Efficacy and Safety of Transanal Opening of Intersphincteric Space in the Treatment of High Complex Anal Fistula: A Meta-Analysis

Abstract

Abstract Background The best treatment of high complex anal fistula is to avoid anal incontinence while improving the cure rate. On this basis, some surgical procedures for preserving the anal sphincter have been proposed. The purpose of this study was to evaluate the efficacy and safety of transanal opening of intersphincteric space for treating high complex anal fistula. Methods According to the preferred reporting items for systematic review and meta-analysis, we searched PubMed, Cochrane Library, China National Knowledge Infrastructure, and the Wanfang Database to collate all the articles on transanal opening of intersphincteric space for treating high complex anal fistula. Two researchers independently completed the whole process, from screening and inclusion to data extraction, and the data was included in the RevMan 5.3 software for analysis. The main outcomes included the patients’ essential characteristics, primary healing rate, management after recurrence, final healing rate, anal incontinence score before and after surgery, postoperative complication rate, and types of complications. Results A total of 5 articles involving 450 patients were included in this meta-analysis. The results showed that the weighted final healing rate of patients after transanal opening of intersphincteric space was 89%(RD = 0.89, 95% CI = 0.86 to 0.92, I2 = 26%, P < 0.00001). The results of the anal incontinence score showed that there was no significant difference between the results before and after transanal opening of intersphincteric space surgery(MD=-0.04,95%Cl=-0.10 to 0.02, I2 = 0%, P = 0.21). Only ten patients were reported to have complications, including urinary retention and bleeding after transanal opening of intersphincteric space with a complication rate of 2.2% (10/450), and the weighted average complication rate was 0%(RD = 0.00,95% CI=-0.00to0.01, I2 = 64%, P = 0.29). Conclusions Transanal opening of intersphincteric space has a high cure rate, a favorable anal incontinence score, a few types of postoperative complications, and a low complication rate, which can be used as a minimally invasive and sphincter-preserving surgical method for treating high complex anal fistula.It is worthy of further promotion and research in clinical practice.