Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis,Techniques in Coloproctology

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Cutting seton for the treatment of cryptoglandular fistula-in-ano: a systematic review and meta-analysis
Techniques in Coloproctology ( IF 2.7 ) Pub Date : 2023-12-13 , DOI: 10.1007/s10151-023-02886-z
J Khamar ₁ , A Sachdeva ₂ , T McKechnie _{3,

4} , Y Lee _{3,

5} , L Tessier ₃ , D Hong _{3,

6} , C Eskicioglu _{3,

6}

Affiliation

Background

The use of cutting seton (CS) for the management of cryptoglandular fistula-in-ano has remained controversial because of reports of fecal incontinence, postoperative pain, and extended healing time. The aim of this review was to provide the first synthesis of studies investigating the use of CS for the treatment of cryptoglandular fistula-in-ano.

Methods

MEDLINE, Embase, and CENTRAL were searched up to October 2022. Randomized controlled trials and observational studies comparing CS with alternative interventions were included, along with single-arm studies evaluating CS alone. The primary outcome was fistula-in-ano recurrence, and secondary outcomes included incontinence, healing time, proportion with complete healing, and postoperative pain. Inverse variance random-effects meta-analyses were used to pool effect estimates.

Results

After screening 661 citations, 29 studies were included. Overall, 1513 patients undergoing CS (18.8% female, mean age: 43.1 years) were included. Patients with CS had a 6% (95% CI: 3–12%) risk of recurrence and a 16% (95% CI: 5–38%) risk of incontinence at 6 months. CS patients had an average healing time of 14.6 weeks (95% CI: 10–19 weeks) with 73% (95% CI: 48–89%) of patients achieving complete healing at 6 months postoperatively. There was no difference in recurrence between CS and fistulotomy, advancement flap, two-stage seton fistulotomy, or draining seton.

Conclusions

Overall, this analysis shows that CS has comparable recurrence and incontinence rates to other modalities. However, this may be at the expense of more postoperative pain and extended healing time. Further comparative studies between CS and other modalities are warranted.

中文翻译：

切割挂线治疗隐腺瘘in-ano：系统评价和荟萃分析

背景

由于大便失禁、术后疼痛和愈合时间延长的报道，使用切割挂线（CS）治疗隐腺瘘仍然存在争议。本综述的目的是提供首次综合研究，调查 CS 治疗隐腺瘘in-ano。

方法

检索时间截至 2022 年 10 月的 MEDLINE、Embase 和 CENTRAL。纳入了比较 CS 与替代干预措施的随机对照试验和观察性研究，以及单独评估 CS 的单臂研究。主要结局是肛瘘复发，次要结局包括尿失禁、愈合时间、完全愈合的比例和术后疼痛。使用逆方差随机效应荟萃分析来合并效应估计。

结果

筛选 661 篇引文后，纳入 29 项研究。总体而言，共纳入 1513 例接受 CS 的患者（18.8% 为女性，平均年龄： 43.1 岁）。CS 患者在 6 个月时有 6% （95% CI： 3-12%）的复发风险和 16% （95% CI： 5-38%）的失禁风险。CS 患者的平均愈合时间为 14.6 周（95% CI： 10-19 周），其中 73% （95% CI： 48-89%）的患者在术后 6 个月完全愈合。CS 与瘘管切开术、前移皮瓣、两期挂线瘘管切开术或引流挂线之间的复发率没有差异。