Objective To trace and review the treatment of complex anal fistula so as to consider whether current procedures and therapies might offer a better choice. Methods Through the literature collected, with the difficulties and contradictions of the treatment of complex anal fistula as the starting point, the currently widely used seton management, the development and deficiency of biological therapy and sphincter preserving surgery, and the change of treatment model of complex anal fistula were reviewed. The research progress and application prospect of intersphincteric fistula ligation was focus attented. Results The treatment of complex anal fistula would be not too much emphasis of healing or radical cure, and more attention to the anus function, shape, fine feeling, and quality of life, has become a consensus. The seton management remained an useful therapy for the treatment of complicated anal fistula through continuous improvement and development, in despite of it has postoperative relapse or mild to moderate anal incontinence. Biotherapy relied on its minimal invasion rising in recent years especially at abroad, but it is limited wider application in China because of its high cost, unstable efficacy, and high recurrence rate. Sphincter-preserving operation always attracts attentions particularly under the background of invasive treatment. It has been already established about efficacy and security of the ligation of intersphincteric fistula tract as a novel procedure, which possessed an excellent advantage for protecting anal continence. Conclusion The ligation of intersphincteric fistula tract is a promising procedure, which tends to be superior than fistulotomy and seton management, may become a first-line treatment of complex anal fistula.
ObjectiveTo understand progress of stem cell transplantation in treatment of complex anal fistula.MethodThe relevant literatures were searched in the PubMed, Web of Science, CNKI, Wanfang, and other databases and the clinical efficacy, advantages and problems of the therapy were analyzed and summarized.ResultsThe stem cells currently used in the field of complex anal fistula were mainly the adipose tissue-derived stem cells, which had the biological characteristics of regenerative differentiation, immune regulation, and repair of intestinal mucosal barrier, which could be used as the seed cells for the treatment of complex anal fistula, its effectiveness was worthy of recognition. But its long-term clinical efficacy remained to be seen due to its clinical treatment options were different and lack of uniform standards. The safety of treatment for complex anal fistula was payed a attention because the stem cells had the oncogene activation and tumor suppressor gene inactivation characteristics.ConclusionsStem cell transplantation, as an emerging therapy, has broad prospects for patients with complex anal fistula that are difficult to solve by surgery, but its long-term efficacy is still unsatisfactory. Due to current sample size, short observation time, and lack of randomized control, current clinical data is not convincing, and high cost also limits its development of technology.
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 investigate the long-term efficacy of intersphincter approach combined with virtual solid and hanging line in the treatment of posterior high complex anal fistulas and risk factors for recurrence. Methods A total of 167 patients with posterior high complex anal fistula treated in our hospital from April 2020 to June 2023 were retrospectively included. According to different treatment methods, the patients were divided into observation group (n=88) and control group (n=79). The observation group was treated with the combination of virtual solid and hanging line via intersphincter approach, while the control group was treated with cutting and wire hanging drainage. The general clinical data, the height of the internal fistula opening and the anorectal pressure before and after 1, 2 and 3 months were compared between the two groups. The patients were divided into recurrence group (n=50) and non-recurrence group (n=117) according to the recurrence situation during the follow-up period. Univariate and multivariate logistic regression were used to analyze the risk factors of postoperative anal fistula recurrence, and Kaplan-Meier method was ued to draw relapse-free curve. ResultsCompared with the control group, the observation group had longer operative time, shorter wound healing time and shorter hospital stay (P<0.05). At 1, 2 and 3 months after operation, the anal resting pressure and maximum anal retraction pressure in the observation group were significantly increased, while the height of the inner mouth was significantly decreased, with statistical significance (P<0.05). There were statistically significant differences in age, body mass index, gender, regular dressing change to hospital after discharge, history of anal fistula surgery, clarity of internal opening and treatment methods between the recurrence group and the non-recurrence group (P<0.05). The results of multivariate logistic regression analysis showed that the independent risk factors for postoperative recurrence of patients with posterior high complicated anal fistula were that they didn’t regularly go to the hospital for dressing change after discharge, had a history of anal fistula operation, had unclear internal orifice and underwent thread-drawing drainage (P<0.05). The cumulative relapse-free rate of patients in the observation group and the control group was 84.58% and 67.73% respectively, and the difference was statistically significant (P<0.05). ConclusionsThe treatment of posterior high complex anal fistulas by intersphincter approach combined with virtual solid and hanging line has a good effect in protecting anal function and promoting wound healing. After discharge, the factors affecting postoperative recurrence in patients with posterior high complex anal fistula are not regularly changed dressing, history of anal fistula surgery, unclear internal mouth, cutting and wire hanging drainage, which should be paid attention to.