Background: Several techniques are available to reduce the risk of sphincter injury when treating anal fistula, such as ligation of the intersphincteric fistula tract (LIFT), video-assisted anal fistula treatment (VAAFT), fistula laser closure (FiLaC) and endoanal flap (EAF). The aim of this meta-analysis is to provide data on the safety, complications and failure of these techniques.

Methods: Studies published after 2017, with patients undergoing at least one among LIFT, VAAFT, FiLaC and EAF for perianal fistula and providing data regarding failure, were retrieved from PubMed and EMBASE. Primary outcome was failure; other outcomes included continence disturbance and complications.

Results: Forty-nine articles with 3520 patients were included. The failure rates were 28.6% (range 3.8-75) for LIFT, 22.3% (6.2-65.2) for VAAFT, 43.9% (11.1-80) for FiLaC and 25.9% (4.7-100) for EAF, with a mean follow-up of 35.4 (6-80.4), 32.4 (6-48), 31.6(6.3-60) and 42.4 (12-155) months. The available network meta-analysis on failure showed RD of -0.08 (95% CI - 0.58 to 0.42) comparing LIFT vs VAAFT and 0.30 (95% CI 0.03 to 0.58) comparing LIFT vs EAF. No patients undergoing VAAFT or FiLaC reported worsening continence, while for LIFT and EAF, the continence disturbance rate was 1.5% and 7.3%, respectively. No major complications were observed. The most common minor complications were pain (1.4%), bleeding (1.1%) and wound infection (1.2%). Overall, minor complication rates were 4.3% for LIFT, 7.2% for VAAFT, 10.2% for FiLaC and 6.2% for EAF. Crohn's disease was associated with a higher failure rate (39.5% vs 31.4%).

Conclusions: FiLaC, VAAFT, LIFT and EAF may represent a valid option in the treatment of anal fistula. VAAFT showed the lowest rate of failure but with no differences from network metanalysis. Wider homogeneous studies with long-term follow-up are necessary to obtain more robust data.

Prospero number: CRD42022375600.

Keywords: Anal fistula; Complications; Endoanal flap; FILAC; LIFT; Recurrence; VAAFT.

© 2025. The Author(s).

背景:

在治疗肛瘘时，有多种技术可以降低括约肌损伤的风险，例如括约肌间瘘管结扎术（LIFT）、经视频辅助肛瘘治疗术（VAAFT）、瘘管激光闭合术（FiLaC）和内肛瓣手术（EAF）。本次元分析的目的是提供有关这些技术的安全性、并发症及失败率的数据。

方法:

从PubMed和EMBASE中检索2017年后发表的研究，患者接受过LIFT、VAAFT、FiLaC或EAF治疗肛周瘘管，并且提供了关于失败数据的文献。主要结局指标是失败；其他结果包括排便功能障碍及并发症。

结果:

共纳入49篇文章，涉及3520名患者。LIFT、VAAFT、FiLaC和EAF的失败率分别为28.6%（范围3.8%-75）、22.3%（6.2-65.2）、43.9%（11.1-80）和25.9%（4.7-100），平均随访时间为35.4个月（6-80.4个月）、32.4个月（6-48个月）、31.6个月（6.3-60个月）和42.4个月（12-155个月）。关于失败的可用网络元分析显示，LIFT与VAAFT相比的风险差异为-0.08（95%CI - 0.58至0.42），而LIFT与EAF相比的风险差异为0.30（95% CI 0.03至0.58）。接受VAAFT或FiLaC治疗的患者没有报告排便功能障碍加重，而对于LIFT和EAF治疗组，排便功能障碍发生率分别为1.5%和7.3%。未观察到重大并发症。最常见的轻微并发症包括疼痛（1.4%）、出血（1.1%）和伤口感染（1.2%）。总体而言，LIFT、VAAFT、FiLaC和EAF的轻微并发症发生率分别为4.3%、7.2%、10.2%和6.2%。克罗恩病患者失败率较高（39.5% vs 31.4%）。

结论:

FILAC、VAAFT、LIFT和EAF可能是治疗肛瘘的有效选择。VAAFT表现出最低的失败率，但网络元分析未显示差异性。需要更大规模且同质的研究及长期随访以获得更可靠的数据。

Prospero编号:

CRD42022375600.

关键词：

肛瘘；并发症；内肛瓣手术；FILAC；LIFT；复发；VAAFT。