Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis

Introduction Identifying the optimal treatment for anal fistula has been challenging. Since first reported in 2007, the ligation of the intersphincteric fistula tract (LIFT) procedure has reported healing rates between 40% and 95% and is being increasingly adopted. The BioLIFT is an augmentation of...

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Main Authors: Richard Gilbert, Husein Moloo, Terry Zwiep, Reilly P Musselman, Isabelle Raiche, Lara Williams, Hilalion (San) Ahn, Richard Hu, Robin P Boushey, Martin Friedlich
Format: Article
Language:English
Published: BMJ Publishing Group 2023-08-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/13/8/e065876.full
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author Richard Gilbert
Husein Moloo
Terry Zwiep
Reilly P Musselman
Isabelle Raiche
Lara Williams
Hilalion (San) Ahn
Richard Hu
Robin P Boushey
Martin Friedlich
author_facet Richard Gilbert
Husein Moloo
Terry Zwiep
Reilly P Musselman
Isabelle Raiche
Lara Williams
Hilalion (San) Ahn
Richard Hu
Robin P Boushey
Martin Friedlich
author_sort Richard Gilbert
collection DOAJ
description Introduction Identifying the optimal treatment for anal fistula has been challenging. Since first reported in 2007, the ligation of the intersphincteric fistula tract (LIFT) procedure has reported healing rates between 40% and 95% and is being increasingly adopted. The BioLIFT is an augmentation of the LIFT with an intersphincteric bioprosthetic mesh and has reported healing rates between 69% and 94%. Despite increased costs and potential complications associated with mesh, the evidence comparing healing rates between BioLIFT and LIFT is unknown. This study details the protocol for a systematic review and meta-analysis of BioLIFT and LIFT to compare outcomes associated with each procedure.Methods and analysis MEDLINE, EMBASE and the Cochrane Database will be searched from inception using a search strategy designed by an information specialist. Randomised controlled trials, prospective and retrospective cohort studies, consecutive series, cross-sectional studies and case series with more than five patients will be included. Both comparative and single group studies will be included. The eligible population will be adult patients undergoing BioLIFT or LIFT for trans-sphincteric anal fistula. The primary outcome will be primary healing rate. Secondary outcomes will capture secondary healing rate and complications. Abstract, full text and data extraction will be completed independently and in duplicate by two reviewers. Study risk of bias will be assessed using Risk of Bias In Non-randomized Studies - of Interventions and the Risk of Bias (RoB 2.0) tool. Quality of evidence for outcomes will be evaluated using Grading of Recommendations, Assessment, Development and Evaluations criteria. A meta-analysis will be performed using a random-effects inverse variance model. Subgroup and sensitivity analyses will be explored in relation to complex fistula characteristics and patients who have undergone previous LIFT. Heterogeneity will be assessed using the I2 statistic.Ethics and dissemination This review does not require research ethics board approval. This study will be completed in September 2022. The findings of this study will be disseminated through peer-reviewed international conferences and journals.PROSPERO registration number CRD42020127996.
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spelling doaj-art-a8369f3d3d6149c0bde85fd26552e6b12024-11-15T10:35:08ZengBMJ Publishing GroupBMJ Open2044-60552023-08-0113810.1136/bmjopen-2022-065876Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysisRichard Gilbert0Husein Moloo1Terry Zwiep2Reilly P Musselman3Isabelle Raiche4Lara Williams5Hilalion (San) Ahn6Richard Hu7Robin P Boushey8Martin Friedlich9General Surgery, University of Ottawa, Ottawa, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaSurgery, Western University, London, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaGeneral Surgery, University of Ottawa, Ottawa, Ontario, CanadaIntroduction Identifying the optimal treatment for anal fistula has been challenging. Since first reported in 2007, the ligation of the intersphincteric fistula tract (LIFT) procedure has reported healing rates between 40% and 95% and is being increasingly adopted. The BioLIFT is an augmentation of the LIFT with an intersphincteric bioprosthetic mesh and has reported healing rates between 69% and 94%. Despite increased costs and potential complications associated with mesh, the evidence comparing healing rates between BioLIFT and LIFT is unknown. This study details the protocol for a systematic review and meta-analysis of BioLIFT and LIFT to compare outcomes associated with each procedure.Methods and analysis MEDLINE, EMBASE and the Cochrane Database will be searched from inception using a search strategy designed by an information specialist. Randomised controlled trials, prospective and retrospective cohort studies, consecutive series, cross-sectional studies and case series with more than five patients will be included. Both comparative and single group studies will be included. The eligible population will be adult patients undergoing BioLIFT or LIFT for trans-sphincteric anal fistula. The primary outcome will be primary healing rate. Secondary outcomes will capture secondary healing rate and complications. Abstract, full text and data extraction will be completed independently and in duplicate by two reviewers. Study risk of bias will be assessed using Risk of Bias In Non-randomized Studies - of Interventions and the Risk of Bias (RoB 2.0) tool. Quality of evidence for outcomes will be evaluated using Grading of Recommendations, Assessment, Development and Evaluations criteria. A meta-analysis will be performed using a random-effects inverse variance model. Subgroup and sensitivity analyses will be explored in relation to complex fistula characteristics and patients who have undergone previous LIFT. Heterogeneity will be assessed using the I2 statistic.Ethics and dissemination This review does not require research ethics board approval. This study will be completed in September 2022. The findings of this study will be disseminated through peer-reviewed international conferences and journals.PROSPERO registration number CRD42020127996.https://bmjopen.bmj.com/content/13/8/e065876.full
spellingShingle Richard Gilbert
Husein Moloo
Terry Zwiep
Reilly P Musselman
Isabelle Raiche
Lara Williams
Hilalion (San) Ahn
Richard Hu
Robin P Boushey
Martin Friedlich
Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis
BMJ Open
title Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis
title_full Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis
title_fullStr Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis
title_full_unstemmed Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis
title_short Comparison of BioLIFT versus LIFT for the treatment of trans-sphincteric anal fistula: a protocol for systematic review and meta-analysis
title_sort comparison of biolift versus lift for the treatment of trans sphincteric anal fistula a protocol for systematic review and meta analysis
url https://bmjopen.bmj.com/content/13/8/e065876.full
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