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Comparison of preoperative examination findings and endoanal ultrasonography results with operation findings in perianal fistula disease

Year 2023, Volume: 48 Issue: 2, 330 - 335, 02.07.2023
https://doi.org/10.17826/cumj.1218980

Abstract

Purpose: The aim of the current study was to compare the preoperative examination findings, endoanal ultrasonography results, and operative findings in patients diagnosed with perianal fistula.
Materials and Methods: A prospective study was conducted between 2021 and 2022 on patients who underwent surgical treatment for perianal fistula. The patients were recorded and classified according to the Park classification by the surgeon performing the operation. Subsequently, a surgeon with 10 years of endoanal ultrasonography experience reclassified the patients and recorded the findings (Ultrasonographic Evaluation - USE). The surgery was performed by a different surgeon who was blind to the USE results and the final diagnosis was recorded (Evaluation Under Anesthesia - EAU). The preoperative examination findings, endoanal ultrasonography findings, and operative findings were compared postoperatively.
Results: The study included 60 patients, with 52 being male and 8 being female, and a mean age of 44.2 ± 12.6 years. The patients were classified as low transsphincteric (TSF), intersphincteric (ISF), and high TSF at ratios of 40%, 33.3%, and 26.7%, respectively (24, 20, and 16 patients, respectively). Endoanal ultrasonography found that 30%, 35%, and 21.7% of patients had low TSF, ISF, and high TSF, respectively (18, 21, and 13 patients, respectively), while postoperatively, 45%, 33%, and 21.7% of patients were classified as low TSF, ISF, and high TSF, respectively (27, 20, and 13 patients, respectively). The ISF rate in preoperative examination findings was significantly higher than in postoperative diagnoses, with intermediate coherence between the two diagnoses (κ: 0.462). The rates of low and high TSF were found to be significantly higher in ultrasonography findings than in postoperative diagnoses, with high coherence between the two (κ: 0.701).
Conclusion: Endoanal ultrasonography is important for mapping, especially for transsphincteric fistulas, in the surgical treatment of perianal fistulas.

References

  • Garg P, Kaur B, Goyal A, Yagnik VD, Dawka S, Menon GR. Lessons learned from an audit of 1250 anal fistula patients operated at a single center: A retrospective review. World J Gastrointest Surg. 2021;13:340-54.
  • Litta F, Parello A, Ferri L, Torrecilla NO, Marra AA, Orefice R et al. Simple fistula-in-ano: is it all simple? A systematic review. Tech Coloproctol. 2021;25:385-99.
  • Stijns J, Zimmerman DDE. Anal fistula, there is more than meets the eye! Tech Coloproctol. 2022;26:331-2.
  • Mei Z, Wang Q, Zhang Y, Liu P, Ge M, Du P et al. Risk factors for recurrence after anal fistula surgery: A meta-analysis. Int J Surg. 2019;69:153-64.
  • Adityan R, Immanuel JP. The role of diagnostic medical imaging techniques in the evaluation of perianal fistula: A review. Int J Radiol Imaging Technol. 2021;7:084.
  • Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology. 2004;233:674-81.
  • Sun Y, Cui LG, Liu JB, Wang JR, Ping H, Chen ZW. Utility of 360° real-time endoanal sonography for evaluation of perianal Fistulas. J Ultrasound Med. 2018;37:93-8.
  • Cho DY. Endosonographic criteria for an internal opening of fistulain ano. Dis Colon Rectum. 1999;42:515–8.
  • Mantoo S, Mandovra P, Goh S. Using preoperative three-dimensional endoanal ultrasound to determine operative procedure in patients with perianal fistulas. Colorectal Dis. 2020;22:931-8.
  • Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73:219-24.
  • Stoker J. Anorectal and pelvic floor anatomy. Best Pract Res Clin Gastroenterol. 2009;23:463-75.
  • Lunniss PJ, Jenkins PJ, Besser GM, Perry LA, Phillips RK. Gender differences in incidence of idiopathic fistula-in-ano are not explained by circulating sex hormones. Int J Colorectal Dis. 1995;10:25-8.
  • Alabiso ME, Iasiello F, Pellino G, Iacomino A, Roberto L, Pinto A et al. 3D-EAUS and MRI in the activity of anal fistulas in crohn's disease. Gastroenterol Res Pract. 2016;2016:1895694.
  • Rojanasakul A, Pattanaarun J, Sahakitrungruang C. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thail. 2007;90:581–6.
  • Sivri M, Koplay M, Nayman A, Cebeci H, Güler İ, Uysal E et al. Perianal fistülün tanısında, sınıflandırılmasında ve değerlendirilmesinde manyetik rezonans görüntüleme’nin önemi. Arch Clin Exp. Med. 2017;2:1-5.
  • Criado J de M, del Salto LG, Rivas PF, del Hoyo LFA, Velasco LG et al. MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics. 2012;32:175-94.
  • Siddiqui MRS, Ashrafian H, Tozer P, Daulatzai N, Burling D et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012;55:576-85.

