Ligation Of Intersphincteric Fistula Tract(LIFT) Compared With Endoanal Advancement Flap(ERAF) For Complex Fistula-in-ano:A Meta-analysis

Objective:The purpose of this study was to evaluate the clinical efficacy of the treatment for complex anal fistulas by using Ligation of intersphincteric fistula tract and transoanorectal mucosal flap.Methods:A systematic literature search including PubMed,Embase,the Cochrane Library,CBM,WANFANG databases was performed to assess the clinical efficac of Ligation of intersphincteric fistula tract and transoanorectal mucosal flap in complex fistlla-in-ano.The quality of each included study was evaluated using the Newcastle Ottawa Quality Assessment Scale(NOS).After data being extracted,RevMan(Version 5.3)was used for all statistical analysis.Pooled outcomes were calculated using a random effects model conservatively.Results:9 studies,which comprising 560 patients with complex anal fistula(292 with LIFT and 268 with ERAF)were included.The efficacy of the Ligation of intersphincteric fistula tract(LIFT)and transoanorectal mucosal flap(ERAF)on complex anal fistula were studied by different aspects.There was no significant difference in the cure rate between two surgical procedures with an OR of 1.19(95% Cl 0.68-2.09 I2 = 35%).According to different follow-up time,the cure rate of ERAF group was better than LIFT group's within 6 months with an OR of 0.32(95% Cl 0.15-0.71 I2 = 0%).However with the follow-up time up to or more than 12 months,the difference between them did not show statistically significant(OR = 1.17 95% Cl 0.64-2.12 I2 = 0%).The short-term postoperative anal control function between the two groups was found higher in the ERAF group than LIFT group with an OR of 0.14(95% Cl 02.-0.80 I2 = 0%).With long-term follow-up time,no significant difference in the control function of anal(evaluate by using Wexner or CCFT)between the two types was found(SMD =-2.04 95% CI-4.75-0.66;I2 = 98%).The incidence of complications was not significantly different(OR = 0.63 95% Cl 0.13-2.97 I2 = 27%).Conclusious:In the treatment of complex anal fistula the short-term cure rate of ERAF is better than LIFT but as the follow-up time prolongs the recurrence rate of ERAF gradually increases and the difference between the two surgical procedures eventually shrinks and loses statistical significance.The rate of anal continence loose in the ERAF group was higher than in the LIFT group but after conservative treatment the anal continence was restored,In the treatment of complex anal fistulas,LIFT may be superior to ERAF in terms of operative time and recovery time.The postoperative complications was not significantly different between the two procedures.