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We evaluate the adoption and success rates of advancement flap procedures (<jats:styled-content style=\"fixed-case\">AFP<\/jats:styled-content>), fibrin glue sealant (<jats:styled-content style=\"fixed-case\">FGS<\/jats:styled-content>), anal collagen plug (<jats:styled-content style=\"fixed-case\">ACP<\/jats:styled-content>) and ligation of intersphincteric fistula tract (<jats:styled-content style=\"fixed-case\">LIFT<\/jats:styled-content>) procedures based on their evolution in time for the management of anal fistula.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A PubMed search from 1992 to 2015. An assessment of adoption, duration of study and success rate was undertaken.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found 133 studies (5604 patients): <jats:styled-content style=\"fixed-case\">AFP<\/jats:styled-content> (40 studies, 2333 patients), <jats:styled-content style=\"fixed-case\">FGS<\/jats:styled-content> (31 studies, 871 patients), <jats:styled-content style=\"fixed-case\">LIFT<\/jats:styled-content> (19 studies, 759 patients), <jats:styled-content style=\"fixed-case\">ACP<\/jats:styled-content> (43 studies, 1641 patients). Success rates ranged from 0% to 100%. Study duration was significantly associated with success rates in <jats:styled-content style=\"fixed-case\">AFP<\/jats:styled-content> (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.01) and <jats:styled-content style=\"fixed-case\">FGS<\/jats:styled-content> (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.02) but not in <jats:styled-content style=\"fixed-case\">LIFT<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">ACP<\/jats:styled-content>. The duration of use of individual procedures since first publication was associated with success rate only in <jats:styled-content style=\"fixed-case\">AFP<\/jats:styled-content> (<jats:italic>P\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.027). There were no statistically significant differences in success rates relative to the number of the patients included in each study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Success and adoption rates tend to decrease with time. Differences in patient selection, duration of follow\u2010up, length of availability of the individual procedure and heterogeneity of treatment protocols contribute to the diverse results in the literature. Differences in success rates over time were evident, suggesting that both international trials and global best practice consensus are desirable. Further prospective randomized controlled trials with homogeneity and clear objective parameters would be needed to substantiate these findings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13330","type":"journal-article","created":{"date-parts":[[2016,3,19]],"date-time":"2016-03-19T00:49:45Z","timestamp":1458348585000},"page":"441-458","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":72,"title":["Adoption and success rates of perineal procedures for fistula\u2010in\u2010ano: a systematic review"],"prefix":"10.1111","volume":"18","author":[{"given":"C.","family":"Kontovounisios","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery The Royal Marsden Hospital London UK"},{"name":"Department of Colorectal Surgery Chelsea and Westminster Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Tekkis","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery The Royal Marsden Hospital London UK"},{"name":"Department of Colorectal Surgery Chelsea and Westminster Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Chelsea and Westminster Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rasheed","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery The Royal Marsden Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Darzi","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery The Royal Marsden Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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