Efficacy and safety of video<b>-</b>assisted anal fistula treatment compared with incision and thread drawing in the treatment of complex anal fistula: a meta<b>-</b>analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XU Yubao ¹ , ZHENG Jie ¹ ,  HU Fengliang ²

1. The First School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;
2. Department of Anorectal Diseases, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;

Corresponding?author：

HU Fengliang, Email: hahahu08@126.com

Keywords：

video-assisted anal fistula treatment; complex anal fistula; incision and thread drawing; meta-analysis

DOI：

10.7507/1007-9424.202208058

Video：

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Objective To systematically evaluate the efficacy and safety for video-assisted anal fistula therapy in the treatment of complex anal fistula. Methods The databases of CKNI, Wanfang, VIP, CBM, Web of Science, PubMed, Cochrane Library and Embase were retrieved from the time of database establishment to may 31 2022. The two researchers independently screened the literatures and evaluated the quality of the literatures that met the inclusion criteria according to the research purpose and quality evaluation criteria. Meta-analysis were performed with the Revman 5.4.1 software. Results A total of 11 articles and 977 patients were included. The results of meta-analysis showed that the video-assisted group were superior to the traditional incision and thread hanging operation group in improved the cure rate [RR=1.14, 95%CI (1.04, 1.24), P<0.05], accelerated wound healing [MD=–10.40, 95%CI (–13.64, –7.17), P<0.05], protected the anal function after surgery [MD=–1.32, 95%CI (–1.85, –0.79), P＜0.05], relieved postoperative 24-hour pain [MD=–1.23, 95%CI (–1.60, –0.86), P＜0.05], shorten the operative time and hospital stay [MD=–9.46, 95%CI (–17.16, –1.75), P<0.05; MD=–3.87, 95%CI (–5.90, –1.84), P<0.05], reduced intraoperative bleeding [MD=–14.24, 95%CI (–17.49, –10.99), P<0.05] and the incidence of postoperative complications [RR=0.39, 95%CI (0.27, 0.56), P<0.05], which difference were statistically significant. However, there was no significant difference in the recurrence rate of 1-year after operation [OR=0.64, 95%CI (0.33, 1.23), P>0.05]. Conclusions Video-assisted anal fistula treatment is a safe and effective sphincter preserving operation for the treatment of complex anal fistula, which is superior to the traditional incision and thread hanging operation. However, due to the limitations and publication bias of the included literature, more prospective, large sample, multi center randomized controlled trial are needed to confirm its long-term efficacy.

Citation： XU Yubao, ZHENG Jie, HU Fengliang. Efficacy and safety of video-assisted anal fistula treatment compared with incision and thread drawing in the treatment of complex anal fistula: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(3): 338-344. doi: 10.7507/1007-9424.202208058 Copy

