Predictive factors for recurrence of cryptoglandular fistulae characterized by preoperative three‐dimensional endoanal ultrasound

Visscher, Arjan P.; Schuur, Daan; Slooff, Robbert Alexander Eduard; Meijerink, W. J. H. J.; Deen-Molenaar, C B H; Felt‐Bersma, R. J. F.

doi:10.1111/codi.13211

Cited by 22 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Visscher et al reported secondary tracts identified during preoperative EAUS as a strong predictor of fistula recurrence (HR 2.4 (95% CI 1.2 to 51), p=0.016)40 and Roig et al had emphasised on the importance of preoperative recognition of anal sphincter defect on preoperative plan 37. However, we had seen four subjects with anal sphincter defect from preoperative EAUS and none of them had symptoms of FI preoperatively.…”

Section: Discussionmentioning

confidence: 66%

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Tantiphlachiva

Sahakitrungruang

Rojanasakul

2019

BMJ Open Gastroenterol

View full text Add to dashboard Cite

ObjectiveEndoanal ultrasound (EAUS) is a recommended preoperative investigation for fistula-in-ano (FiA) which aims to provide the best chance of healing and preservation of continence function. This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors associated with clinical outcomes after FiA surgery.DesignRetrospective analysis of subjects with cryptogenic FiA between January 2011 and December 2016, in a tertiary hospital, was performed by comparing EAUS and no-EAUS groups. Postoperative change in St. Mark’s faecal incontinence severity score (cFISS=FISS at 6 months after surgery–FISS before surgery) were compared. General linear model was used to determine factors associated with cFISS. Binary logistic regression was used to assess factors related to clinical outcomes. A p-value of <0.05 is considered significant.Results We enrolled 339 subjects; 109 (M:F 91:18, mean age 41.7±13.6 years) of 115 in EAUS group and 230 in no-EAUS group (M:F 195:35, mean age 42.6±13.0 years). There were higher proportions of recurrent cases (24.8% vs 13.9%, p=0.014) and complex FiA (80.7% vs 50.4%, p=0.001) in EAUS group. Postoperative FISS (mean±SE) were increased in both groups; preoperative versus postoperative FISS were 0.36±0.20 versus 0.59±0.25 in EAUS group (p=0.056) and 0.31±0.12 versus 0.76±0.17 in no-EAUS group (p<0.001). EAUS had significant effects on cFISS in both univariate analysis, F(1,261)=4.053, p=0.045; and multivariate analysis, F(3,322)=3.147, p=0.025, Wilk’s Lambda 0.972. Other associated factors included recurrent fistula (F(3,322)=0.777, p=0.007, Wilk’s Lambda 0.993) and fistula classification (F(3,322)=16.978, p<0.001, Wilk’s Lambda 0.863). After a mean follow-up of 33.6±28.6 weeks, success rate was 63.3%(EAUS) and 60% (no-EAUS), p=0.822. Factors associated with clinical outcomes were fistula complexity, number of tracts, recurrence, number of previous surgery and type of operations. Accuracy of EAUS was 90.8% and not related to clinical outcomes (p=0.522).ConclusionEAUS had favourable effects on functional outcome after FiA surgery while multiple factors were associated with clinical outcomes. EAUS is useful, accurate, inexpensive and can be the first tool for planning of complex and recurrent FiA.

show abstract

Section: Discussionmentioning

confidence: 66%

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Tantiphlachiva

Sahakitrungruang

Rojanasakul

2019

BMJ Open Gastroenterol

View full text Add to dashboard Cite

show abstract

“…One study indicated that patients with low fistulas treated by fistulotomy had soiling rates of 40% after surgery, with 7% recurrence at 3 years [65]. Recurrence after fistulotomy can be due to inadequate delineation of the fistula tract, failure to identify a secondary fistula tract, or the patient’s predisposition for cryptoglandular disease [66]. Marsupialization of the tract during fistulotomy is associated with less postoperative bleeding and better wound healing [61].…”

Section: Perianal Abscess and Fistulasmentioning

confidence: 99%

Benign anorectal disease: hemorrhoids, fissures, and fistulas

Gardner

Siddharthan

Tsikitis

2019

aog

View full text Add to dashboard Cite

Hemorrhoids, anal fissures, and fistulas are common benign anorectal diseases that have a significant impact on patients' lives. They are primarily encountered by primary care providers, including internists, gastroenterologists, pediatricians, gynecologists, and emergency care providers. Most complex anorectal disease cases are referred to colorectal surgeons. Knowledge of these disease processes is essential for proper treatment and follow up. Hemorrhoids and fissures frequently benefit from non-operative treatment; they may, however, require surgical procedures. The treatment of anorectal abscess and fistulas is mainly surgical. The aim of this review is to examine the etiology, diagnosis, medical, and surgical treatment for these benign anorectal diseases.

