Document Detail

Surgical management of anal fistulae: a systematic review.
MedLine Citation:
PMID:  18479308     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The anal fistula has been a common surgical ailment reported since the time of Hippocrates but little systematic evidence exists on its management. We aimed to systematically review the available studies relating to the surgical management of anal fistulas. METHOD: Studies were identified from PubMED, EMBASE, Cochrane Controlled Trials Register, ClinicalTrials.Gov and Current Controlled Trials. All uncontrolled, nonrandomized, retrospective studies, duplications or those unrelated to the surgical management of anal fistulas were excluded. RESULTS: The search strategy revealed 443 trials. After exclusions 21 randomized controlled trials remained evaluating: fistulotomy vs fistulectomy (n = 2), seton treatment (n = 3), marsupialization (n = 2), glue therapy (n = 3), anal flaps (n = 3), radiosurgical approaches (n = 2), fistulotomy/fistulectomy at time of abscess incision (n = 5) and intra-operative anal retractors (n = 1). Two meta-analyses evaluating incision and drainage alone vs incision + fistulotomy were obtained. CONCLUSION: Marsupialization after fistulotomy reduces bleeding and allows for faster healing. Results from small trials suggest flap repair may be no worse than fistulotomy in terms of healing rates but this requires confirmation. Flap repair combined with fibrin glue treatment of fistulae may increase failure rates. Radiofrequency fistulotomy produces less pain on the first postoperative day and may allow for speedier healing. Major gaps remain in our understanding of anal fistula surgery.
A I Malik; R L Nelson
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland     Volume:  10     ISSN:  1463-1318     ISO Abbreviation:  Colorectal Dis     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-15     Completed Date:  2008-07-21     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  100883611     Medline TA:  Colorectal Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  420-30     Citation Subset:  IM    
Colorectal Unit, Department of Surgery, Northern General Hospital, Sheffield, UK.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Digestive System Surgical Procedures / methods
Fibrin Tissue Adhesive
Rectal Fistula / surgery*
Surgical Flaps
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Fibrin Tissue Adhesive
Comment In:
Colorectal Dis. 2009 Jan;11(1):105; author reply 105   [PMID:  18637933 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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