Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, University 'Aldo Moro of Bari', Bari, Italy.
Colorectal Dis. 2022 Dec;24(12):1462-1471. doi: 10.1111/codi.16248. Epub 2022 Jul 31.
The optimal surgical treatment for anatomical anal stenosis (AS) remains to be determined. The aim of this study was to determine the rates of complications and recurrence after anoplasty for anatomical AS and, wherever feasible, compare the outcomes for the various techniques.
A PROSPERO-registered systematic review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, PubMed, Embase, Cochrane Library of Systematic Review, Scopus and Web of Science were searched for articles published up to May 2021. Studies that assessed the outcomes of anoplasty in adult patients with anatomical AS were selected. The primary outcomes were complications and recurrence. The methodological quality of studies was appraised using the Joanna Briggs Institute critical appraisal tools.
From the total of 2705 unique screened records, 151 were assessed for eligibility. Only 29 studies (two prospective) met the inclusion criteria, reporting data on 556 patients [mean age 53 (18-83) years, 46% female]. Previous history of surgery for haemorrhoidal disease accounted for three quarters of cases. A total of 14 types of anoplasty were found, with the Y-V flap being the most performed technique [27% of cases (n = 149)]. Complications frequently occurred, with a pooled prevalence of 10.2% (95% CI 3.9%-24.1%) after Y-V flap and 11.5% (5.3%-23.0%) after rhomboid/diamond flap. Patients undergoing house flap achieved better results in terms of clinical improvement, satisfaction and quality of life compared with Y-V flap and rhomboid/diamond flap. When considering only studies with at least 12 months of follow-up, the pooled prevalence of recurrence was 4.7% (2.2%-9.8%), with significantly higher rates observed in the prospective versus retrospective series [pooled prevalence 18.9% (11.5%-29.5%) vs. 3.6% (1.7-7.8%), respectively; p < 0.001].
Both complications and recurrence were significantly lower after house flap compared with rhomboid/diamond and Y-V flap. Better designed multicentre studies with longer follow-up are needed to confirm these findings.
CRD42021239493.
解剖性肛门狭窄（AS）的最佳手术治疗方法仍有待确定。本研究旨在确定肛门成形术治疗解剖性 AS 的并发症和复发率，并在可行的情况下比较各种技术的结果。
根据系统评价和荟萃分析首选报告项目的原则，对 PROSPERO 注册的系统评价进行了报告。检索了截至 2021 年 5 月发表的评估成人解剖性 AS 患者肛门成形术结果的文章，包括 Medline、PubMed、Embase、Cochrane 系统评价图书馆、Scopus 和 Web of Science。选择评估成人解剖性 AS 患者肛门成形术结果的研究。主要结局是并发症和复发。使用 Joanna Briggs 研究所的批判性评估工具评估研究的方法学质量。
在总共 2705 份筛选记录中，有 151 份符合入选标准，仅 29 项研究（两项前瞻性）符合纳入标准，报告了 556 例患者的数据[平均年龄 53（18-83）岁，46%为女性]。既往痔病手术史占病例的四分之三。共发现 14 种肛门成形术，其中 Y-V 皮瓣是最常进行的技术[27%（n=149）]。并发症发生率较高，Y-V 皮瓣的总发生率为 10.2%（95%CI 3.9%-24.1%），菱形/钻石皮瓣为 11.5%（5.3%-23.0%）。与 Y-V 皮瓣和菱形/钻石皮瓣相比，行房式皮瓣的患者在临床改善、满意度和生活质量方面的结果更好。当仅考虑随访至少 12 个月的研究时，复发的总发生率为 4.7%（2.2%-9.8%），前瞻性系列的发生率明显高于回顾性系列[总发生率分别为 18.9%（11.5%-29.5%）和 3.6%（1.7%-7.8%）；p<0.001]。
与菱形/钻石和 Y-V 皮瓣相比，房式皮瓣的并发症和复发率明显较低。需要更好设计、更长随访的多中心研究来证实这些发现。
PROSPERO 注册号：CRD42021239493。
