Is anal endosonography useful in the study of recurrent complex fistula-in-ano?

Abstract

Introduction: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-inano.Patients and method: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings.Results: we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied.Conclusion: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.

Prognostic Value of Endoanal Ultrasound for Fistula-in-Ano: A Retrospective Analysis

“…It provides detailed anatomic definition of the fistula and its relationship to the anal sphincters, aiding the surgeon in decision making and choice of operation. [1][2][3][4][5][6][7][8] Several studies have demonstrated that the addition of H 2 O 2 as a contrast medium can provide a more detailed visualization of the anatomy, including the internal opening. [9][10][11][12] In 21 consecutive patients studied by Poen and colleagues, 12 the fistulous tract was identified correctly in 95 percent when hydrogen peroxide was used vs. 62 percent with EAUS alone.…”

“…Endoanal ultrasound (EAUS) is sometimes used to delineate the anatomy of fistulous disease and plan surgical therapy. [1][2][3][4][5][6][7][8] This imaging modality allows one to establish the relationship of the primary fistula tract to the anal sphincters, demonstrate the internal opening, differentiate a simple from a complex fistula, identify the presence of abscesses or extension into the supralevator space, and may delineate secondary tracts. However, the use of endoanal ultrasound comes with a cost.…”

Recurrent Multiple Complex Anal Fan-Shape Fistula

“…Performing the surgical technique or procedure with which we are most familiar is definitive, and is a decisive factor, and it is essential to have elements to support a proper diagnosis and plan the best possible course of treatment for each patient; in the literature, endoanal ultrasound is reported as a useful guide to planning a surgical strategy for each case [4]. On the other hand, nuclear magnetic resonance is a highly accurate parameter in surgery, which reduces recurrence up to 75% in patients and should be applied for this type of fistulas [5][6][7].…”

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?

“…In this way, anorectal ultrasonography (ARUS) is an imaging technique that allows visualization of the rectal walls and the anal canal. Its utility is clearly defined for anorectal cancer staging, in the study of anal incontinence, and for perianal sepsis (6,7).…”