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Related Experiment Video

Updated: Jun 18, 2026

Colonial Wig Pancreaticojejunostomy
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Published on: March 12, 2019

Anal fistulas: do classification systems predict surgical outcomes?

José Américo Bacchi Hora1, Lucas Faraco Sobrado1, Carlos Walter Sobrado1

  • 1Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Division of Coloproctology - São Paulo (SP), Brazil.

Arquivos Brasileiros De Cirurgia Digestiva : ABCD = Brazilian Archives of Digestive Surgery
|June 17, 2026
PubMed
Summary
This summary is machine-generated.

The Parks and American Society of Colon and Rectal Surgeons (ASCRS) classifications effectively predict anal fistula closure with continence preservation. Parks classification showed slightly higher sensitivity for predicting successful outcomes.

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Area of Science:

  • Colorectal Surgery
  • Surgical Outcomes Research
  • Medical Imaging Analysis

Background:

  • Anal fistulas present significant surgical challenges, often leading to recurrence and incontinence.
  • Existing classification systems for anal fistulas have unclear predictive value for surgical and functional outcomes.

Purpose of the Study:

  • To compare the predictive accuracy of Parks, American Society of Colon and Rectal Surgeons (ASCRS), and St. James's University Hospital (SJUH) MRI-based classifications.
  • To assess the ability of these classifications to predict surgical outcomes, including continence preservation.

Main Methods:

  • Retrospective analysis of 89 patients with anorectal fistulas (excluding rectovaginal, Crohn's disease, or prior radiotherapy).
  • Fistulas classified using Parks, ASCRS, and SJUH systems.
  • Outcomes measured included fistula closure, closure without continence deterioration, and procedure type, with continence assessed by the Cleveland Clinic Jorge-Wexner score.

Main Results:

  • 86.5% of patients achieved fistula closure, with 73% preserving continence.
  • Parks and ASCRS classifications were significantly associated with fistula closure and continence preservation (p<0.01).
  • Parks classification remained significant for closure alone (p=0.005), while ASCRS showed borderline significance (p=0.051). SJUH classification predicted only procedure selection.

Conclusions:

  • Parks and ASCRS classifications are valuable for predicting anal fistula closure with continence preservation and guiding initial procedure choice.
  • Parks classification demonstrated slightly greater sensitivity in predicting successful closure.
  • Accurate classification is crucial for surgical planning, patient counseling, and improving outcomes in complex anal fistula management.