Systematic Review
Anal fistula plug vs rectal advancement flap for the treatment of complex cryptoglandular anal fistulas: a systematic review and meta-analysis of studies with long-term follow-up
H. Lin,
Z. Jin,
Y. Zhu,
M. Diao,
W. Hu,
H. Lin
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
These authors have contributed equally to this work.Search for more papers by this authorZ. Jin
Hangzhou Geriatric Hospital, Hangzhou First People's Hospital Group, Hangzhou, China
These authors have contributed equally to this work.Search for more papers by this authorY. Zhu
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorM. Diao
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorCorresponding Author
W. Hu
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Correspondence to: W. Hu, Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, Zhejiang 310006, China.
E-mail: [email protected]
Search for more papers by this authorH. Lin,
Z. Jin,
Y. Zhu,
M. Diao,
W. Hu,
H. Lin
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Department of Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
These authors have contributed equally to this work.Search for more papers by this authorZ. Jin
Hangzhou Geriatric Hospital, Hangzhou First People's Hospital Group, Hangzhou, China
These authors have contributed equally to this work.Search for more papers by this authorY. Zhu
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorM. Diao
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Search for more papers by this authorCorresponding Author
W. Hu
Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
Correspondence to: W. Hu, Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, Zhejiang 310006, China.
E-mail: [email protected]
Search for more papers by this authorAbstract
Aim
The aim was to compare the effectiveness of the anal fistula plug (AFP) with the rectal advancement flap (RAF) for complex cryptoglandular anal fistulas.
Methods
We conducted a literature search to identify relevant available articles published without language restriction from Embase and PubMed databases and the Cochrane Library. Studies comparing outcomes with the AFP vs RAF for complex cryptoglandular anal fistulas were eligible for inclusion.
Results
A total of 11 articles with 810 patients were included in this meta-analysis. Four RCTs and one observational clinical study provided long-term follow-up. The pooled analysis of all 11 studies indicated that there was no significant difference between the AFP and RAF in terms of healing rate, recurrence rate and incidence of fistula complications. However, the pooled results of studies with long-term follow-up revealed that the RAF group had a significantly higher healing rate (OR 0.32, 95% CI 0.13, 0.78, P = 0.01) and lower recurrence rate (OR 4.45, 95% CI 1.45, 13.65, P = 0.009) than the AFP group.
Conclusions
For the treatment of complex cryptoglandular anal fistulas, the RAF was superior to the AFP in terms of healing and recurrence rate after pooling of randomized controlled trials with long-term follow-up, even though a comparison based on the pooling of all studies showed no significant difference.
Conflicts of interest
We declare that we have no conflicts of interest.
Supporting Information
| Filename | Description |
|---|---|
| codi14504-sup-0001-FigS1-S2.docxWord document, 196 KB |
Figure S1. The subgroup analysis of studies with long-term follow-up after the study of Ortiz et al. was excluded (healing rate). Figure S2. The subgroup analysis of studies with long-term follow-up after the study of Ortiz et al. was excluded (recurrence rate). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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