{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T22:38:06Z","timestamp":1788820686857,"version":"build-2803163510"},"reference-count":51,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T00:00:00Z","timestamp":1670371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Complex perineal fistulas (CPFs) are among the most challenging problems in colorectal practice. Various procedures have been used to treat CPFs, with none being a panacea. Our study aimed to assess the overall success and complication rates after gracilis muscle interposition in patients with CPF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>PubMed, Scopus and Google Scholar databases were systematically searched until January 2022 according to PRISMA 2020 guidelines. Studies including children &lt;18\u2009years or &lt;10 patients were excluded, as well as reviews, duplicate or animal studies, studies with poor documentation (no report of success rate) and non\u2010English text. An open\u2010source, cross\u2010platform software for advanced meta\u2010analysis openMeta [Analyst]\u2122 version 12.11.14 and Cochrane Review Manager 5.4\u00ae were used to conduct the meta\u2010analysis of data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010five studies published between 2002 and 2021 were identified. The studies included 658 patients (409 women). Most patients had rectovaginal (50.7%) or rectourethral fistulas (33.7%). The most common causes of CPF were pelvic surgery (29.4%) and inflammatory bowel disease (25.2%). A history of radiotherapy was reported in approximately 18% of the patients. 498 (75.7%) patients with CPF achieved complete healing after gracilis muscle interposition. The weighted mean rate of success of the gracilis interposition procedure was 79.4% (95% CI 73.8%\u201385%, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u200975.3%), the weighted mean short\u2010term complication rate was 25.7% (95% CI 18.1\u201333.2, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u200984.1%) and the weighted mean rate for 30\u2010day reoperation was 3.6% (95% CI 1.6\u20135.6, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u200942%). The weighted mean rate of fistula recurrence was 16.7% (95% CI 11%\u201322.3%, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a061%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The gracilis muscle interposition technique is a viable treatment option for CPF. Surgeons should be familiar with indications and techniques to offer it as an option for patients. Given the relatively infrequent use of the operation, referral rather than performance of graciloplasty is an acceptable option.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.16427","type":"journal-article","created":{"date-parts":[[2022,11,22]],"date-time":"2022-11-22T14:29:45Z","timestamp":1669127385000},"page":"549-561","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Gracilis muscle interposition for complex perineal fistulas: A systematic review and meta\u2010analysis of the literature"],"prefix":"10.1111","volume":"25","author":[{"given":"Zoe","family":"Garoufalia","sequence":"first","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida  Weston Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Gefen","sequence":"additional","affiliation":[{"name":"Ellen Leifer Shulman and Steven Shulman Digestive Disease 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