A prospective study of fistula in ano with reference to clinicopathology, imaging and management
Keywords:Fistula in ano, Fistula surgery, Recurrent fistula, Complex fistula, Fistulography. MRI fistulography, Tuberculosis in fistula
Background: The aim was to study and review clinical presentation, pathological aspects & prevalent modalities of investigation and treatment for fistula in ano.
Methods: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulography was done as a preliminary investigation in 72 cases and MR Fistulography was done for complex and recurrent fistula (16 cases). Patients were operated and histopathology of fistula tract was done. In patients with clinical suspicion of tuberculosis smear examination of pus with ziehl neelsen staining for acid fast bacilli (AFB) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on pus/slide was used to find out tuberculosis in patients of anal fistula. The clinical presentation, operation performed, pathological findings were recorded & a descriptive analysis was done.
Results: A prospective study of 90 patients of fistula in ano admitted from March 2015 to December 2016 was done. Fistulography was done as a preliminary investigation in 72 cases and MR Fistulography was done for complex and recurrent fistula (16 cases). Patients were operated and histopathology of fistula tract was done. In patients with clinical suspicion of tuberculosis smear examination of pus with ziehl neelsen staining for acid fast bacilli (AFB) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on pus/slide was used to find out tuberculosis in patients of anal fistula. The clinical presentation, operation performed, pathological findings were recorded & a descriptive analysis was done.
Conclusions: With careful clinical evaluation, appropriate imaging studies and conventional surgical techniques anal fistula can be treated effectively with less morbidity, incontinence and recurrence.
Poggio JL, Fistula-in-Ano Treatment & Management, Drugs & diseases, Gen. Surgery, https://emedicine.medscape.com/article/190234-treatment. Accessed 15 February 2017.
Anal fistula. Corman ML, Bergamaschi RCM, Nicholls RJ, Fazio VW, eds. Corman's Colon and Rectal Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2013: 384-427.
Davis BR, Kasten KR. Anorectal abscess and fistula. Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore AJ, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 3rd ed. New York: Springer; 2016: 215-244.
Steele SR, Kumar R, Feingold DL. American Society of Colon and Rectal Surgeons. Practice parameters for treatment of fistula-in-ano--supporting documentation. The Standards Practice Task Force. Dis Colon Rectum. 1996;39(12):1363-72.
Khadia M, Muduli IC, Das SK, Mallick SN, Bag L, Pati MR. Management of fistula-in-ano with special reference to ligation of intersphincteric fistula tract. Niger J Surg. 2016;22:1-4.
Saino P. Fistula-in-ano in a defined population. Incidence and epidemiological aspects. Ann Chir Gynaecol. 1984;73(4):219-24.
Vasilevsky CA, Gordon PH. The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration. Dis Colon Rectum. 1984;27(2):126-30.
Bruhl S. Perianal fistulae. Part A: survey. Coloproctology. 1986;8:109-14.
Ani AN, Solanke TF. Anal Fistula: A Review of 82 cases. Dis Colon Rectum. 1976;19:51.
Sangwan YP, Rosen L, Riether RD, Stasik JJ, Sheets JA, Khubchandani IT. Is simple fistula-in-ano simple?. Dis Colon Rectum. 1994;37(9):885-9.
Parks AG, Gordon PH, Hardcastle JD. A classification of fistula‑in‑ano. Br J Surg. 1976;63:1‑12.
Abbas MA, Lemus‑Rangel R, Hamadani A. Long‑term outcome of endorectal advancement flap for complex anorectal fistulae. Am Surg. 2008;74:921‑4.
Jarrar A, Church J. Advancement flap repair: A good option for complex anorectal fistulas. Dis Colon Rectum. 2011;54:1537‑41.
Waniczek D, Adamczyk T, Arendt J, Kluczewska E, Kozińska-Marek E. Usefulness assessment of preoperative MRI fistulography in patients with perianal fistulas. Pol J Radiol. 2011;76(4):40-4.
Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics. 2000; 20(3):623–35.
Rojanasakul A. LIFT procedure: A simplified technique for fistula‑in‑ano. Tech Coloproctol. 2009;13:237‑40.
Rojanasakul A, Pattanaarun J, Sahakitrungruang C, Tantiphlachiva K. Total anal sphincter saving technique for fistula‑in‑ano; the ligation of intersphincteric fistula tract. J Med Assoc Thai. 2007;90:581‑6.
Abbas MA, Jackson CH, Haigh PI. Predictors of outcome for anal fistula surgery, Arch Surg. 2011;146:1011‑6.
Ho KS, Tsang C, Seow‑Choen F, Ho YH, Tang CL, Heah SM, et al. Prospective randomised trial comparing ayurvedic cutting seton and fistulotomy for low fistula‑in‑ano. Tech Coloproctol 2001;5:137‑41.
Meinero P, Mori L. Video‑assisted anal fistula treatment (VAAFT): A novel sphincter‑saving procedure for treating complex anal fistulas. Tech Coloproctol. 2011;15:417‑22.
de la Portilla F, Rada R, León E, Cisneros N, Maldonado VH, Espinosa E. Evaluation of the use of BioGlue in the treatment of high anal fistulas: Preliminary results of a pilot study. Dis Colon Rectum. 2007;50:218‑22.
Barillari P, Basso L, Larcinese A, Gozzo P, Indinnimeo M. Cyanoacrylate glue in the treatment of ano‑rectal fistulas. Int J Colorectal Dis. 2006;21:791‑4.
Han JG, Wang ZJ, Zhao BC, Zheng Y, Zhao B, Yi BQ, et al. Long‑term outcomes of human acellular dermal matrix plug in closure of complex anal fistulas with a single tract. Dis Colon Rectum. 2011;54:1412‑8.
Dawar R, Jain SK, Rani H, Mendiratta L, Sardana R. Recurrent high fistula-in-ano: Think of tuberculosis!. Ann Trop Med Public Health. 2016;9:273-5.
Shukla HS, Gupta SC, Singh G, Singh PA. Tubercular fistula in ano. Br J Surg. 1988;75:38-9
Garg P, Garg MK, Agarwal N. Comparison of histopathology, acid fast bacillus smear and real-time polymerase chain reaction for detection of Mycobacterium tuberculosis in anal fistula in 161 patients: A prospective controlled trial. Int J Mycobacteriol. 2016;5(1):S208-9.
Anim JT, Sowayan SA, Grant CS, Al-Breiki H. Fistula-In-Ano: a pathological study. Ann Saudi Med. 1991;11(4).
Marks CG, Ritchie JK. Anal fistulas at St. Mark's Hospital. Br J Surg. 1977;64:84-91.