Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long‐term follow‐up of 151 cases

Garg, Pankaj; Yagnik, Vipul D; Kaur, Baljit; Menon, Geetha R; Dawka, Sushil

doi:10.1111/codi.15695

Cited by 9 publications

(10 citation statements)

References 24 publications

(43 reference statements)

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“…Third, the selection of parameters that characterize healing was not performed by an objective method in a systematic review process. This was not possible because there are very few studies that have analyzed parameters on MRI which characterize long-term fistula healing 4 and this is the first study on this topic (scoring system to predict long-term healing of cryptoglandular anal fistulas). Therefore, it was not possible to conduct a systematic review.…”

Section: Discussionmentioning

confidence: 99%

“…All possible parameters that had been studied in the literature and could potentially affect or characterize fistula healing were listed. 4 , 12–17 These were:…”

Section: Methodsmentioning

confidence: 99%

“…Apart from difficult anatomy, involvement of sphincters, lack of a gold-standard treatment, etc., an important reason is the inability to confidently and accurately assess fistula healing in the postoperative period. 1 , 4–6 This problem is compounded by recurrence of the fistula months to years after it had apparently healed well. 4 , 7 , 8 Understandably, this causes immense frustration and anxiety to the operated patients and the treating surgeons who are always fearful of “fistula coming back” even when the fistula appears clinically healed.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 4–6 This problem is compounded by recurrence of the fistula months to years after it had apparently healed well. 4 , 7 , 8 Understandably, this causes immense frustration and anxiety to the operated patients and the treating surgeons who are always fearful of “fistula coming back” even when the fistula appears clinically healed. 9 , 10 There are no established standardized criteria to assess postoperative healing after surgery of cryptoglandular anal fistulas.…”

Section: Introductionmentioning

confidence: 99%

“… 9 , 10 There are no established standardized criteria to assess postoperative healing after surgery of cryptoglandular anal fistulas. 4 So, there was a need to develop a scoring system which could help to objectively assess postoperative healing in fistulas. The main desired outcome of any fistula surgery is long-term healing.…”

Section: Introductionmentioning

confidence: 99%

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A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas

Garg¹,

Yagnik²,

Dawka³

et al. 2022

CEG

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Background Anal fistulas cause great uncertainty and anxiety in patients and surgeons alike. This is largely because of the inability to accurately confirm postoperative fistula healing, especially long-term healing. There is no scoring system available that can objectively assess cryptoglandular anal fistulas for postoperative healing and can also accurately predict long-term healing. Methods Several parameters that could indicate anal fistula healing were assessed. Out of these, six parameters (four MRI-based and two clinical) were finalized, and a weighted score was given to each parameter. A novel scoring system (NSS) was developed. A minimum possible score (zero) indicated complete healing whereas the maximum weighted score (n = 20) indicated confirmed non-healing. Scoring was done with postoperative MRI (at least 3 months post-surgery), then compared with the actual healing status, and subsequently correlated with the final long-term clinical outcome. Results The NSS was validated in 183 operated cryptoglandular fistula-in-ano patients over a 3-year period in whom 283 MRIs (preoperative plus postoperative) were performed. The postoperative follow-up was 12–48 months (median-30 months). The NSS was found to have a very high positive predictive value (98.2%) and moderately high negative predictive value (83.7%) for long-term fistula healing. Additionally, its sensitivity and specificity in predicting healing were 93.9% and 94.7%, respectively. Conclusion Thus, this new scoring system is highly accurate and would be a useful tool for surgeons and radiologists managing anal fistulas. By objectivizing the assessment of postoperative healing, it can both ease and streamline management. Moreover, reliable prediction of recurrence-free long-term healing will greatly allay the apprehensions associated with this dreaded disease.

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Section: Discussionmentioning

confidence: 99%

“…All possible parameters that had been studied in the literature and could potentially affect or characterize fistula healing were listed. 4 , 12–17 These were:…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas

Garg¹,

Yagnik²,

Dawka³

et al. 2022

CEG

Self Cite

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Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review

Teymouri,

Keshvari,

Ashjaei

et al. 2023

Health Science Reports

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Background and Aims: Anal fistula (AF) with cryptoglandular origin tends to recur, and multiple risk factors are implicated. Recently, some magnetic resonance imaging (MRI) findings with predictive value for disease outcomes have been proposed. These intrinsic anatomic features include those of the AF and its surrounding structures. This study aims to clarify the prognostic role of MRI in AF.Methods: We performed a systematic search of PubMed, Embase, and EBSCO databases. Two independent reviewers conducted the search and screened the articles. We selected studies that used MRI to assess AF and reported its relationship to disease outcome. We extracted data regarding the study design, type of intervention, outcome, MRI-measured items, and their significance.Results: Out of 1230 retrieved articles, 18 were eligible for final inclusion, and a total of 4026 patients were enrolled in the selected studies. For preoperative MRI, the significant items affecting the outcome were the length of the fistula, horseshoe type, presence of multiple tracts, supralevator extension, and apparent diffusion coefficient (ADC) value. Other studies investigated the healing process using postoperative MRI. Conclusion:This review found that MRI can be useful in the management of AF, both preoperatively and postoperatively. Factors, such as fistula length, horseshoe type, presence of multiple tracts, supralevator extension, and ADC value were found to be significantly associated with treatment outcomes. The presence of the fistula tract and the development of new abscesses on postoperative MRI was found to hinder the healing process. Further studies are needed to confirm these findings.

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Recent Advances in Benign Anorectal Disorders

Garg

2022

GI Surgery Annual

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Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long‐term follow‐up of 151 cases

Cited by 9 publications

References 24 publications

A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas

A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas

Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review

Recent Advances in Benign Anorectal Disorders

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