Evidence map›Paper›PMID 40072575›Full record

Observational studyInternational journal of colorectal disease2025

Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study.

Tamer A A M Habeeb, Massimo Chiaretti, Igor A Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A M Adam, Mohamed A Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh and 29 more

Registry-linked trialAbstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in International journal of colorectal disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06616662 (Comparative Outcomes of Ligation of the Intersphincteric Fistula Tract and Mucosal Advancement Flap Techniques in Elderly Patients with Transsphincteric Perianal Fistulas), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06616662 completednot on this map

Comparative Outcomes of Ligation of the Intersphincteric Fistula Tract and Mucosal Advancement Flap Techniques in Elderly Patients with Transsphincteric Perianal Fistulas: Recurrence, Incontinence and Risk Factors

TypeobservationalSponsorZagazig UniversityRan2018 to 2024Enrolled257ConditionsPerianal FistulaArmsMAF, LIFT
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

39 authors.

Tamer A A M HabeebDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt. tameralnaimy@hotmail.com.
Massimo ChiarettiDepartment of General Surgery Specialties and Organ Transplant, Faculty of Pharmacy and Medicine, Sapienza Rome University, Rome, Italy.
Igor A KryvoruchkoDepartment of Surgery No. 2, Kharkiv National Medical University, Kharkiv, Ukraine.
Antonio PesceAzienda Unità Sanitaria Locale Ferrara, Ferrara, Italy.
Aristotelis KechagiasDepartment of Surgery, Athens Metropolitan General Hospital, and University of Nicosia Medical School by HEAL Academy, Athens, Greece.
Abd Al-Kareem EliasDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.
Abdelmonem A M AdamDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.
Mohamed A GadallahDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.
Saad Mohamed Ali AhmedDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.
Ahmed KhyrallhDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.
Mohammed H AlsayedDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.
Esmail Tharwat Kamel AwadDepartment of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit Branch, Assuit, Egypt.
Mohammed Hassan ElshafeyGeneral Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Mohamed Ibrahim Abo AlsaadGeneral Surgery Department, Faculty of Medicine, Merit University, Sohag, Egypt.
Abouelatta Kh AliMisr University for Science and Technology, Cairo, Egypt.
Hamdi ElbelkasiMataryia Teaching Hospital (GOTHI), Cairo, Egypt.
Mahmoud Ali Abou ZaidGeneral Surgery Department, El Mahala Hepatic Insistute, Al Gharbia, El Mahala, Tanta, Egypt.
Hoda A A YoussefDepartment of General Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.
Mona Mohammad Farid Al-ZamekDepartment of General Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt.
Alaa FiadDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Tamer Mohamed ElshahidyDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mahmoud R ElballatDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Ahmed Kamal El TaherDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohamed Mahmoud Mokhtar MohamedDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Ahmed Khaled AboZeidDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohamed Ibrahim MansourDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mahmoud Abdou YassinDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Ahmed Salah ArafaDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohamed LotfyDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Bassam MousaDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Baher AtefDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Sameh Mohamed NaguibDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Ibrahim A HeggyDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohamed ElnemrDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohamed Abdallah ZaitounDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Ehab Shehata AbdAllahDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Mohamad S MoussaDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Abd Elwahab M HamedDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Rasha S ElsayedDepartment of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThere is no consensus on the standard approach for trans-sphincteric perianal fistulas (TPAF) in the elderly population. The most commonly used sphincter-saving procedures are ligation of the inter-sphincteric fistula tract (LIFT) and mucosal advancement flap (MAF). We aimed to evaluate the incidence and risk factors for recurrence and incontinence in elderly patients with TPAF using both approaches.

methodsThis retrospective study included 257 patients who underwent LIFT (136 patients) or MAF (121 patients) for de novo and cryptoglandular TPAF between July 2018 and July 2021. Recurrent fistulas were clinically and radiologically detected using MRI. Postoperative incontinence was evaluated using the Wexner score and anorectal manometry. Logistic regression analysis was used to detect the risks of recurrence and incontinence.

resultsThe median ages of the patients were 68 (64, 74) and 68 (65, 74) years in the LIFT and MAF groups, respectively. Higher recurrence rates were observed after LIFT (17 (12.5%)) than after MAF (13 (10.7%)), but the difference was not statistically significant (P = 0.662). Postoperative incontinence was observed in 18 patients (13.2%) and seven patients (5.8%) in the LIFT and MAF groups, respectively (P = 0.044). The predictors for fistula recurrence were smoking (OR, 75.52; 95% CI, 1.02 to 5611.35; P = 0.049), length of tract (OR, 17.3; 95% CI, 1.49 to 201.13; P = 0.023), and CD classification (OR, 7.08; 95% CI, 1.51 to 33.14; P = 0.013). A low Charlson comorbidity index score (≤ 5) (OR, 0.68; 95% CI, 0.47 to 0.99; P = 0.046) and high postoperative mean squeeze anal pressure (OR, 0.97; 95% CI, 0.95 to 0.99; P = 0.001) were significant factors associated with reduced risk of incontinence. In particular, LIFT was associated with a significantly higher risk of incontinence than MAF (OR, 2.089; 95% CI, 1.006 to 4.33; P = 0.04).

conclusionsThe healing rates of MAF and LIFT procedures did not differ significantly; however, continence was significantly better after MAF. MAF should be added to the guidelines as a good option for the treatment of TPAF in elderly patients.

trial registrationThe study was registered as a clinical trial www. CLINICALTRIALS: gov (NCT06616662).

Indexed as

Anal CanalRectal FistulaSurgical FlapsAgedFecal IncontinenceFemaleHumansLigationMaleMiddle AgedPostoperative ComplicationsRecurrenceRetrospective StudiesRisk FactorsTreatment OutcomeElderlyIncontinenceLigation inter-sphincteric fistula surgeryMucosal advancement flapObservational studyRecurrenceTrans-sphincteric perianal fistula

Identifiers

PMID40072575
PMCPMC11903622

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Registered trials

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