title: Systematic review and meta-analysis of surgical interventions for high cryptoglandular perianal fistula.
abstract: OBJECTIVE
  Perianal fistulas, and specifically high perianal fistulas, remain a surgical treatment challenge. Many techniques have, and still are, being developed to improve outcome after surgery. A systematic review and meta-analysis was performed for surgical treatments for high cryptoglandular perianal fistulas.
  
  
  METHODS
  Medline (Pubmed, Ovid), Embase and The Cochrane Library databases were searched for relevant randomized controlled trials on surgical treatments for high cryptoglandular perianal fistulas. Two independent reviewers selected articles for inclusion based on title, abstract and outcomes described. The main outcome measurement was the recurrence/healing rate. Secondary outcomes were continence status, quality of life and complications.
  
  
  RESULTS
  The number of randomized trials available was low. Fourteen studies could be included in the review. A meta-analysis could only be performed for the mucosa advancement flap versus the fistula plug, and did not show a result in favour of either technique in recurrence or complication rate. The mucosa advancement flap was the most investigated technique, but did not show an advantage over any other technique. Other techniques identified in randomized studies were seton treatment, medicated seton treatment, fibrin glue, autologous stem cells, island flap anoplasty, rectal wall advancement flap, ligation of intersphincteric fistula tract, sphincter reconstruction, sphincter-preserving seton and techniques combined with antibiotics. None of these techniques seem superior to each other.
  
  
  CONCLUSIONS
  The best surgical treatment for high cryptoglandular perianal fistulas could not be identified. More randomized controlled trials are needed to find the best treatment. The mucosa advancement flap is the most investigated technique available.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Post box 5800, 6202 AZ, Maastricht, The Netherlands, k.gottgens@me.com.
authors.forename: K W A
authors.initials: KW
authors.lastname: Göttgens
authors.forename: R R
authors.initials: RR
authors.lastname: Smeets
authors.forename: L P S
authors.initials: LP
authors.lastname: Stassen
authors.forename: G
authors.initials: G
authors.lastname: Beets
authors.forename: S O
authors.initials: SO
authors.lastname: Breukink
mesh_terms: D001705:Bioprosthesis; D016022:Case-Control Studies; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012003:Rectal Fistula / Q000473:pathology* / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D033581:Stem Cell Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D020535:Video-Assisted Surgery; D014945:Wound Healing / Q000502:physiology
chemical_list: D015718:Fibrin Tissue Adhesive