| Summary, etc. |
ABSTRACT: BACKGROUND: Fistula-in-ano, one of the leading causes of anorectal surgeries, is a disease that truly affect the patients' quality of life. The cornerstone treatment of anal fistulas is the elimination of sepsis, preserving fecal continence and avoidance of recurrence. An anal fistula is traditionally treated by fistulotomy and this requires opening the fistula, and may transect through the sphincter muscle. Adding marsupialization as part of the surgical treatment is optional but marsupialization of the fistulotomy edges has demonstrated improvement in the several postoperative outcomes. OBJECTIVES: The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials on fistulotomy with marsupialization in comparison to fistulotomy alone in the surgical management of patients with simple anal fistula in terms of: wound healing, recurrence, incontinence and postoperative pain. METHODS: A meta-analysis was conducted in conformity with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses} 2020 updated guidelines for meta-analysis. This study included single blinded randomized controlled trials determining the efficacy of fistulotomy with marsupialization. The population of interest were individuals diagnosed with simple fistula-in-ano. The following databases were searched: Pubmed, EBSCOHOST, ClinicalKey, ProQuest 5000, ResearchGate, and Google Scholar (first 300 articles) from 1990 to 2022. The quality of all selected articles were assessed using a critical appraisal checklist by Jadad and was appraise the risk of bias using Cochrane embedded in the Review Manager (RevMan 5.4) software. Thematic analysis for qualitative study was used in presenting the results and Random Effect Model was used in quantitative synthesis of included journals. RESULTS: Overall, 6 single blinded randomized controlled trials were included in this meta-analysis: Y.H Ho et al., 1998; C. Sahakitrungnung et al., 2011; M. Raslan, et al., 2018; M. Anan et al., 2019; H. Nour et al., 2020; S. Khan et al., 2022. In summary, fistulotomy with marsupialization is associated with a significant shorter time of wound healing compared with fistulotomy alone (SMD -1.66, 95% Cl= -2.24 to -1.08, p value <0.00001; Chi2= 12.66,df= 3 (P=0.005),l2= 76%) and there is moderate evidence to say that the probability of postoperative pain after1week in fistulotomy with marsupialization is lesser compared with fistulotomy alone (SMD -1.03, 95% Cl= -2.02 to -0.05,p valuer 0.04; Chi2= 36.79, df= 3 (P< 0.00001), l2= 92%). CONCLUSION: Marsupialization of fistulotomy wounds for simple fistula-in-ano is associated with a shorter healing time and lesser postoperative pain after 1week. However, no established evidence in decreasing recurrence, incontinence and postoperative pain after 24 hours as omitting marsupialization. KEYWORDS: Fistula-in-ano, Fistulotomy, Marsupialization, Randomized Controlled Trials, Meta-analysis |
