A meta-analysis of marsupialisation versus none in the treatment of simple fistula-in-ano

Introduction Marsupialisation of post-fistulotomy wounds results in a smaller raw surface area and may improve postoperative outcomes. However, it remains a variable practice. We performed a systematic review and meta-analysis to evaluate the effectiveness of marsupialisation in the treatment of simple fistula-in-ano. Materials and methods PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until April 2020. All trials that reported on marsupialisation in anal fistula treatment were included. The primary outcome measure was time to complete healing, while secondary outcomes included recurrence, pain scores and incontinence. Random effects models were used to calculate pooled effect size estimates. A sensitivity analysis was performed. Results Six randomised controlled trials were included capturing 461 patients. The mean (SD) age of the cohort was 39.31 (± 8.71) years. There were 395 males (85.7%). All fistulae were of the cryptoglandular aetiology. On random effects analysis, marsupialisation was associated with a significantly shorter time to healing compared with no marsupialisation (SMD – 0.97 weeks, 95% CI = − 1.36 to − 0.58, p < 0.00001). However, there was no difference in recurrence (RD = − 0.00, 95% CI = − 0.02 to 0.02, p = 0.72), pain scores at 24 h (SMD – 0.03, 95% CI = − 0.56 to 0.50, p = 0.91) or incontinence (RD = − 0.01, 95% CI = − 0.05 to 0.02, p = 0.42). On sensitivity analysis, focusing exclusively on fistulotomy for simple fistula-in-ano, the results for time to healing, recurrence and incontinence remained similar. Conclusions Marsupialisation of fistulotomy wounds for simple fistula-in-ano is associated with a significantly shorter healing time, but similar recurrence, pain scores at 24 h and incontinence rates, compared with omitting marsupialisation..

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:36

Enthalten in:

International journal of colorectal disease - 36(2020), 3 vom: 06. Okt., Seite 429-436

Sprache:

Englisch

Beteiligte Personen:

Sahebally, Shaheel Mohammad [VerfasserIn]
O’Byrne, Lisa [VerfasserIn]
Troy, Alexandra [VerfasserIn]
Byrnes, Kevin Gerard [VerfasserIn]
Burke, John [VerfasserIn]
McNamara, Deborah [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.87$jGastroenterologie

Themen:

Fistula-in-ano
Fistulotomy
Healing
Incontinence
Marsupialisation
Recurrence

RVK:

RVK Klassifikation

Anmerkungen:

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

doi:

10.1007/s00384-020-03759-9

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2123802956

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