1.	汪建平. 中華結直腸肛門外科學. 北京: 人民衛生出版社, 2014: 776.
2.	García-Aguilar J, Belmonte C, Wong DW, et al. Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg, 1998, 85(2): 243-245.
3.	Durgun V, Perek A, Kapan M, et al. Partial fistulotomy and modified cutting seton procedure in the treatment of high extrasphincteric perianal fistulae. Dig Surg, 2002, 19(1): 56-58.
4.	Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol, 2011, 15(4): 417-422.
5.	阿布都維力?阿布都熱合曼, 沙巴義丁?吐爾遜 . 視頻輔助下肛瘺治療術治療復雜性肛瘺的療效. 中國臨床研究, 2021, 34(2): 169-173.
6.	王靜林, 趙奎, 孟浩. 視頻輔助瘺管刨削術治療復雜性肛瘺的臨床應用研究. 結直腸肛門外科, 2018, 24(4): 381-384.
7.	Liu HL, Tang X, Chang Y, et al. Comparison of surgical outcomes between video-assisted anal fistula treatment and fistulotomy plus seton for complex anal fistula: A propensity score matching analysis—Retrospective cohort study. Int J Surg, 2020, 75: 99-104.
8.	司中華, 王業皇, 劉飛, 等. 拔根塞源法結合微創技術治療高位復雜性肛瘺的臨床療效分析. 時珍國醫國藥, 2018, 29(4): 919-920.
9.	司中華, 王業皇, 劉飛. 肛瘺微創平臺用于治療高位復雜性肛瘺的臨床研究. 中華結直腸疾病電子雜志, 2020, 9(3): 260-264.
10.	劉剛. 肛瘺微創平臺與低位切開高位掛線術治療高位復雜性肛瘺的臨床研究. 基層醫學論壇, 2021, 25(4): 529-531.
11.	魯林源, 曹永清, 張強, 等. 視頻輔助治療手術對復雜性肛瘺病人癥狀及預后的影響. 臨床外科雜志, 2019, 27(12): 1041-1043.
12.	陳天杰. 傳統切開掛線術與視頻輔助肛瘺治療術治療復雜性肛瘺患者的療效. 醫療裝備, 2020, 33(18): 97-99.
13.	鄭力, 陸金燕, 浦玉偉, 等. 視頻輔助肛瘺治療術與傳統切開掛線術治療復雜性肛瘺臨床療效的比較研究. 中華胃腸外科雜志, 2018, 21(7): 793-797.
14.	楊勇, 高大勇. 視頻輔助下肛瘺治療技術治療復雜性肛瘺30例療效觀察. 中國肛腸病雜志, 2021, 41(9): 31-33.
15.	李明輝, 白曉剛, 劉申, 等. 肛瘺微創平臺對高位復雜性肛瘺治療效果、肛門功能及并發癥的影響. 中國現代醫藥雜志, 2021, 23(7): 47-49.
16.	宋順心. 美國結直腸外科醫師學會肛周膿腫、肛瘺和直腸陰道瘺臨床診治指南. 中華胃腸外科雜志, 2017, 20(12): 1437-1439.
17.	Giamundo P, Geraci M, Tibaldi L, et al. Closure of fistula-in-ano with laser—FiLaC^TM: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis, 2014, 16(2): 110-115.
18.	Buchanan GN, Bartram CI, Phillips RK S, et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum, 2003, 46(9): 1167-1174.
19.	Sileri P, Franceschilli L, Angelucci GP, et al. Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study. Tech Coloproctol, 2011, 15(4): 413-416.
20.	郭高正, 王怡明, 鄭雪平. 高位復雜性肛瘺術后復發危險因素分析. 上海醫學, 2022, 45(2): 99-104.
21.	姚一博, 王琛, 梁宏濤, 等. 基于影像學和臨床體征的隧道式拖線術治療復雜性肛瘺預后因素COX回歸分析. 世界中醫藥, 2016, 11(6): 1027-1032.
22.	張東銘. 盆底與肛門病學. 貴陽: 貴州科學技術出版社, 2000: 453-457.
23.	Chowbey PK. Minimally invasive anal fistula treatment—a true minimal invasive surgical procedure. Indian J Surg, 2015, 77(6): 475-476.
24.	劉海龍, 肖毅華, 張勇, 等. 一種新型視頻輔助肛瘺治療技術治療復雜性肛瘺的初步療效分析. 中華胃腸外科雜志, 2015, 18(12): 1207-1210.

