CERobs Consulting, LLC, 2612 North Lumina Ave., Wrightsville Beach, NC, 28480, USA.
Takeda Pharmaceuticals, Cambridge, MA, 02139, USA.
Adv Ther. 2023 May;40(5):1926-1956. doi: 10.1007/s12325-023-02452-x. Epub 2023 Mar 11.
This systematic literature review (SLR) assessed incidence/prevalence of cryptoglandular fistulas (CCF) and outcomes associated with local surgical and intersphincteric ligation procedures for CCFs.
Two trained reviewers searched PubMed and Embase for observational studies evaluating the incidence/prevalence of cryptoglandular fistula and clinical outcomes of treatments for CCF after local surgical and intersphincteric ligation procedures for CCF.
In total 148 studies met a priori eligibility criteria for all cryptoglandular fistulas and all intervention types. Of those, two assessed incidence/prevalence of cryptoglandular fistulas. Eighteen reported clinical outcomes of surgeries of interest in CCF and were published in the past 5 years. Prevalence was reported as 1.35/10,000 non-Crohn's patients, and 52.6% of non-IBD patients were found to progress from anorectal abscess to fistula over 12 months. Primary healing rates ranged from 57.1% to 100%; recurrence occurred in a range of 4.9-60.7% and failure in 2.8-18.0% of patients. Limited published evidence suggests postoperative fecal incontinence and long-term postoperative pain were rare. Several of the studies were limited by single-center design with small sample sizes and short follow-up durations.
This SLR summarizes outcomes from specific surgical procedures for the treatment of CCF. Healing rates vary according to procedure and clinical factors. Differences in study design, outcome definition, and length of follow-up prevent direct comparison. Overall, published studies offer a wide range of findings with respect to recurrence. Postsurgical incontinence and long-term postoperative pain were rare in the included studies, but more research is needed to confirm rates of these conditions following CCF treatments.
Published studies on the epidemiology of CCF are rare and limited. Outcomes of local surgical and intersphincteric ligation procedures show differing success and failure rates, and more research is needed to compare outcomes across various procedures. (PROSPERO; registration number CRD42020177732).
本系统文献回顾（SLR）评估了肛隐窝瘘（CCF）的发病率/患病率，以及局部手术和括约肌间结扎治疗 CCF 的相关结局。
两名经过培训的审查员在 PubMed 和 Embase 上搜索了评估 CCF 发病率/患病率的观察性研究，以及评估 CCF 局部手术和括约肌间结扎治疗后 CCF 治疗的临床结局的研究。
共有 148 项研究符合所有肛隐窝瘘和所有干预类型的预先设定的纳入标准。其中两项研究评估了肛隐窝瘘的发病率/患病率。18 项研究报告了 CCF 中感兴趣的手术的临床结局，且均在过去 5 年内发表。报告的患病率为 1.35/10000 例非克罗恩病患者，非 IBD 患者中有 52.6%在 12 个月内从肛门直肠脓肿发展为瘘管。一期愈合率范围为 57.1%至 100%；复发率为 4.9%至 60.7%，失败率为 2.8%至 18.0%。有限的已发表证据表明，术后粪便失禁和长期术后疼痛很少见。这些研究中有几篇受到单中心设计、样本量小和随访时间短的限制。
本 SLR 总结了治疗 CCF 的特定手术程序的结果。根据手术和临床因素的不同，愈合率也有所不同。由于研究设计、结局定义和随访时间的不同，无法直接进行比较。总体而言，发表的研究在复发方面提供了广泛的发现。在纳入的研究中，术后失禁和长期术后疼痛很少见，但需要更多的研究来确认这些情况在 CCF 治疗后的发生率。
关于 CCF 的流行病学的已发表研究很少且有限。局部手术和括约肌间结扎治疗的结果显示出不同的成功率和失败率，需要进行更多的研究来比较各种手术的结果。
