline (95% CI: 2%-16%, I = 80% p < 0.001) and 2% suffered sphincter dehiscence (95% CI: 0%-10%, I = 89% p < 0.001).
The evidence suggests FISR is a safe, effective procedure. However, data are limited by inconsistencies in reporting of continence and definition of fistula height, particularly high anal fistulae. Significant heterogeneity means that outcomes in high fistulae remain uncertain.
本系统评价旨在评估切开术或切除术联合即刻括约肌修复术（FISR）在总体和高位肛瘘患者中的愈合、失禁和括约肌裂开情况。
检索 Medline、Embase 和 The Cochrane library 中接受 FISR 治疗肛瘘的患者研究。提取关于总体愈合、控便和括约肌裂开的数据，并针对高位肛瘘进行分析。采用 DerSimonian-Laird 随机效应方法进行汇总分析，基于研究间异质性的显著性和 I ² 值评估研究间的异质性。使用 Cochrane 偏倚风险工具和纽卡斯尔-渥太华量表评估偏倚风险。
我们共确定了 21 项研究，纳入了 1700 名患者。愈合的汇总分析达到了 93%（95%CI：91%-95%，I ² = 51%，p 值用于异质性检验 = 0.004），控便障碍和控便恶化的发生率分别为 11%（95%CI：6%-18%，I ² = 87%，p 值 < 0.001）和 8%（95%CI：4%-13%，I ² = 74%，p 值 < 0.001）。根据肛瘘高度进行的亚组分析只能基于有限的数据进行。高位肛瘘的汇总愈合率为 89%（95%CI：84%-94%，I ² = 76%，p 值 < 0.001），16%的患者出现控便障碍（95%CI：7%-27%，I ² = 89%，p 值 < 0.001），8%的患者基线控便恶化（95%CI：2%-16%，I ² = 80%，p 值 < 0.001），2%的患者出现括约肌裂开（95%CI：0%-10%，I ² = 89%，p 值 < 0.001）。
证据表明 FISR 是一种安全、有效的治疗方法。然而，由于在报告控便情况和肛瘘高度的定义方面存在不一致，数据存在局限性，特别是在高位肛瘘方面。显著的异质性意味着高位肛瘘的治疗效果仍不确定。
