Fuschillo G, Pata F, D'Ambrosio M, Selvaggi L, Pescatori M, Selvaggi F, Pellino G
Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli," Policlinico CS, Piazza Miraglia 2, 80138, Naples, Italy.
Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy.
Tech Coloproctol. 2025 May 20;29(1):116. doi: 10.1007/s10151-025-03152-0.
Several techniques are available to reduce the risk of sphincter injury when treating anal fistula, such as ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula laser closure (FiLaC) and endoanal flap (EAF). The aim of this meta-analysis is to provide data on the safety, complications and failure of these techniques.
Studies published after 2017, with patients undergoing at least one among LIFT, VAAFT, FiLaC and EAF for perianal fistula and providing data regarding failure, were retrieved from PubMed and EMBASE. Primary outcome was failure; other outcomes included continence disturbance and complications.
Forty-nine articles with 3520 patients were included. The failure rates were 28.6% (range 3.8-75) for LIFT, 22.3% (6.2-65.2) for VAAFT, 43.9% (11.1-80) for FiLaC and 25.9% (4.7-100) for EAF, with a mean follow-up of 35.4 (6-80.4), 32.4 (6-48), 31.6(6.3-60) and 42.4 (12-155) months. The available network meta-analysis on failure showed RD of -0.08 (95% CI - 0.58 to 0.42) comparing LIFT vs VAAFT and 0.30 (95% CI 0.03 to 0.58) comparing LIFT vs EAF. No patients undergoing VAAFT or FiLaC reported worsening continence, while for LIFT and EAF, the continence disturbance rate was 1.5% and 7.3%, respectively. No major complications were observed. The most common minor complications were pain (1.4%), bleeding (1.1%) and wound infection (1.2%). Overall, minor complication rates were 4.3% for LIFT, 7.2% for VAAFT, 10.2% for FiLaC and 6.2% for EAF. Crohn's disease was associated with a higher failure rate (39.5% vs 31.4%).
FiLaC, VAAFT, LIFT and EAF may represent a valid option in the treatment of anal fistula. VAAFT showed the lowest rate of failure but with no differences from network metanalysis. Wider homogeneous studies with long-term follow-up are necessary to obtain more robust data.
CRD42022375600.
在治疗肛瘘时，有多种技术可降低括约肌损伤风险，如括约肌间瘘管结扎术（LIFT）、视频辅助肛瘘治疗（VAAFT）、肛瘘激光闭合术（FiLaC）和肛管皮瓣术（EAF）。本荟萃分析的目的是提供这些技术的安全性、并发症及失败率的数据。
从PubMed和EMBASE检索2017年后发表的研究，这些研究纳入了接受LIFT、VAAFT、FiLaC和EAF中至少一种治疗肛周瘘且提供失败相关数据的患者。主要结局是失败；其他结局包括控便障碍和并发症。
纳入49篇文章，共3520例患者。LIFT的失败率为28.6%（范围3.8 - 75），VAAFT为22.3%（6.2 - 65.2），FiLaC为43.9%（11.1 - 80），EAF为25.9%（4.7 - 100），平均随访时间分别为35.4（6 - 80.4）、32.4（6 - 48）、31.6（6.3 - 60）和42.4（12 - 155）个月。关于失败的可用网状荟萃分析显示，比较LIFT与VAAFT时RD为 - 0.08（95%CI - 0.58至0.42），比较LIFT与EAF时为0.30（95%CI 0.03至0.58）。接受VAAFT或FiLaC治疗的患者均未报告控便能力恶化，而LIFT和EAF的控便障碍率分别为1.5%和7.3%。未观察到严重并发症。最常见的轻微并发症是疼痛（1.4%）、出血（1.1%）和伤口感染（1.2%）。总体而言，LIFT的轻微并发症发生率为4.3%，VAAFT为7.2%，FiLaC为10.2%，EAF为6.2%。克罗恩病与较高的失败率相关（39.5%对31.4%）。
FiLaC、VAAFT、LIFT和EAF可能是治疗肛瘘的有效选择。VAAFT显示出最低的失败率，但与网状荟萃分析无差异。需要更广泛的同质研究及长期随访以获得更可靠的数据。
PROSPERO编号：CRD42022375600。
