SynthesisUpdates in surgery2025
Systematic review and network meta-analysis of cryptoglandular complex anal fistula treatment: evaluation of surgical strategies.
Synthesis in Updates in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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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.
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.
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Who cites it
6 citing papers in PubMed.
- Certainty of evidence assessment using the CINeMA framework in a network meta-analysis of surgical strategies for complex cryptoglandular anal fistulas.Updates in surgery · 2026Article
- Clinical efficacy and failure-related factors of the loose-seton procedure combined with transanal opening of the intersphincteric space technique (LoSet-TROPlS) in the treatment of complex anal fistulas.Techniques in coloproctology · 2026Article
- Article
- Why it is not a good idea to perform a meta-analysis comprising only randomized controlled trials in complex anal fistula?Updates in surgery · 2026Article
- Complete Healing After Umbilical Mesenchymal Stem Cell-Derived Exosome Therapy For a Refractory Complex Anal Fistula.Cureus · 2026Article
- Female Trans-Sphincteric Anterior Anal Fistula: Still an Unsolved Problem-Results from a Nationwide Cohort Study.Journal of clinical medicine · 2025Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSeveral surgical approaches are available for managing complex cryptoglandular perianal fistulas. However, a gold standard surgical technique has not yet been established. This network meta-analysis aims to assess and compare postoperative failure and anal incontinence pooled rates for different available surgical techniques for complex cryptoglandular anal fistulas.
methodsSystematic searches were carried out on Pubmed, Ovid, the Cochrane Library database and ClinicalTrials.gov up to June 2023. All randomized comparative trials of nine surgical techniques for cryptoglandular complex perianal fistulas in adult patients were included. A systematic review and network meta-analysis was conducted using the PRISMA-NMA methodology. The endorectal advancement flap was used as the control technique, and the odds ratios (ORs) were calculated through pairwise and network meta-analysis with random effects.
results16 randomized trials were included in this study. Network meta-analysis was conducted for each outcome. Techniques, such as cutting seton, fistulotomy with sphincter reconstruction, LIFT, and VAAFT, obtained similar results in terms of technique failure to the transanal advancement flap with no statistically significant differences. PLUG (OR = 3.6 [95%CI 1.1-11.5]), fibrin glue (OR = 7.5 [95%CI 2.2-25], and platelet-rich plasma (PRP) (OR = 11.5[95%CI 1.3-99]) demonstrated a statistically significant increase in the pooled failure rate. For anal incontinence, only the cutting seton technique exhibited a higher risk of postoperative incontinence (OR = 8.6 [95%CI 1-72.5]).
conclusionOur research highlights effective therapeutic approaches for complex anal fistulas, stressing the need to customize treatment based on location, anatomy, patient characteristics, and preferences. However, it advises against using plugs, fibrin glue, PRP therapy due to lower healing rates, and the seton technique because of its potential impact on anal continence. PROSPERO number CRD42022304345.
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