{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:18:22Z","timestamp":1788185902657,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T00:00:00Z","timestamp":1634860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This systematic review aimed to assess the outcomes of fistulotomy or fistulectomy and immediate sphincter repair (FISR) in relation to healing, incontinence and sphincter dehiscence both overall and in patients with high anal fistulae.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Medline, Embase and The Cochrane library were searched for studies of patients undergoing FISR for anal fistula. Data regarding healing, continence and sphincter dehiscence were extracted overall and for high anal fistulae. The DerSimonian\u2010Laird random\u2010effects method was used for pooled analysis, heterogeneity between studies was assessed based on the significance of between\u2010study heterogeneity, and on the size of the\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0value. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle\u2010Ottawa scale.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 21\u00a0studies evaluating 1700 patients. Pooled analysis of healing reached 93% (95% CI: 91%\u201395%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a051%\n                      <jats:italic>p<\/jats:italic>\n                      \u2010value for heterogeneity\u00a0=\u00a00.004), with continence disturbance and worsening continence reaching 11% (95% CI: 6%\u201318%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a087%\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and 8% (95% CI: 4%\u201313%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a074%\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), respectively. Subgroup analysis according to fistula height could only be conducted on limited data. Pooled healing in high anal fistulae was 89% (95% CI: 84%\u201394%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a076%\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), 16% suffered disturbance of continence (95% CI: 7%\u201327%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a089%\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), 8% worsening continence from baseline (95% CI: 2%\u201316%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a080%\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and 2% suffered sphincter dehiscence (95% CI: 0%\u201310%,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a089%\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The evidence suggests FISR is a safe, effective procedure. However, data are limited by inconsistencies in reporting of continence and definition of fistula height, particularly high anal fistulae. Significant heterogeneity means that outcomes in high fistulae remain uncertain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.15945","type":"journal-article","created":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T05:01:33Z","timestamp":1633755693000},"page":"3073-3089","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Is fistulotomy with immediate sphincter reconstruction (FISR) a sphincter preserving procedure for high anal fistula? A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3264-7362","authenticated-orcid":false,"given":"Nusrat","family":"Iqbal","sequence":"first","affiliation":[{"name":"Robin Phillips\u2019 Fistula Research Unit St Mark's Hospital and Academic Institute  Harrow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6159-9916","authenticated-orcid":false,"given":"Stella Maye","family":"Dilke","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery St Mark's Hospital and Academic Institute  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen","family":"Geldof","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospital  Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-5752","authenticated-orcid":false,"given":"Kapil","family":"Sahnan","sequence":"additional","affiliation":[{"name":"Robin Phillips\u2019 Fistula Research Unit St Mark's Hospital and Academic Institute  Harrow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Adegbola","sequence":"additional","affiliation":[{"name":"Robin Phillips\u2019 Fistula Research Unit St Mark's Hospital and Academic Institute  Harrow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bassett","sequence":"additional","affiliation":[{"name":"Statsconsultancy Ltd  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2532-7267","authenticated-orcid":false,"given":"Philip","family":"Tozer","sequence":"additional","affiliation":[{"name":"Robin Phillips\u2019 Fistula Research Unit St Mark's Hospital and Academic Institute  Harrow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-011-0676-6"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-013-2198-1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2018.06.009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-015-1323-4"},{"issue":"1","key":"e_1_2_9_6_1","first-page":"36","article-title":"[Functional results following fistulectomy with primary muscle suture in high anal fistula. 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