Abstract
PURPOSE: Fistula-in-ano anatomy and its relationship with anal sphincters are
important factors influencing the results of surgical management. Preoperative
definition of fistulous track(s) and the internal opening play a primary role in
minimizing iatrogenic damage to the sphincters and recurrence of the fistula.
METHODS: Physical examination and endoanal ultrasound (performed with a 10 MHz
endoprobe), either conventionally or with an injection of hydrogen peroxide,
were performed in 26 consecutive patients. Results were matched with surgical
features to establish their accuracy in preoperative fistula-in-ano assessment.
RESULTS: Accuracy rates of clinical examination endoanal ultrasound, and
hydrogen peroxide-enhanced ultrasound were 65.4, 50, and 76.9 percent for
primary tracks, 73.1, 65.4, and 88.5 percent for secondary tracks, and 80.8,
80.8, and 92.3 percent for horseshoe extensions, respectively. Compared with
physical examination and endoanal ultrasound, accuracy of hydrogen
peroxide-enhanced ultrasound was higher for transsphincteric and
intersphincteric primary tracks and horseshoe extensions. Both endoanal
ultrasound and hydrogen peroxide-enhanced ultrasound displayed a significantly
higher accuracy in detecting the internal openings (53.8 and 53.8 percent,
respectively) compared with clinical evaluation (23.1 percent; P = 0.027).
CONCLUSIONS: Our data suggest that hydrogen peroxide-enhanced ultrasound can be
very reliable and useful in the definition of fistula anatomy, its relationship
with anal sphincters, and, hence, surgical strategy. It also improves
identification of secondary extensions, particularly horseshoe tracks. This
method, besides being safe, economic and reputable, both preoperatively and
postoperatively, could be helpful in checking operative results and recurrence.
Lingua originale | English |
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pagine (da-a) | 1375-1382 |
Numero di pagine | 8 |
Rivista | DISEASES OF THE COLON & RECTUM |
DOI | |
Stato di pubblicazione | Pubblicato - 2000 |
Keywords
- Endoanal ultrasoundanal fistula
- anal abscess