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.
ObjectiveTo compare clinical efficacy of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) in treatment of colorectal cancer.MethodsThe Pubmed, Embase, Cochrane library, CBM, CNKI, VIP, and Wanfang Data were searched to collect the comparative study of the SILS and CLS in the treatment of colorectal cancer. The data were extracted and evaluated by the RevMan 5.3 software.ResultsEventually, 13 articles were included, including 3 randomized controlled trials and 10 case-control studies with a total of 1 466 patients. The meta-analysis results suggested that the SILS could shorten the postoperative hospital stay [MD=–0.63, 95% CI (–1.10, –0.16), P=0.009] and time to the first flatus [MD=–0.23, 95% CI (–0.33, –0.13), P<0.000 01] and the lymph node dissection was relatively completed [MD=0.77, 95% CI (0.05, 1.48), P=0.04] as compared with the CLS. In the total complications of surgery [OR=0.73, 95% CI (0.51, 1.03), P=0.08], operation time [MD=–0.33, 95% CI (–11.36, 10.69), P=0.95], intraoperative blood loss [MD=5.61, 95% CI (–4.20, 15.43), P=0.26], conversion to laparotomy [OR=1.06, 95% CI (0.18, 6.13), P=0.95], distance between tumor and proximal margin [MD=0.11, 95% CI (–0.48, 0.69), P=0.71], distance between tumor and distal margin [MD=0.32, 95% CI (–0.23, 0.87), P=0.25] had no statistically significant differences between the SILS and CLS.ConclusionsSILS is safe and effective for radical resection of colorectal cancer. However, results of study still need to be validated by a randomized controlled trial with a large sample designed strictly.