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
J. coloproctol. (Rio J., Impr.)
;
41(3): 308-315, July-Sept. 2021. tab, graf
Artigo
em Inglês
| LILACS
| ID: biblio-1346418
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 OutcomeMeasures:
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 studiesmet 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 setonwas 40%(IQR26.6-51.2%), 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. (AU)
Texto completo:
DisponíveL
Índice:
LILACS (Américas)
Assunto principal:
Fístula Retal
Tipo de estudo:
Pesquisa qualitativa
/
Revisões Sistemáticas Avaliadas
Limite:
Adolescente
/
Adulto
/
Idoso
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Aged80
/
Feminino
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Humanos
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Masculino
Idioma:
Inglês
Revista:
J. coloproctol. (Rio J., Impr.)
Assunto da revista:
Cirurgia
/
Doenas Retais
/
Doenas do Colo
/
Gastroenterologia
/
Cirurgia
Ano de publicação:
2021
Tipo de documento:
Artigo
País de afiliação:
Espanha
Instituição/País de afiliação:
Donostia University Hospital, Biodonostia (Gastrointestinal Diseases Group)/ES
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