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Magnetic resonance imaging for primary fistula in ano
G N Buchanan1, S Halligan, A B Williams
1Department of Surgery, St Mark's Hospital, Northwick Park, London, UK.
Background:
This was a prospective study designed to determine the therapeutic impact of magnetic resonance imaging (MRI) in primary fistula in ano, and to assess its effect on outcome.
Methods:
Thirty patients with suspected primary fistula in ano underwent preoperative MRI, and the findings were revealed during surgery following examination under anaesthesia (EUA). Any effect on operative approach was noted. Outcome was assessed at a median of 12 months.
Results:
Two patients had sinuses, one had no sepsis and 27 had fistulas: five superficial, seven intersphincteric, 14 trans-sphincteric and one suprasphincteric. MRI and EUA agreed in 15 patients and MRI findings altered the surgical approach in a further three (10 per cent); two of the latter patients were believed to have a sinus at EUA, which MRI correctly identified as a fistula, allowing definitive treatment. The therapeutic impact of MRI was therefore 10 per cent. Persisting disagreement between MRI and EUA in 12 patients mostly related to minor discrepancies in classification. Only one patient required further unplanned surgery, which was for skin-bridging rather than any new sepsis.
Conclusion:
In experienced hands, MRI has a therapeutic impact of 10 per cent for primary fistula in ano, precipitating surgery that is likely to reduce recurrence in a small, but important, proportion of patients.
Insights
Magnetic resonance imaging (MRI) impacts treatment for primary fistula in ano by altering surgical approach in 10% of patients. This improves outcomes and reduces recurrence for a small but significant patient group.
Area of Science:
- Medical imaging
- Surgical outcomes
- Anorectal diseases
Background:
- Primary fistula in ano is a common anorectal condition.
- Accurate diagnosis is crucial for effective treatment and preventing recurrence.
- Magnetic resonance imaging (MRI) is a non-invasive imaging modality.
Purpose of the Study:
- To determine the therapeutic impact of MRI in primary fistula in ano.
- To assess MRI's effect on surgical outcomes.
- To evaluate MRI's role in reducing fistula recurrence.
Main Methods:
- Prospective study of 30 patients with suspected primary fistula in ano.
- Preoperative MRI followed by surgical examination under anesthesia (EUA).
- Assessment of changes in surgical approach and patient outcomes at 12 months.
Main Results:
- MRI findings altered the surgical approach in 10% of patients (3/30).
- MRI correctly identified fistulas missed by EUA in two cases, enabling definitive treatment.
- Overall, MRI demonstrated a 10% therapeutic impact, with only one patient requiring further surgery for a different issue.
Conclusions:
- MRI has a 10% therapeutic impact in primary fistula in ano cases.
- MRI can guide surgical decisions, potentially reducing recurrence rates.
- Experienced interpretation of MRI is key to maximizing its therapeutic benefit.