The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

Carlos Placer-Galán; Jose Mª Enriquez-Navascués; Tania Pastor-Bonel; Ignacio Aguirre-Allende; Yolanda Saralegui-Ansorena

doi:10.1055/s-0041-1730039

Journal of Coloproctology, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(03): 308-315
DOI: 10.1055/s-0041-1730039

Review Article

The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

Carlos Placer-Galán

¹Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain

,

Jose Mª Enriquez-Navascués

¹Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain

,

Tania Pastor-Bonel

¹Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain

,

Ignacio Aguirre-Allende

¹Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain

,

Yolanda Saralegui-Ansorena

¹Colorectal Surgery Unit, Department of General and Digestive Surgery, Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group), San Sebastián, Spain

› Institutsangaben

Abstract

Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula.

Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano.

Design systematic review and meta-analysis.

Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases.

Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included.

Intervention The intervention assessed was the LIFT with and without prior seton placement.

Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery.

Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I² value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%)

Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels.

Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.

International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

Keywords

anal fistula - seton - LIFT - intersphincteric

Volltext

Referenzen

References
1 Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula-in ano: The ligation of intersphincteric fistula tract. J Med Assoc Thai 2007; 90: 581-586
2 Matos D, Lunniss PJ, Phillips RKS. Total sphincter conservation in high fistula in ano: results of a new approach. Br J Surg 1993; 80: 802-804
3 Emile SH, Khan SM, Adejumo A, Koroye O. Ligation of intersphincteric fistula tract (LIFT) in treatment of anal fistula: An updated systematic review, meta-analysis, and meta-regression of the predictors of failure. Surgery 2020; 167 (02) 484-492
4 Hong KD, Kang S, Kalaskar S, Wexner SD. Ligation of intersphincteric fistula tract (LIFT) to treat anal fistula: systematic review and meta-analysis. Tech Coloproctol 2014; 18: 685-691
5 Gendia AM. Abd-erRazik MA, Hanna HH. Ligation of the intersphincteric fistula tract procedure and its modifications. J Coloproctol (Rio J) 2018; 38: 324-336
6 Placer Galán C, Lopes C, Múgica JA, Saralegui Y, Borda N, Enriquez Navascués JM. Patterns of recurrence/persistence of criptoglandular anal fistula after the LIFT procedure. Long-term observatinal study. Cir Esp 2017; 95: 385-390
7 Yassin NA, Hammond TH, Lunniss PJ, Phillips RKS. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Dis 2013; 15: 527-535
8 Zirak-Schmidt S, Perdawood SK. Management of anal fistula by ligation of the intersphincteric fistula tract-a systematic review. Dan Med J 2014; 61: A4977
9 Stroup DF, Berlin JA, Morton SC. et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012
10 Espin E, Lozoya R, Vallribera F, Jimenez LM, Marti M, Sánchez M. LIF (Ligation of intersphincteric fistula tract): long-term results. Colorectal Dis 2011; 13 (Suppl. 06) 47
11 Sugrue J, Mantgilla N, Abcarian A. et al. Sphincter-sparing anal fistula repair: Are we getting better?. Dis Colon Rectum 2017; 60: 1071-1077
12 Wells GA, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2013
13 Penson DF, Krishnaswami S, Jules A. Newcastle-Ottawa Quality Assessment form for Cohort studies. Ottawa: Ottawa Hospital Research Institute; 2012
14 Wallin UG, Mellgren AF, Madoff RD, Goldberg SM. Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery. Dis Colon Rectum 2012; 55: 1173-1178
15 Liu WI, Aboulian A, Kaji AH, Kumar RR. Long-term results of ligation of intersphincteric fistula tract (LIFT) for fistula-in-ano. Dis Colon Rectum 2013; 56: 343-347
16 Wang QM, Chong HY, Wexcner SD, Hong KD, Maron DJ, Silva GD. Seton placement prior to lift: does it affect the outcome?. Colorectal Dis 2013; 15 (Suppl. 01) 56
17 Sileri P, Giarratano G, Franceschilli L. et al. Ligation of the intersphincteric fistula tract (LIFT): A minimally invasive procedure for complex anal fistula: Two-year results of a prospective multicentric study. Surg Innov 2014; 2: 476-480
18 Hall JF, Bordeianou L, Hyman N. et al. Outcomes after operations for anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum 2014; 57: 1304-1308
19 Ye F, Tang CH, Wang D, Zheng S. Early experience with the modificated approach of ligation of the intersphincteric fistula tract for high transsphincteric fistula. World J Surg 2015; 39: 1059-1065
20 Vander Mijnsbrugge GJH, Felt-Bersma RJF, Ho DKF, Molenaar CBH. Perianal fistulas and the lift procedure: results, predictive factors for success and long-term results with subsequent treatment. Tech Coloproctol 2019; 23: 639-647
21 Moreno N, Readi A, Melkonian E, Capona R, Martinez M. Ligadura interesfinteriana del trayecto fistuloso (LIFT) como alternativa de tratamiento a una fístula perianal compleja. Rev Chil Cir 2019; 71: 42-46
22 Lynn P, Carrano FM, Grieco M, Carter J, Grucela A, Bernstein M. Ligation of the intersphincteric fistula tract: are there any factors associated with persistent/recurrence?. Dis Colon Rectum 2019; 62: e339-e340
23 Mushaya CH, Bartlett L, Schultze B, Ho YH. Ligation of intersphincteric fistula tract compared with advancement flap for complex anorectal fistulas requering inictial seton drainage. Am J Surg 2012; 204: 283-289
24 Stellingwerf ME, van Pragg EM, Tozer PJ, Bemelman WA, Buskens CJ. Systematic review and meta-analysis of endorectal advancement flap and ligation of the intersphincteric fistula tract for cryptoglandular and Crohn's high perianal fistulas. Br J Surg 2019; 3: 231-241
25 Malakorn S, Sammour T, Khomvilai S. et al. Ligation of intersphincteric fistula tract for fistula in ano: Lessons learned from a decade of experience. Dis Colon Rectum 2017; 60: 1065-1070
26 Mitalas LE, van Onkelen RS, Monkhorst K, Zimmerman DD, Gosselink MP, Schouten WR. Identification of epitheliazation in high transsphincteric fistulas. Tech Coloproctol 2012; 16: 113-117
27 van Koperen PJ, ten Kate FJ, Bemelman WA, Slors JF. Histological identification of epithelium in perianal fistulae: a prospective study. Colorectal Dis 2009; 12: 891-895
28 Koh SZ, Tsang CB. The LIFT procedure. Sem Colon Rectum. 2014; 25: 190-199
29 Tan KK, Alsuwaigh R, Tan AM. et al. To LIFT or to flap? Which surgery to perform following seton insertion for high anal fistula?. Dis Colon Rectum 2012; 55: 1273-1277
30 Schultze B, Ho YH. Management of compolex anorectal fistulas with seton drainage plus partial fistulotomy and subsequent ligation of intersphincteric fistula tract (LIFT). Tech Coloproctol 2015; 19: 89-95
31 Aboulian A, Kaji AH, Kumar RR. Early result of ligation of the intersphincteric fistula tract for fistula-in-ano. Dis Colon Rectum 2011; 54 (03) 289-292

Zusatzmaterial

Supplementary Material