show abstract

“…A 3D-EUS system was used (Hawk type 2050, B-K Medical, Naerum, Denmark), with a rotating endoprobe with two crystals, covering 6–16 MHz (standard 12 MHz, focal range 2 to 4.5 cm, diameter 1.7 cm), producing a 360-degree view. 3D-EUS was performed by a proctologic surgeon (IHG, VRS, GVM, CDM) with the patient in the left lateral position, according to our previously described methods [ 1 , 2 ]. The fistula tract was described as simple (one tract, low (< 1/3 sphincter length)), or complex (high (> 1/3 sphincter length) or branched), and also the tract course was analysed.…”

Section: Methodsmentioning

confidence: 99%

“…Perianal fistulas as well as related surgical treatment may damage the anal sphincters leading to problems such as soiling and faecal incontinence with subsequent diminished quality of life. Especially recurrent fistulas are notorious [ 1 – 5 ]. Pre-operative identification of the fistula anatomy and sphincter function is important to reduce complications like recurrence or faecal incontinence.…”

Section: Introductionmentioning

confidence: 99%

“…The current standard technique to visualise the anatomy of the anal sphincter complex is 3D endoanal ultrasonography (3D-EUS) or MRI. It provides information regarding the number of fistula tracts or sphincter defects, and thus guides surgical strategy [ 1 , 2 , 5 – 7 ]. According to a systematic review of the prevailing guidelines [ 8 ] and the Dutch Proctology Guidelines [ 9 ], a fistulotomy is performed in low (< 1/3 sphincter length) fistulas, while in higher (> 1/3 sphincter length) fistulas a more conservative approach is used by placing a seton or performing a sphincter saving technique such as a mucosal advancement plasty or a LIFT procedure [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound

et al. 2018

View full text Add to dashboard Cite

BackgroundPerianal fistula surgery can damage the anal sphincters which may cause faecal incontinence. By measuring regional pressures, 3D-HRAM potentially provides better guidance for surgical strategy in patients with perianal fistulas. The aim was to measure regional anal pressures with 3D-HRAM and to compare these with 3D-EUS findings in patients with perianal fistulas.MethodsConsecutive patients with active perianal fistulas who underwent both 3D-EUS and 3D-HRAM at a clinic specialised in proctology were included. A group of 30 patients without fistulas served as controls. Data regarding demographics, complaints, previous perianal surgical procedures and obstetric history were collected. The mean and regional anal pressures were measured with 3D-HRAM. Fistula tract areas detected with 3D-EUS were analysed with 3D-HRAM by visual coding and the regional pressures of the corresponding and surrounding area of the fistula tract areas were measured. The study was granted by the VUmc Medical Ethical Committee.ResultsForty patients (21 males, mean age 47) were included. Four patients had a primary fistula, 19 were previously treated with a seton/abscess drainage and 17 had a recurrence after previously performed fistula surgery. On 3D-HRAM, 24 (60%) fistula tract areas were good and 8 (20%) moderately visible. All but 7 (18%) patients had normal mean resting pressures. The mean resting pressure of the fistula tract area was significantly lower compared to the surrounding area (47 vs. 76 mmHg; p < 0.0001). Only 2 (5%) patients had a regional mean resting pressure < 10 mmHg of the fistula tract area. Using a Δ mean resting pressure ≥ 30 mmHg difference between fistula tract area and non-fistula tract area as alternative cut-off, 21 (53%) patients were identified. In 6 patients 3D-HRAM was repeated after surgery: a local pressure drop was detected in one patient after fistulotomy with increased complaints of faecal incontinence.ConclusionsProfound local anal pressure drops are found in the fistula tract areas in patients normal mean resting pressures. Fistulotomy may affect local sphincter pressure. This might influence surgical decision making in future.

show abstract

Predictive factors for recurrence of cryptoglandular fistulae characterized by preoperative three‐dimensional endoanal ultrasound

Cited by 22 publications

References 34 publications

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

Benign anorectal disease: hemorrhoids, fissures, and fistulas

3D high-resolution anorectal manometry in patients with perianal fistulas: comparison with 3D-anal ultrasound

Contact Info

Product

Resources

About