3D-EAUS is an accurate and reproducible modality for the assessment of type and height of anal fistulas.

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Conventional surgical treatment of anal fistula is associated not only with a high recurrence rate, but also with a complication that patients find very difficult to tolerate,namely deterioration of fecal and gas continence.The anatomical course of the fistulous tract with regard to the sphincter musclesin combination with the results of function tests constitute the most important elements which decide about the selection of the surgical technique. In Poland, endoanalultrasonography (EUS) is much more readily available than magnetic resonance imaging (MRI). In order to plan properly the extent of the surgical field, and limit the riskof incontinence, it is essential to determine the height of the fistula and whether it isanterior or posterior. The other significant anatomical features that have an impacton the choice of the surgical method include the number and the kind of branching,the location of the internal opening, and presence of purulent cisterns. Like everydiagnostic procedure, endoanal ultrasonography (EUS) has its limitations, and imaging of fistulae is not free of difficulties. The article discusses the diagnostic problemsrelated to endoanal ultrasonography, and the improvements of the method introducedover the years. Close cooperation between the ultrasonographer and the surgeon isessential. Besides details with regard to the fistula itself, the surgeon expects information if any damage of the sphincter muscles or any other visible pathologies arepresent. Despite the fact that EUS is not a function test, a contraction of the externalsphincter muscle imaged during this procedure provides the surgeon with valuableinformation, hence relevant description should always be provided. Attaching theEUS description with a schematic drawing also helps the surgeon to understandthe course of the fistulous tract better, especially in the case of especially complexfistulae. The surgeon, on the other hand, should provide the ultrasonographer withreliable, conscientiously filled in information when formally referring the patient tothe EUS laboratory for the tes

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