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Use of diagnostic modalities in the treatment of perianal fistula: A retrospective cohort study of 307 patients

Year 2018, Volume: 3 Issue: 2, 49 - 52, 20.07.2018
https://doi.org/10.25000/acem.406511

Abstract

Aim:
Deciding on the type of fistula and deciding on the most appropriate type of
surgery is still a challenge for anal fistula disease. In this study, we aimed
to evaluate whether magnetic resonance imaging (MRI), endoscopic examination
and co-administration of both in preoperative preparations of anal fistulas are
beneficial in this respect.



Methods:
The study was retrospectively performed in patients treated surgically for
perianal fistula between 2008 and 2017. The data of 307 patients operated for
anal fistulas were reviewed with hospital records. Patients were grouped under
the headings of preoperative MRI and non-MRI, endoscopic and non-endoscopic
examination, and both performed and non-performed. The demographic data (age,
sex), fistula type (simple or complicated), presence or absence of seton and
the type of surgery were recorded. These parameters were compared with the groups.



Results:
In the preoperative evaluation, 162 (53%) patients had MRI, 83 (27%) patients
had endoscopic examination and 60 (20%) patients had both. There was a
statistically significant correlation between the presence of preoperative MRI
and the need for seton placement (p <0.05 for all). Preoperative MRI,
preoperative endoscopy and preoperative both modalities groups didn’t show
statistically significant correlation with patient’s demographic data, fistula
type and surgical method (p> 0.05 for all).



Conclusion: Preoperative modalities such as MRI and
endoscopy are not sufficient in determining the type of fistula in an anal
fistula and determining the surgical method to be applied. We believe that
combining these studies with perioperative examination may be helpful in
obtaining more effective results. Also, performing MRI preoperatively may help
surgeons for decision of seton placement.

References

  • 1. Malik AI, Nelson RL. Surgical management of anal fistula: a systematic review. Colorectal Disease. 2008;10:420-30.
  • 2. Parks AG. Pathogenesis and treatment of fistula-in-ano. Br Med J. 1961;18:1.
  • 3. Gosselink MP, van Onkelen RS, Schouten WR. The cryptoglandular theory revisited. Colorectal Dis. 2015;17:1041–3.
  • 4. Jon D. Vogel, Eric K. Johnson. Clinical Practice Guideline for the Managementof Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum. 2016;59:1117–33.
  • 5. 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.
  • 6. Gültekin FA, Çipe G, Sümer D, Sücüllü İ, Sungurtekin U, Bugra D. Anal Fistül Cerrah Tutum Anketi 2013, Sonuç Rapor. Kolon Rektum Hast Derg. 2013;23:81-8.
  • 7. Juillerat P, Peytremann-Bridevaux I, Vader JP, Arditi C, SchusseléFilliettaz S, Dubois RW, et al. Appropriateness of colonoscopy in Europe (EPAGE II). Presentation of methodology, general results, and analysis of complications. Endoscopy. 2009;41:240-6.
  • 8. Kok L, Elias SG, Witteman BJ, Goedhard JG, Romberg-Camps MJ, Muris JW, Moons KG, de Wit NJ. Application of the Rome III criteria is not likely to reduce the number of unnecessary referrals for colonoscopy in primary care. Eur J Gastroenterol Hepatol. 2013;25:568-74.
  • 9. Arditi C, Peytremann-Bridevaux I, Burnand B, Eckardt VF, Bytzer P, Agréus L, et al. Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer. Endoscopy. 2009;41:200–8.
  • 10. Kiehne K, Fincke A, Brunke G, Lange T, Fölsch UR, Herzig KH. Antimicrobial peptides in chronic anal fistula epithelium. Scand J Gastroenterol. 2007;42:1063-9.
  • 11. Abcarian H. Anorectal infection: Abscess-Fistula. Clin Colon Rectal Surg. 2011;24:14–21.
  • 12. Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, García-Olmo D. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis. 2007; 22:1459–1462.
  • 13. Hall JF, Bordeianou L, Hyman N, Read T, Bartus C, Schoetz D, et al. Outcomes after operationsfor anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum. 2014;57:1304–8.
  • 14. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula in- ano. Br J Surg. 1976; 63:1–12.
  • 15. Beets-Tan RG1, Beets GL, van der Hoop AG, Kessels AG, Vliegen RF, Baeten CG, et al. Preoperative MR imaging of anal fistulas: Does it really help the surgeon? Radiology. 2001;218:75-84.
  • 16. Sivri M, Koplay M, Nayman A, Cebeci H, Güler İ, Uysal E, Paksoy Y. Perianal fistülün tanısında, sınıflandırılmasında ve değerlendirilmesinde Manyetik Rezonans Görüntüleme’nin önemi. Arch Clin Exp Med. 2017; 2:1-5.
  • 17. Giacosa A, Frascio F, Munizzi F. Epidemiology of colorectal polyps. Techniques in Coloproctology 2004;8:243-7.
  • 18. Göktürk S, Karaca C. İnflamatuar Barsak Hastalıkları Epidemiyolojisi. Turkiye Klinikleri J Gastroenterohepatol Special Topics. 2012;5:11-6.
  • 19. Yamada K, Miyakura Y, Koinuma K, Horie H, Lefor AT, Yasuda Y. Primary and secondary adenocarcinomas associated with anal fistula. Surg Today. 2014;44:888-96.
  • 20. Yu D, Hopman WM, Paterson WG. Wait time for endoscopic evaluation at a Canadian tertiary care centre: comparison with Canadian Association of Gastroenterology targets. Can J Gastroenterol. 2008;22:621-6.