Perianal fistül hastalığında preoperatif muayene bulguları ile endoanal ultrasonografi bulgularının ameliyat bulguları ile kıyaslanması

Year 2023, Volume: 48 Issue: 2, 330 - 335, 02.07.2023
https://doi.org/10.17826/cumj.1218980

Abstract

Amaç: Bu çalışmada, perianal fistül tanısı alan hastaların preoperatif muayene bulguları ile endoanal ultrasonografi bulgularının ameliyat bulguları ile kıyaslanması amaçlandı
Gereç ve Yöntem: Çalışma 2021-2022 yılları arasında perianal fistül nedeniyle cerrahi olarak tedavi edilen hastalarda prospektif olarak yapıldı. Anal fistül nedeniyle ameliyat edilen hastalara operasyonu yapacak cerrah tarafından poliklinik şartlarında muayene edilerek Park sınıflamasına göre sınıflandırılarak kayıt altına alındı. Daha sonra tüm hastalar, 10 yılllık endoanal ultrasonografi deneyimi olan bir cerrah tarafından sınıflandırılarak kayıt altına alınmıştır (Ultrasonographic evaluation (USE)). Ameliyatı ise FM yapan cerrah tarafından EUS sonucundan habersiz olarak gerçekleştirmiş ve nihai tanıyı kayıt altına almıştır (EAU evaluation under anesthesia). Operasyondan sonra fizik muayene bulguları ve endoanal ultrsound bulguları operasyon bulguları ile karşılaştırıldı.
Bulgular: Hastaların 52’si erkek 8’i kadındı. Yaş ortalaması 44,2±12,6 idi. Klinik değerlendirme ile hastaların %40 alçak TSF(transfinkterik), %33,3’ü İSF (intersfinkterik) ve %26,7’si yüksek TSF olarak sınıflandırıldı (sırasıyla 24, 20 ve 16 hasta). Endosonografik olarak hastaların %30’u alçak TSF, %35’i İSF, %21,7’si yüksek TSF olarak sınıflandırıldı (sırasıyla 18, 21 ve 13 hasta). Perioperatif değerlendirilen hastaların %45’i alçak TSF, %33’ü İSF ve %21,7’si yüksek TSF olarak değerlendirildi (sırasıyla 27, 20 ve 13 hasta). Fiziki muayene bulgularının İSF oranı ile postop tanı bulgularında anlamlı derece yüksek bulundu. Fiziki muayene tanı bulguları ile postop tanı bulguları arasındaki uyumluluğun ise orta düzeyde bir uyumluluk gösterdiği tespit edildi (κ: 0,462) Ultrason muayene bulgularında Alçak ve Yüksek TSF oranlarının postop tanı bulgularında anlamlı derece yüksek olduğu tespit edildi. Ultrason muayene tanı bulguları ile postop tanı bulguları arasındaki uyumluluğun ise yüksek düzeyde bir uyumluluk gösterdiği belirlendi (κ: 0,701)
Sonuç: Perianal fistül cerrahi tedavisinde endoanal ultrasoun özellikle transfinkterik fistüllerin haritalandırmasında önemli olduğu saptanmıştır

