| Abstract [eng] |
ABSTRACT Background: Management of anorectal fistula is complex and requires an accurate preoperative assessment. The grade and complexity of the fistula should be considered in the classification and thus guide the modality of management and patient support. The objective of this systematic review is to examine and evaluate all existing classifications and viewpoints on anal fistula and to compare the findings of different researchers to address the considerable diversity in recurrence and success rates observed globally. Through this approach, the goal is to enhance knowledge and management of this condition. Methods: The Scopus and PubMed databases were searched using specific keywords and medical subject headings in prospective and retrospective studies published during the period of 1936 and 2022, which present classifications of anorectal fistulas. The results were reported in the form of a table as well as in the form of a narrative synthesis. The qualitative assessment of the analysed classifications was evaluated using the Risk of Bias 2 (RoB 2) tool. Results: Of 2,714 articles, eight papers were identified using the inclusion criteria. A further nine classifications were extracted from the identified articles. All 17 classifications were described and their advantages and disadvantages analysed based on their usefulness, current knowledge and validation. Discussion: Various classifications of anal fistulas, starting with the oldest classification proposed in 1934 by Milligan and Morgan are discussed. A brief summary of each classification, its advantages, and disadvantages, along with its validation and management-oriented approach is provided. The classifications discussed include those proposed by Milligan and Morgan, Stelzner, Goligher, Thompson, Lilius, Sumikoshi, Parks, Eisenhammer, Hanley, Shafik, Morris et al., Schaefer et al., Whiteford et al., Abeysuriya et al., Garg, Rojanasakul and Tsang, and Emile et al. The most widely used and well-known classification, Parks' classification, is now considered less effective. The newer classifications integrate clinical experience, Magnetic Resonance Imaging (MRI), and surgical results and provide treatment recommendations, making them more clinically useful. However, they also have some draw-backs, such as the dependence on MRI, lack of extensive validation, and limited guidance for treatment decisions. The limitations of the review are also acknowledged, as some original articles of classifications were not accessible. |