Perianal fistül tedavisinde tanısal yöntemlerin kullanımı: 307 hastanın retrospektif kohort çalışması

Year 2018, Volume: 3 Issue: 2, 49 - 52, 20.07.2018
https://doi.org/10.25000/acem.406511

Abstract

Amaç:
Anal fistül hastalığında fistül tipine karar vermek ve en uygun ameliyat tipine
karar vermek ileri tetkiklerin kullanılmasına karşın halen içerisinde zorluklar
barındırmaktadır. Bu çalışmada, anal fistül hastalarının ameliyat öncesi hazırlıklarında
manyetik rezonans görüntüleme (MRG), endoskopik inceleme ve her ikisinin birlikte
uygulanmasının bu konuda yararlı olup olmadığını değerlendirmeyi amaçladık.



Yöntemler:
Çalışma 2008-2017 yılları arasında perianal fistül nedeniyle cerrahi tedavi uygulanan
hastalarda retrospektif olarak yapıldı. Anal fistül nedeniyle ameliyat edilen
307 hastanın verileri hastane kayıtları ile gözden geçirildi. Hastalar ameliyat
öncesi MRG yapılan ve yapılmayanlar, endoskopik inceleme yapılan ve yapılmayanlar
ve her ikisi yapılan ve yapılmayanlar başlıkları altında gruplandırıldı. Hastaların
demografik verileri (yaş, cinsiyet), fistül tipi (basit veya komplike), seton yerleşiminin
olup olmadığı ve uygulanan cerrahi tipi kaydedildi. Bu parametreler gruplarla karşılaştırıldı.



Bulgular:
Ameliyat öncesi değerlendirmede 162 (% 53) hastaya MRG, 83 (% 27) hastaya endoskopik
inceleme ve 60 (% 20) hastaya da her ikisinin birden yapıldığı saptandı.
Ameliyat öncesi MRG varlığı ile seton yerleştirilme gereksinimi arasında istatistiksel
olarak anlamlı korelasyon saptandı (p<0,05). Ameliyat öncesi MRG, ameliyat öncesi
endoskopi ve ameliyat öncesi her iki uygulamanın varlığı ile hastaların demografik
özellikleri, fistül tipi ve uygulanan cerrahi tipi arasında istatistiksel olarak
anlamlı ilişki saptanmadı (p>0,05). 



Sonuç:
Anal fistül hastalığında fistül tipini saptamada ve uygulanacak cerrahi şekline
karar vermede MRG, endoskopi gibi preoperatif modaliteler yeterli olamamaktadır,
bu incelemelerin peroperatif muayene ile birleştirilerek değerlendirilmesinin daha
etkili sonuç elde etmede faydalı olacağı kanaatindeyiz. Ayrıca preoperatif MRG
uygulamasının seton gereksinimi konusunda cerrahlara yardımcı olabileceğini düşünmekteyiz. 

