OBJECTIVE To validate the Martini staging system for post-operative RUF utilizing data from previous studies to determine whether it can accurately predict post-operative success rate .
METHODS A systematic search of peer-reviewed studies was conducted through January , 2020 . The primary inclusion criteria for the studies were studies that evaluated outcomes based on the etiology of the fistula (i.e . radiotherapy/ablation (RA) vs non-radiotherapy/ablation (NRA). Martini RUF classification was utilized for the subgroup analysis .
RESULTS Out of 1948 papers, 7 studies with a total of 490 patients (251 in RA vs 239 NRA) were included in this study . Receiving RA increased the risk of permanent bowel diversion by 11.1 folds, eventual fistula recurrence by 9.1 folds, and post-op urinary incontinence (UI) by 2.6 folds . Similarly, compared to a Grade 0 fistula, a Grade I fistula increased the risk of permanent bowel diversion by 9.1 folds, fistula recurrence by 20 folds, and post-op UI by 2.7 folds . There were some valuable variables that were not captured by the Martini classification .
CONCLUSIONS Overall, the Martini classification system is efficacious in stratifying post-op complications from RUF repair based on the grade and etiology; however, it is limited in application . There is an opportunity for the development of more comprehensive staging systems in this domain.