Accuracy prediction of Goodsall's rule for anal fistulas of crypotogladular origin, is still standing?
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View abstract on PubMed
Summary
This summary is machine-generated.Goodsall's rule accurately predicts anal fistula internal openings in 74.75% of cases, showing higher accuracy for posterior and shorter fistulas. Its effectiveness varies with fistula characteristics, impacting treatment planning.
Area Of Science
- Colorectal surgery
- Surgical anatomy
- Diagnostic accuracy
Background
- Anal fistula treatment is challenging due to high recurrence and incontinence risks.
- Accurate identification of the internal fistula opening is crucial for successful surgical outcomes.
- Goodsall's rule is a commonly used but controversial method for predicting fistula tract anatomy.
Purpose Of The Study
- To evaluate the accuracy and positive predictive value of Goodsall's rule in predicting the internal opening of anal fistulas.
- To compare Goodsall's rule predictions with MRI and intraoperative findings.
- To assess the influence of fistula characteristics on the rule's accuracy.
Main Methods
- A prospective case series study involving 320 consecutive anal fistula patients.
- Application of Goodsall's rule based on external fistula opening location.
- Comparison of predicted internal opening locations with perineal/pelvic MRI and intraoperative findings.
Main Results
- Goodsall's rule demonstrated an overall accuracy of 74.75%, with a positive predictive value of 77.1%, sensitivity of 74.5%, and specificity of 72.05%.
- Accuracy was higher for posterior (73%) compared to anterior (52.4%) tracts.
- The rule was more accurate for short, superficial fistulas than long, high fistulas.
Conclusions
- Goodsall's rule is moderately accurate for predicting anal fistula internal openings, with performance varying by location and length.
- Anterior fistulas, especially long ones (>3 cm), frequently deviate from Goodsall's rule predictions.
- Posterior short fistulas may exhibit radial courses rather than direct midline openings, challenging the rule's assumptions.
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