References

  • 1. Malik AI, Nelson RL. Surgical management of anal fistula: a systematic review. Colorectal Disease. 2008;10:420-30.
  • 2. Parks AG. Pathogenesis and treatment of fistula-in-ano. Br Med J. 1961;18:1.
  • 3. Gosselink MP, van Onkelen RS, Schouten WR. The cryptoglandular theory revisited. Colorectal Dis. 2015;17:1041–3.
  • 4. Jon D. Vogel, Eric K. Johnson. Clinical Practice Guideline for the Managementof Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula. Dis Colon Rectum. 2016;59:1117–33.
  • 5. 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.
  • 6. Gültekin FA, Çipe G, Sümer D, Sücüllü İ, Sungurtekin U, Bugra D. Anal Fistül Cerrah Tutum Anketi 2013, Sonuç Rapor. Kolon Rektum Hast Derg. 2013;23:81-8.
  • 7. Juillerat P, Peytremann-Bridevaux I, Vader JP, Arditi C, SchusseléFilliettaz S, Dubois RW, et al. Appropriateness of colonoscopy in Europe (EPAGE II). Presentation of methodology, general results, and analysis of complications. Endoscopy. 2009;41:240-6.
  • 8. Kok L, Elias SG, Witteman BJ, Goedhard JG, Romberg-Camps MJ, Muris JW, Moons KG, de Wit NJ. Application of the Rome III criteria is not likely to reduce the number of unnecessary referrals for colonoscopy in primary care. Eur J Gastroenterol Hepatol. 2013;25:568-74.
  • 9. Arditi C, Peytremann-Bridevaux I, Burnand B, Eckardt VF, Bytzer P, Agréus L, et al. Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer. Endoscopy. 2009;41:200–8.
  • 10. Kiehne K, Fincke A, Brunke G, Lange T, Fölsch UR, Herzig KH. Antimicrobial peptides in chronic anal fistula epithelium. Scand J Gastroenterol. 2007;42:1063-9.
  • 11. Abcarian H. Anorectal infection: Abscess-Fistula. Clin Colon Rectal Surg. 2011;24:14–21.
  • 12. Zanotti C, Martinez-Puente C, Pascual I, Pascual M, Herreros D, García-Olmo D. An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis. 2007; 22:1459–1462.
  • 13. Hall JF, Bordeianou L, Hyman N, Read T, Bartus C, Schoetz D, et al. Outcomes after operationsfor anal fistula: results of a prospective, multicenter, regional study. Dis Colon Rectum. 2014;57:1304–8.
  • 14. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula in- ano. Br J Surg. 1976; 63:1–12.
  • 15. Beets-Tan RG1, Beets GL, van der Hoop AG, Kessels AG, Vliegen RF, Baeten CG, et al. Preoperative MR imaging of anal fistulas: Does it really help the surgeon? Radiology. 2001;218:75-84.
  • 16. Sivri M, Koplay M, Nayman A, Cebeci H, Güler İ, Uysal E, Paksoy Y. Perianal fistülün tanısında, sınıflandırılmasında ve değerlendirilmesinde Manyetik Rezonans Görüntüleme’nin önemi. Arch Clin Exp Med. 2017; 2:1-5.
  • 17. Giacosa A, Frascio F, Munizzi F. Epidemiology of colorectal polyps. Techniques in Coloproctology 2004;8:243-7.
  • 18. Göktürk S, Karaca C. İnflamatuar Barsak Hastalıkları Epidemiyolojisi. Turkiye Klinikleri J Gastroenterohepatol Special Topics. 2012;5:11-6.
  • 19. Yamada K, Miyakura Y, Koinuma K, Horie H, Lefor AT, Yasuda Y. Primary and secondary adenocarcinomas associated with anal fistula. Surg Today. 2014;44:888-96.
  • 20. Yu D, Hopman WM, Paterson WG. Wait time for endoscopic evaluation at a Canadian tertiary care centre: comparison with Canadian Association of Gastroenterology targets. Can J Gastroenterol. 2008;22:621-6.
There are 20 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Original Research
Authors

Abdullah Şişik

Ali Kılıç

Publication Date July 20, 2018
Published in Issue Year 2018 Volume: 3 Issue: 2

Cite

Vancouver Şişik A, Kılıç A. Use of diagnostic modalities in the treatment of perianal fistula: A retrospective cohort study of 307 patients. Arch Clin Exp Med. 2018;3(2):49-52.