摘要
AIM:To investigate the efficacy of the anal fistula plug(AFP) compared to the mucosa advancement flap(MAF),considered the best procedure for patients with a complex anal fistula.METHODS:The literature search included PubMed,EMBASE,Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011.Randomized controlled trials,controlled clinical trials and prospective cohort studies were included in the review.After information collection,a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity.The quality of postoperative life was also included with the clinical results.RESULTS:Six studies involving 408 patients(AFP = 167,MAF = 241) were included in the meta-analysis.The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference(RD) =-0.12,95%CI:-0.39-0.14;RD = 0.13;95%CI:-0.18-0.43,respectively].However,for the AFP,the risk of postoperative impaired continence was lower(RD =-0.08,95%CI:-0.15--0.02) as was the incidence of other complications(RD =-0.06,95%CI:-0.11-0.00).The postoperative quality of life,for patients treated using the AFP was superior to that of the MAF patients.Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced.CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula;it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life.Additional evidence is needed to confirm these findings.
AIM: To investigate the efficacy of the anal fistula plug (AFP) compared to the mucosa advancement flap (MAF), considered the best procedure for patients with a complex anal fistula. METHODS: The literature search included PubMed, EMBASE, Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011. Randomized controlled trials, controlled clinical trials and prospective cohort studies were included in the review. After information collection, a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity. The quality of postoperative life was also included with the clinical results. RESULTS: Six studies involving 408 patients (AFP = 167, MAF = 241) were included in the meta-analysis. The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference (RD) = -0.12, 95%CI: -0.39 - 0.14; RD = 0.13; 95%CI: -0.18 - 0.43, respectively]. However, for the AFP, the risk of postoperative impaired continence was lower (RD = -0.08, 95%CI: -0.15 - -0.02) as was the incidence of other complications (RD = -0.06, 95%CI: -0.11 - -0.00). The postoperative quality of life, for patients treated using the AFP was superior to that of the MAF patients. Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced. CONCLUSION: The AFP is an effective procedure for patients with a complex anal fistula; it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life. Additional evidence is needed to confirm these findings.
