Can Three-Dimensional Anorectal Ultrasonography Be Included as a Diagnostic Tool for the Assessment of Anal Fistula Before and After Surgical Treatment?

Murad-Regadas, Sthela M.; Filho, Francisco L. de Caldas; Holanda, Erico de Carvalho; Veras, Lara Burlamaqui; Vilarinho, Adjra da Silva; Lopes, Monalisa Soares

doi:10.1590/s0004-2803.201800000-42

Cited by 14 publications

(18 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Shafik et al [23], had [29], reported all fistulas could be classified into four main groups and they suggested that the suprasphincteric fistula tract passes in the intersphincteric plane over the top of the puborectalis. However, in recent studies, puborectalis muscle involvement findings were observed through 3D ultrasonography and MRI [30]. In the present study, five types of clinical manifestations were shown in the suprasphincteric fistula with puborectalis muscle involvement.…”

Section: A C C E P T E D a R T I C L Econtrasting

confidence: 43%

Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment

et al. 2021

View full text Add to dashboard Cite

Purpose: According to recent studies, magnetic resonance imaging (MRI) assessment of complex fistulas provides a significant benefit compared to fistulography, computed tomography, and ultrasonography. The aim of this study was to describe the accuracy of MRI and the importance of identifying puborectalis muscle involvement on MRI in patients with complex fistula.Methods: All patients who were clinically diagnosed with ‘complex’ or showed multiple fistula tracts underwent fistula MRI. Eligible patients were consecutive patients who underwent fistula MRI between September 2018 and September 2019 at our hospital.Results: A total of 83 patients (74 males, 9 females; 116 tracts) were included in this study. The sensitivity and specificity of MRI in diagnosing fistula tracts were 94.8% and 98.2%, respectively. The sensitivity and specificity in identifying internal opening were 93.9% and 97.3%, respectively. Of the 35 patients with puborectalis muscle involvement in the MRI, 31 images of suprasphincteric-type patients on the Park’s classification were classified. The patients of puborectalis involvement were divided into 2 groups according to the surgical procedure that was performed. There were 12 sphincter-saving procedures and 19 sphincter division procedures performed. Recurrence was seen in 2 patients in the sphincter-saving procedure group, while no case was seen in the sphincter division procedure group. Five complications were found in the sphincter division procedure group, of which 2 reported incontinence.Conclusion: Fistula MRI is a highly accurate examination for evaluating complex fistulas, and the puborectalis muscle involvement findings are very important for diagnosis and treatment.

show abstract

Section: A C C E P T E D a R T I C L Econtrasting

confidence: 43%

Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Risk of FI is associated with females, the surgical technique, a previous history of fistula surgery and high fistulae [3]. There is currently no firm evidence correlating rates of postoperative FI with length of sphincter division, and this remains a grey area of colorectal surgery [4,5].…”

Section: Introductionmentioning

confidence: 99%

Sphincter damage during fistulotomy for perianal fistulae and its relationship with faecal incontinence

García-Botello

Garcés-Albir

Espi-Macías

et al. 2021

Langenbecks Arch Surg

View full text Add to dashboard Cite

Background The length of sphincter which can be divided during fistulotomy for perianal fistula is unclear. The aim was to quantify sphincter damage during fistulotomy and determine the relationship between such damage with symptoms and severity of faecal incontinence and long-term quality of life (QOL). Methods A prospective cohort study was performed over a 2-year period. Patients with intersphincteric and mid to low transsphincteric perianal fistulas without risk factors for faecal incontinence were scheduled for fistulotomy. All patients underwent 3D endoanal ultrasound (3D-EAUS) pre-operatively and 8 weeks postoperatively. Measurements were taken of pre- and postoperative anal sphincter involvement and division. Anal continence was assessed using the Jorge-Wexner scale and QOL scores pre, 6 and 12 months postoperatively. Results Forty-nine patients were selected. A strong correlation between pre- and postoperative measurements was found p < 0.001. A median length of 41% of the external anal sphincter and 32% of the internal anal sphincter was divided during fistulotomy. Significant differences in mild symptoms of anal continence were found with increasing length of external anal sphincter division. But there was no significant deterioration in continence, soiling, or quality of life scores at the 1-year follow-up. Division of over two-thirds of the external anal sphincter was associated with the highest incontinence rates. Conclusions 3D-EAUS is a valuable tool for quantifying the extent of sphincter involvement pre- and postoperatively. Post-fistulotomy faecal incontinence is mild and increases with increasing length of sphincter division but does not affect long-term quality of life.

show abstract

“…Polyglactin, because it is absorbable and multifilamentous, induces a greater inflammatory reaction than polypropylene, as it is a monofilament material. 15,16 However, a greater degree of fibrosis was expected that in the group submitted only to fistulotomy and curettage, since the wound left for healing by second intention would have a greater inflammatory response and consequently greater fibrosis, 17 which did not occur; in that group, the fibrosis observed was equivalent to that in polypropylene-treated animals and significantly lower than in the polyglactin group.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of polypropylene and polyglactin sutures in primary sphincteroplasty for the treatment of anal fistula in rats

Conde

Santos

Dourado

et al. 2019

Journal of Coloproctology

View full text Add to dashboard Cite

Rationale Fistulotomy followed by primary sphincteroplasty is one of the therapeutic options in transsphincteric fistulae; however, it was not known which suture would present a better result. Objective To compare polypropylene and polyglactin sutures in primary sphincteroplasty in rats subjected to fistulotomy. Method Thirty Wistar rats were subjected to peritoneal anesthesia with ketamine and xylazine, followed by transfixation of the anal sphincter with steel thread, which remained for 30 days to develop the anal fistula. After this period, the steel thread was removed and four groups were formed: A – Control ( n = 5), without treatment; B – Fistulotomy ( n = 5), performed fistulotomy only; C – Polypropylene ( n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polypropylene suture; D – Polyglactin ( n = 10), in which fistulotomy was performed followed by primary sphincteroplasty with polyglactin suture; after 30 days the animals were anesthetized again and submitted to euthanasia by deepening the anesthetic plane to remove the specimens, analyzing fistula closure, muscle fiber distance, and inflammatory process. Results The fistula persisted in all animals of the control group and in none of the other groups; the distances between the muscle fibers were 1620 μm, 4665 μm, and 2520 μm, respectively in Groups B, C, and D ( p = 0.067); in relation to fibrosis, the means were 2.4, 2.8, and 3.6, respectively in Groups B, C, and D, showing greater fibrosis in the latter group ( p = 0.041). Conclusion There was no persistence of the fistula in any of the treated animals; there was no difference in the distance between the muscle fibers between the groups subjected to primary sphincteroplasty with polypropylene or polyglactin, or between these groups and the one treated only by fistulotomy. There was greater fibrosis in animals treated with primary sphincteroplasty with polyglactin.

show abstract

Can Three-Dimensional Anorectal Ultrasonography Be Included as a Diagnostic Tool for the Assessment of Anal Fistula Before and After Surgical Treatment?

Cited by 14 publications

References 24 publications

Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment

Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment

Sphincter damage during fistulotomy for perianal fistulae and its relationship with faecal incontinence

Evaluation of polypropylene and polyglactin sutures in primary sphincteroplasty for the treatment of anal fistula in rats

Contact Info

Product

Resources

About