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Vol. 99. Issue 3.
Pages 183-189 (March 2021)
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Vol. 99. Issue 3.
Pages 183-189 (March 2021)
Review article
DOI: 10.1016/j.cireng.2021.02.022
LIFT procedure for posterior fistula-in-ano. Are outcomes good enough? A systematic review and meta-analysisis of observational studies
Procedimiento LIFT en fístulas anales de localización posterior. ¿Son buenos los resultados? Revisión sistemática y metaanálisis de estudios observacionales
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Carlos Placer Galán
Corresponding author
carlos943313762@gmail.com

Corresponding author.
, Ignacio Aguirre, Tania Pastor, Ane Etxart, Jose María Enriquez Navascués
Sección de Cirugía Colo-rectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, Biodonostia, San Sebastián, Spain
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Table 1. Characteristics of the studies and patients included.
Table 2. Results of the LIFT procedure in studies according to the location of the fistula.
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Abstract
Introduction

Efficacy of the ligation of intersphincteric fistula tract (LIFT) procedure for posterior fistula-in-ano remains under debate. However, there is scarcity of quality evidence analysing this issue. Thus, the aim of this study is to evaluate outcomes of LIFT surgery in patients with posterior anal fistula.

Material and methods

Systematic review and meta-analysis to evaluate efficacy of LIFT procedure for posterior anal fistula. MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar data sources were searched for key-words (MeSH terms): “LIFT” OR “Ligation of the intersphincteric fistula tract” AND “posterior anal fistula” OR “posterior fistula-in-ano”. Original, observational and experimental, non-language restriction studies published from January 2000 to March 2020 and reporting outcomes on LIFT procedure for posterior anal fistula were reviewed. Quality and potential biases were assessed using Newcastle-Ottawa scale, following AHRQ recommendations. Additional sensitivity analysis and publication bias evaluation (Beg and Egger’s test) were performed.

Results

No significant differences were found in recurrence rate among patients undergoing LIFT procedure for posterior fistula-in-ano in contrast to other locations (OR 1.36 [95%CI 0.60–3.07]; P = .46). I2 test value was 77%, expressing a fair heterogeneity among included studies. The weighed median for overall recurrence was 37.8% (IQR 18.3%-47.7%); with a weighed median of 47.1% (IQR 30.7% - 63.7%) and 36.3% (IQR 15.8%-51.3%) (P= .436) respectively for recurrence after LIFT for posterior fistula and fistula in other locations. There was not clear evidence about the sample size (n) of included studies nor the disparities in quality assessment of those, could justify the observed heterogeneity. No significant publication bias was found.

Conclusion

This systematic review and meta-analysis suggests that there are no clear data in the literature for not performing the LIFT procedure in posteriorly located fistulas.

Keywords:
Ligation of the intersphincteric fistula tract
LIFT
Posterior fistula-in-ano
Fistula recurrence
Meta-analysis
Resumen
Introducción

El procedimiento LIFT para las FA de localización posterior ha sido cuestionado. Sin embargo esta controversia no ha sido analizada previamente y es el objetivo de esta revisión sistemática con metaanálisis.

Material y método

Revisión sistemática PRISMA, de las bases MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library y Google Scholar hasta marzo de 2020. La evaluación de la calidad y sesgos de los estudios seleccionados se ha realizado mediante la escala Newcastle-Ottawa, según la AHRQ. Se empleó el método inverso de la varianza y el modelo de efectos aleatorios. Además, se realizó un análisis de sensibilidad y sobre el sesgo de publicación mediante funnel-plot y las pruebas de Beg y Egger.

Resultados

No se apreciaron diferencias significativas en el porcentaje de recurrencias entre los pacientes con fístula posterior y el resto de localizaciones (OR 1,36 [IC 95% 0,60-3,07]; p = 0,46). El valor I2 fue de 77%, lo cual muestra la heterogeneidad de resultados entre los estudios elegidos. Los 9 estudios incluidos presentaron una mediana ponderada (RI) de recidiva global del 37,8% (RI 18,3-47,7%), recidiva de fístula posterior del 47,1% (RI 30,7-63,7%) y de fístula no posterior del 36,3% (RI 15,8-51,3%) (p = 0,436). Ni el número de pacientes ni la diferente calidad metodológica de los estudios explican el nivel de heterogeneidad de los mismos. No se demostró sesgo de publicación.

Conclusiones

Nuestro metaanálisis sugiere que no existen datos claros en la literatura para no realizar el procedimiento LIFT en fístulas de localización posterior.

Palabras clave:
Ligadura interesfinteriana del tracto fistuloso
LIFT
Fístula anal posterior
Recurrencia
Metaanálisis

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