Evidence - Based Medicine Research On Complex Anal Fistula Treatment

Objective: To investigate the healing rate as well as post-operative conditions of ligation of the intersphincteric fistula(LIFT) and incision-thread-drawing procedure for complex anal fistula.Methods: Pubmed, Embase, Cochrane Library, CNKI, Wanfang and CQVIP databases were searched. Reports of randomized controlled trials, cohort studies, case–control studies, and case series were included. Further screening was done in relevant studies to identify studies suitable for inclusion. The full texts of all eligible art icles were retrieved.Results: 388 articles were found following the searching strategy, thirteen were finally included for analysis. The sample size ranged from 58 t o 90, with a total number of 910 patients. Overall healing rate ranged from 50% to 95% in LIFT group and 20% to 97.7% in Incision-thread-drawing procedure group. Meta-analysis showed that LIFT has an edge over Incision-thread-drawing procedure in the treatment of complex anal fistula(OR=2.01; 95%CI: 1.35- 2.99; p=0.0006) as well as healing tim e and anal function statistically.Conclusion: LIFT was superior to Incision-thread-drawing procedure in terms of healing rate, healing time and anal function, which was worth promoting in our daily treatment.Objectives: Sphincter-saving techniques(SST) seem to be promising in the treatment of anal fistula and cause less fecal incontinence. The aim of this article was to investigate the clinical effectiveness of Ligation of the Intersphincteric Fistula(LIFT) and advancement flap in anal fistula.Method: Pub Med(January 1966 to October 2015), EMBASE(January 1980 to October 2015) and the Cochrane database were searched. Reports of randomized controlled trials, cohort studies, case –control studies, and case series were included. The abstracts of all potentially relevant studies were consulted to identify studies suitable for inclusion. The full texts of all eligible articles were retrieved.Results: Seventy-nine articles were found following the searching strategy, six were finally included for analysis. The sample size range d from 39 to 70, with a total number of 337 patients. Overall success rate range d from 51.4% to 92% in LIFT group and 60% to 93.5% in advancement flap group. Only one study showed that advancement flap technique had a significantly higher success rate in comparison with the LIFT approach. No difference s in success rates were found in other studies(pooled OR=0.82; 95%CI: 0.35-1.91; p=0.65), although the follow-up time range d from 1 month to 67 months. LIFT cost less operative time compared with advancement flap(mean difference =-23.01; 95%CI:-41.23--4.79; p=0.01).Post-operative continence showed no difference statistically, while various complications were reporte d.Conclusion: LIFT procedure is quicker and easier to perform and causes less postoperative pain, w hile the overall healing rate shows no statistically difference. More randomized controlled and long follow-up trials are necessary to determine the true effectiveness of LIFT compared to advancement flap or other sphincter-preserving procedures.