Comparison of an anal fistula plug and mucosa advancement flap for complex anal fistulas: a meta-analysis.
OBJECTIVE
The aim of this analysis was to compare the advantages of the anal fistula plug (AFP) with the mucosa advancement flap (MAF) for complex anal fistulas.


METHODS
Comparative studies of the efficacy of AFP and MAF were included. Two independent reviewers selected articles for inclusion. After information collection, a meta-analysis was performed using data on overall healing rates, complications, incontinences and recurrences. The quality of postoperative life and cost were also included with the clinical results.


RESULTS
Ten studies included 778 patients who were divided into AFP and MAF groups in this meta-analysis. During the follow-up period, no significant difference in healing rates, complications and recurrences were found (P = 0.55, P = 0.78 and P = 0.23, respectively). The incontinence rate of AFP was lower than that of MAF (P = 0.04). The postoperative quality of life of AFP patients was superior to that of MAF patients. The AFP patients had less persistent pain of a shorter duration and shortened healing time and hospital stay. The treatment cost of AFP patient was lower than that of MAF.


CONCLUSIONS
Compared to the MAF procedure, the AFP procedure has some advantages for complex anal fistulas, but more and large randomized clinical trials comparing the two procedures for fistula management need to be conducted.
Emergency Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Yansong
Y
Xu
Colorectal and Anal Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Weizhong
W
Tang
D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D011788:Quality of Life; D012003:Rectal Fistula / Q000523:psychology / Q000601:surgery*; D013524:Surgical Flaps
anal fistula plug; complex anal fistula; meta-analysis; mucosa advancement flap