{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:06:25Z","timestamp":1793052385860,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2025,6]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Perianal fistulas are a common anorectal pathology. The sphincter\u2010cutting techniques of fistulectomy and fistulotomy are associated with high cure rates for low or simple fistula\u2010in\u2010ano, with negligible risk of incontinence. However, the superiority of either technique has not previously been conclusively demonstrated. The aim of this systematic review is to compare the outcomes of the two surgical techniques for the management of simple fistula\u2010in\u2010ano.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A search of MEDLINE, EMBASE and Cochrane Databases for randomized controlled trials (RCT) comparing fistulotomy to fistulectomy for simple fistula\u2010in\u2010ano was conducted. The primary outcome was healing time; secondary outcomes included operative time, length of hospital stay, post\u2010operative pain score, post\u2010operative complications and fistula recurrence.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirteen RCTs meet inclusion criteria, comprising a total of 685 fistulectomy and 688 fistulotomy patients. There was no significant difference between the techniques for healing time (\n P<\/jats:italic>\n \u2009=\u20090.15), operative time (\n P<\/jats:italic>\n \u2009=\u20090.13), length of stay (\n P<\/jats:italic>\n \u2009=\u20090.05), wound infection (\n P<\/jats:italic>\n \u2009=\u20090.97), flatus or faecal incontinence (\n P<\/jats:italic>\n \u2009=\u20090.35 and\n P<\/jats:italic>\n \u2009=\u20090.70, respectively) or recurrence (\n P<\/jats:italic>\n \u2009=\u20090.19). Post\u2010operative pain at 24\u2009h, assessed using a visual analogue scale, was significantly lower in the fistulectomy group (MD\u20100.49, 95% CI: \u22120.90, \u22120.08;\n P<\/jats:italic>\n \u2009=\u20090.02), and we found significantly fewer post\u2010operative bleeding complications in the fistulotomy group (OR: 3.81, 95% CI: 1.23, 11.80;\n P<\/jats:italic>\n \u2009=\u20090.02).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This systematic review did not find conclusive evidence of the superiority of either fistulectomy or fistulotomy in terms of healing time. The two statistically significant findings were lower post\u2010operative pain scores with fistulectomy and reduced post\u2010operative bleeding with fistulotomy.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ans.70095","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T09:14:25Z","timestamp":1742894065000},"page":"1074-1090","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Fistulotomy versus fistulectomy for simple fistula\u2010in\u2010ano: a systematic review and meta\u2010analysis of randomized controlled trials"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6731-6101","authenticated-orcid":false,"given":"Rakesh","family":"Quinn","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery Nepean Hospital Kingswood New South Wales Australia"},{"name":"University of Sydney, Sydney Medical School Faculty of Medicine and Health Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Peacock","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Concord Hospital Concord New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3270-5198","authenticated-orcid":false,"given":"Rebecca J","family":"Lendzion","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Concord Hospital Concord New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"e_1_2_8_2_1","article-title":"Surgery of simple and complex anal fistulae in adults: a review of the literature for optimal surgical outcomes","volume":"15","author":"Charalampopoulos A","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800630102"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-005-0055-3"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0000000000002473"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.16741"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40064-016-3406-8"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2010.02.007"},{"key":"e_1_2_8_9_1","unstructured":"The Cochrane Collaboration.Review Manager (RevMan). 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