Effect of MRI on clinical outcome of recurrent fistula-in-ano

• Published in: The Lancet (British edition) Vol. 360; no. 9346; pp. 1661 - 1662
• Main Authors: Buchanan, Gordon, Halligan, Steve, Williams, Andrew, Cohen, C Richard G, Tarroni, Danilo, Phillips, Robin KS, Bartram, Clive I
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 23.11.2002; Lancet; Elsevier Limited
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Classification; Clinical outcomes; Digestive system; Female; Fistula; Fistulae; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Male; Medical disorders; Medical imaging; Medical sciences; Middle Aged; Patients; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Rectal Fistula - classification; Rectal Fistula - prevention & control; Rectal Fistula - surgery; Reoperation; Secondary Prevention; Sepsis; Surgeons; Surgery; Treatment Outcome; Human; Recurrence; Radiodiagnosis; Fistula; Nuclear magnetic resonance imaging; Incidence; Association; Treatment; Anus; Surgery; Digestive diseases; Medical imagery; Technique; Anorectal disease
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(02)11605-9

Recurrent fistula-in-ano is usually due to sepsis missed at surgery, which can be identified by MRI. We aimed to establish the therapeutic effect of MRI in patients with fistula-in-ano. We did MRI in 71 patients with recurrent fistula, with further surgery done at the discretion of the surgeon. Surgery and MRI agreed in 40 patients, five (13%) of whom had further recurrence, compared with 16 (52%) of 31 in whom surgery and MRI disagreed (p=0·0005). Further recurrence in all 16 was at the site predicted by MRI. For surgeons who always acted on MRI, further recurrences arose in four of 25 (16%) operations versus eight of 14 (57%) operations for those who ignored imaging (p=0·008). Surgery guided by MRI reduces further recurrence of fistula-in-ano by 75% and should be done in all patients with recurrent fistula.