Meta-Analysis
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World J Gastrointest Surg. Nov 27, 2012; 4(11): 256-261
Published online Nov 27, 2012. doi: 10.4240/wjgs.v4.i11.256
Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis
Qiang Leng, Hei-Ying Jin
Qiang Leng, Hei-Ying Jin, National Center of Colorectal Surgery, the Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210001, Jiangsu Province, China
Author contributions: All authors contributed to this manuscript equally.
Correspondence to: Hei-Ying Jin, MD, Professor, National Center of Colorectal Surgery, the Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, 1 Jinling Road, Nanjing 210001, Jiangsu Province, China. jinheiying@yahoo.com.cn
Telephone: +86-25-52276200 Fax: +86-25-52276200
Received: December 17, 2011
Revised: September 20, 2012
Accepted: November 17, 2012
Published online: November 27, 2012
Abstract

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.

Keywords: Complex anal fistula; Anal fistula plug; Mucosa advancement flap; Meta-analysis