1. 汪建平. 中華結直腸肛門外科學. 北京: 人民衛生出版社, 2014: 776.
2. García-Aguilar J, Belmonte C, Wong DW, et al. Cutting seton versus two-stage seton fistulotomy in the surgical management of high anal fistula. Br J Surg, 1998, 85(2): 243-245.
3. Durgun V, Perek A, Kapan M, et al. Partial fistulotomy and modified cutting seton procedure in the treatment of high extrasphincteric perianal fistulae. Dig Surg, 2002, 19(1): 56-58.
4. Meinero P, Mori L. Video-assisted anal fistula treatment (VAAFT): a novel sphincter-saving procedure for treating complex anal fistulas. Tech Coloproctol, 2011, 15(4): 417-422.
5. 阿布都維力?阿布都熱合曼, 沙巴義丁?吐爾遜 . 視頻輔助下肛瘺治療術治療復雜性肛瘺的療效. 中國臨床研究, 2021, 34(2): 169-173.
6. 王靜林, 趙奎, 孟浩. 視頻輔助瘺管刨削術治療復雜性肛瘺的臨床應用研究. 結直腸肛門外科, 2018, 24(4): 381-384.
7. Liu HL, Tang X, Chang Y, et al. Comparison of surgical outcomes between video-assisted anal fistula treatment and fistulotomy plus seton for complex anal fistula: A propensity score matching analysis—Retrospective cohort study. Int J Surg, 2020, 75: 99-104.
8. 司中華, 王業皇, 劉飛, 等. 拔根塞源法結合微創技術治療高位復雜性肛瘺的臨床療效分析. 時珍國醫國藥, 2018, 29(4): 919-920.
9. 司中華, 王業皇, 劉飛. 肛瘺微創平臺用于治療高位復雜性肛瘺的臨床研究. 中華結直腸疾病電子雜志, 2020, 9(3): 260-264.
10. 劉剛. 肛瘺微創平臺與低位切開高位掛線術治療高位復雜性肛瘺的臨床研究. 基層醫學論壇, 2021, 25(4): 529-531.
11. 魯林源, 曹永清, 張強, 等. 視頻輔助治療手術對復雜性肛瘺病人癥狀及預后的影響. 臨床外科雜志, 2019, 27(12): 1041-1043.
12. 陳天杰. 傳統切開掛線術與視頻輔助肛瘺治療術治療復雜性肛瘺患者的療效. 醫療裝備, 2020, 33(18): 97-99.
13. 鄭力, 陸金燕, 浦玉偉, 等. 視頻輔助肛瘺治療術與傳統切開掛線術治療復雜性肛瘺臨床療效的比較研究. 中華胃腸外科雜志, 2018, 21(7): 793-797.
14. 楊勇, 高大勇. 視頻輔助下肛瘺治療技術治療復雜性肛瘺30例療效觀察. 中國肛腸病雜志, 2021, 41(9): 31-33.
15. 李明輝, 白曉剛, 劉申, 等. 肛瘺微創平臺對高位復雜性肛瘺治療效果、肛門功能及并發癥的影響. 中國現代醫藥雜志, 2021, 23(7): 47-49.
16. 宋順心. 美國結直腸外科醫師學會肛周膿腫、肛瘺和直腸陰道瘺臨床診治指南. 中華胃腸外科雜志, 2017, 20(12): 1437-1439.
17. Giamundo P, Geraci M, Tibaldi L, et al. Closure of fistula-in-ano with laser—FiLaC^TM: an effective novel sphincter-saving procedure for complex disease. Colorectal Dis, 2014, 16(2): 110-115.
18. Buchanan GN, Bartram CI, Phillips RK S, et al. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum, 2003, 46(9): 1167-1174.
19. Sileri P, Franceschilli L, Angelucci GP, et al. Ligation of the intersphincteric fistula tract (LIFT) to treat anal fistula: early results from a prospective observational study. Tech Coloproctol, 2011, 15(4): 413-416.
20. 郭高正, 王怡明, 鄭雪平. 高位復雜性肛瘺術后復發危險因素分析. 上海醫學, 2022, 45(2): 99-104.
21. 姚一博, 王琛, 梁宏濤, 等. 基于影像學和臨床體征的隧道式拖線術治療復雜性肛瘺預后因素COX回歸分析. 世界中醫藥, 2016, 11(6): 1027-1032.
22. 張東銘. 盆底與肛門病學. 貴陽: 貴州科學技術出版社, 2000: 453-457.
23. Chowbey PK. Minimally invasive anal fistula treatment—a true minimal invasive surgical procedure. Indian J Surg, 2015, 77(6): 475-476.
24. 劉海龍, 肖毅華, 張勇, 等. 一種新型視頻輔助肛瘺治療技術治療復雜性肛瘺的初步療效分析. 中華胃腸外科雜志, 2015, 18(12): 1207-1210.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy and safety of video-assisted anal fistula treatment compared with incision and thread drawing in the treatment of complex anal fistula: a meta-analysis

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