Use of 3D Anorectal Ultrasonography in the Preoperative Assessment of Complex Anal Fistulas and Patterns of Healing, Failure, and Recurrence After Ligation of the Intersphincteric Fistula Tract (LIFT)

• Published in: Journal of ultrasound in medicine Vol. 43; no. 11; pp. 2039 - 2050
• Main Authors: Murad‐Regadas, Sthela M., Regadas, Francisco Sergio P., Regadas Filho, Francisco Sergio P., Nogueira, Felipe R., Holanda, Erico de C., Dias Mont'Alverne, Ricardo E., Cunha, Carlos Magno Queiroz, Ferreira, David G.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.11.2024
• Subjects: abscess; Adult; Aged; Anal Canal - diagnostic imaging; Anal Canal - surgery; anal fistula; anorectal disease; endoanal ultrasonography; Female; Humans; Imaging, Three-Dimensional - methods; Ligation - methods; Male; Middle Aged; Preoperative Care - methods; Rectal Fistula - diagnostic imaging; Rectal Fistula - surgery; Recurrence; Treatment Outcome; Ultrasonography - methods; Wound Healing - physiology; Young Adult; anorectal disease; endoanal ultrasonography; abscess; anal fistula
• ISSN: 0278-4297; 1550-9613; 1550-9613
• DOI: 10.1002/jum.16533

Objectives To use three‐dimensional anorectal ultrasonography (3D‐US) to evaluate the outcome of ligation of the intersphincteric fistula tract (LIFT) in patients with crypto‐glandular transsphincteric fistula and describing the patterns of healing, failure, and recurrence rate. Methods After classifying the fistula and determining the length of the sphincter muscle to be transected, the patients were submitted to LIFT. The accuracy of pre‐ and postoperative 3D‐US with 360° endoprobe (16 MHz) with automatic scanning and clinical findings was evaluated against surgical findings. Three outcomes were considered: healing, failure (persistent anal fistula through the original external opening or intersphincteric), and recurrence (reappearance of the anal fistula). Results Sixty‐three patients of both sexes were evaluated. The 3D‐US assessment revealed primary healing in 50 (79.3%) patients, although in 6 (9.5%) cases healing was delayed and the cavity was without communication with the anal canal. The procedure failed in 9 (15.9%) and fistula recurred in 4 (6.3%), all of whom underwent a second surgery based on a new 3D‐US, resulting in a 92.3% (12/13) healing rate on 3D‐US. Conclusions A 3D‐US was found to be useful in the preoperative assessment of fistulas by quantifying the percentage of muscle to be transected, and in the postoperative assessment by identifying healing, types of failure, and recurrence. The 3D‐US was accurate and consistent with surgical findings.