Comparative effectiveness of sphincter-sparing and non-sphincter-sparing procedures for complex anal fistulas: A systematic review and network meta-analysis of postoperative incontinence, pain, and quality of life.
Mohamad Sadek Zoghbi, Lama Hamade, Dima Itani et al.
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In 30 seconds
This systematic review and network meta-analysis compared procedures for adults with complex cryptoglandular anal fistulas, assessing postoperative fecal incontinence, pain, quality of life, and recurrence. It included 2,972 patients across 43 randomized and nonrandomized controlled studies. Compared with seton, several approaches—particularly video-assisted anal fistula treatment combined with ligation of the intersphincteric fistula tract—showed better continence, pain, or quality-of-life outcomes. Recurrence was lower with adipose-derived stem cells plus fibrin glue (relative risk, 0.02) and acellular dermal matrix (relative risk, 0.08) than with seton.
Key findings
- Adipose-derived stem cells plus fibrin glue and video-assisted anal fistula treatment with intersphincteric tract ligation showed the most consistent reductions in fecal incontinence versus seton.
- JUMP seton and video-assisted anal fistula treatment with intersphincteric tract ligation were associated with lower pain scores than seton.
- Several approaches, including video-assisted treatment with intersphincteric tract ligation, had higher quality-of-life scores than seton.
- Recurrence was lower with adipose-derived stem cells plus fibrin glue (relative risk, 0.02) and acellular dermal matrix (relative risk, 0.08) versus seton.
Why it matters
Complex fistula treatment must balance healing against preservation of continence and quality of life. This synthesis compares outcomes across multiple procedural approaches and suggests that some sphincter-sparing or adhesive-based options may offer advantages over seton-based techniques. The findings help frame outcome trade-offs, while the evidence does not establish that one procedure is best for every patient.
What to keep in mind
The review combined randomized and nonrandomized studies, and the abstract notes that direct comparative evidence remains limited.