References

  • Garg P, Kaur B, Goyal A, Yagnik VD, Dawka S, Menon GR. Lessons learned from an audit of 1250 anal fistula patients operated at a single center: A retrospective review. World J Gastrointest Surg. 2021;13:340-54.
  • Litta F, Parello A, Ferri L, Torrecilla NO, Marra AA, Orefice R et al. Simple fistula-in-ano: is it all simple? A systematic review. Tech Coloproctol. 2021;25:385-99.
  • Stijns J, Zimmerman DDE. Anal fistula, there is more than meets the eye! Tech Coloproctol. 2022;26:331-2.
  • Mei Z, Wang Q, Zhang Y, Liu P, Ge M, Du P et al. Risk factors for recurrence after anal fistula surgery: A meta-analysis. Int J Surg. 2019;69:153-64.
  • Adityan R, Immanuel JP. The role of diagnostic medical imaging techniques in the evaluation of perianal fistula: A review. Int J Radiol Imaging Technol. 2021;7:084.
  • Buchanan GN, Halligan S, Bartram CI, Williams AB, Tarroni D, Cohen CR. Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard. Radiology. 2004;233:674-81.
  • Sun Y, Cui LG, Liu JB, Wang JR, Ping H, Chen ZW. Utility of 360° real-time endoanal sonography for evaluation of perianal Fistulas. J Ultrasound Med. 2018;37:93-8.
  • Cho DY. Endosonographic criteria for an internal opening of fistulain ano. Dis Colon Rectum. 1999;42:515–8.
  • Mantoo S, Mandovra P, Goh S. Using preoperative three-dimensional endoanal ultrasound to determine operative procedure in patients with perianal fistulas. Colorectal Dis. 2020;22:931-8.
  • Sainio P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73:219-24.
  • Stoker J. Anorectal and pelvic floor anatomy. Best Pract Res Clin Gastroenterol. 2009;23:463-75.
  • Lunniss PJ, Jenkins PJ, Besser GM, Perry LA, Phillips RK. Gender differences in incidence of idiopathic fistula-in-ano are not explained by circulating sex hormones. Int J Colorectal Dis. 1995;10:25-8.
  • Alabiso ME, Iasiello F, Pellino G, Iacomino A, Roberto L, Pinto A et al. 3D-EAUS and MRI in the activity of anal fistulas in crohn's disease. Gastroenterol Res Pract. 2016;2016:1895694.
  • Rojanasakul A, Pattanaarun J, Sahakitrungruang C. Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract. J Med Assoc Thail. 2007;90:581–6.
  • Sivri M, Koplay M, Nayman A, Cebeci H, Güler İ, Uysal E et al. Perianal fistülün tanısında, sınıflandırılmasında ve değerlendirilmesinde manyetik rezonans görüntüleme’nin önemi. Arch Clin Exp. Med. 2017;2:1-5.
  • Criado J de M, del Salto LG, Rivas PF, del Hoyo LFA, Velasco LG et al. MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics. 2012;32:175-94.
  • Siddiqui MRS, Ashrafian H, Tozer P, Daulatzai N, Burling D et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012;55:576-85.
There are 17 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research
Authors

Haluk Tümer 0000-0002-0383-3353

İsmail Cem Eray 0000-0002-1560-7740

Early Pub Date July 9, 2023
Publication Date July 2, 2023
Acceptance Date March 25, 2023
Published in Issue Year 2023 Volume: 48 Issue: 2

Cite

MLA Tümer, Haluk and İsmail Cem Eray. “Comparison of Preoperative Examination Findings and Endoanal Ultrasonography Results With Operation Findings in Perianal Fistula Disease”. Cukurova Medical Journal, vol. 48, no. 2, 2023, pp. 330-5, doi:10.17826/cumj.1218980.