Annals of Coloproctology

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Benign proctology

Puborectalis Muscle Involvement on Magnetic Resonance Imaging in Complex Fistula: A New Perspective on Diagnosis and Treatment: Hong Yoon Jeong, Seok Gyu Song, Woo Jung Nam, Jong Kyun Lee; Ann Coloproctol. 2021;37(1):51-57. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.26.1

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Purpose
According to recent studies, magnetic resonance imaging (MRI) assessment of complex fistulas provides a significant benefit compared to fistulography, computed tomography, and ultrasonography. The aim of this study was to describe the accuracy of MRI and the importance of identifying puborectalis muscle involvement on MRI in patients with complex fistula.
Methods
All patients who were clinically diagnosed with ‘complex’ or showed multiple fistula tracts underwent fistula MRI. Eligible patients were consecutive patients who underwent fistula MRI between September 2018 and September 2019 at our hospital.
Results
A total of 83 patients (74 males, 9 females; 116 tracts) were included in this study. The sensitivity and specificity of MRI in diagnosing fistula tracts were 94.8% and 98.2%, respectively. The sensitivity and specificity in identifying internal opening were 93.9% and 97.3%, respectively. Of the 35 patients with puborectalis muscle involvement in the MRI, 31 images of suprasphincteric-type patients on the Park’s classification were classified. The patients of puborectalis involvement were divided into 2 groups according to the surgical procedure that was performed. There were 12 sphincter-saving procedures and 19 sphincter division procedures performed. Recurrence was seen in 2 patients in the sphincter-saving procedure group, while no case was seen in the sphincter division procedure group. Five complications were found in the sphincter division procedure group, of which 2 reported incontinence.
Conclusion
Fistula MRI is a highly accurate examination for evaluating complex fistulas, and the puborectalis muscle involvement findings are very important for diagnosis and treatment.

Citations

Citations to this article as recorded by

Levator ani involvement in perianal fistulas: MRI-based insights into complex anatomy
Sezer Nil Yılmazer Zorlu, Diğdem Kuru Öz, Ayşe Erden
Abdominal Radiology.2025;[Epub] CrossRef
Efficacy and safety of transanal opening of intersphincteric space in the treatment of high complex anal fistula: A meta‑analysis
Chunqiang Wang, Tianye Huang, Xuebing Wang
Experimental and Therapeutic Medicine.2024;[Epub] CrossRef
Comparison of loose combined cutting seton and traditional cutting seton for high anal fistula: a meta-analysis
Yi SUN, Chunqiang WANG, Tianye HUANG, Xuebing WANG
Gazzetta Medica Italiana Archivio per le Scienze Mediche.2023;[Epub] CrossRef
Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas
Pankaj Garg, Vipul D Yagnik, Sushil Dawka, Baljit Kaur, Geetha R Menon
World Journal of Gastroenterology.2022; 28(16): 1608. CrossRef
What Does Puborectalis Muscle Involvement on Magnetic Resonance Imaging Indicate in Patients With Complex Anal Fistula?
Sung Uk Bae
Annals of Coloproctology.2021; 37(1): 3. CrossRef
Anal fistula at roof of ischiorectal fossa inside levator-ani muscle (RIFIL): a new highly complex anal fistula diagnosed on MRI
Pankaj Garg, Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon
Abdominal Radiology.2021; 46(12): 5550. CrossRef

The Ligation of Intersphincteric Fistula Tract Technique: A Preliminary Experience: Pasquale Cianci, Nicola Tartaglia, Alberto Fersini, Libero Luca Giambavicchio, Vincenzo Neri, Antonio Ambrosi; Ann Coloproctol. 2019;35(5):238-241. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2018.08.16.1

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151 Download
8 Web of Science
11 Citations

Abstract PDF

Purpose
Surgery is the only treatment for anal fistula. Many surgical techniques have been described. The aim of this study was to communicate the authors’ preliminary experience in the use of a recently proposed, simplified technique.
Methods
This was a prospective study of 28 patients admitted from January 13, 2016 through July 20, 2017. Patients were managed with the ligation of intersphincteric fistula tract (LIFT) technique and results were observed and documented, including recurrence rate, incontinence rate, and other postoperative complications.
Results
A total of 28 patients were studied. The mean operation time was 31 minutes (range, 23–44 minutes), and there were no intra- and postoperative complications. The overall complete healing rate was 85.7%, and the recurrence rate was 14.2%. Follow-up was conducted at 1, 3, and 6 months.
Conclusion
Many surgical techniques have been described for the treatment of anal fistula. The correct choice of surgical technique out of available procedures is the most important factor for proper treatment and reducing the risk of recurrence or incontinence. In the authors’ experience, the LIFT technique is simple and easy to learn, and is a good choice for the treatment of simple anal fistula; however, a tailored surgery remains the gold standard for this condition.

Citations

Citations to this article as recorded by

Ligation of intersphincteric fistula tract for complex fistula in ano at a tertiary care centre in Northern India: A 3-year prospective study
Musharraf Husain, Mir Mujtaba Ahmad, Tajamul Rashid, Ajay Kumar Thakral
Journal of Clinical Sciences.2025; 22(1): 27. CrossRef
Is the ligation of the intersphincteric fistula tract (LIFT) procedure truly a sphincter preserving procedure for anal fistula? A scoping review of the literature
Ian Jse-Wei Tan, Bei En Siew, Jerrald Lau, Carol Pei Ling Yap, Stephanie Marie May Ee Soon, Ker-Kan Tan
European Journal of Medical Research.2025;[Epub] CrossRef
Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula
Yang-Tao Chen, Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang
Surgery Open Science.2025; 27: 15. CrossRef
Transanal opening of intersphincteric space (TROPIS) treatment for high complex anal fistula: a systematic review and meta-analysis
Pengfei Zhou, Jingen Lu, Yanting Sun, Jiawen Wang
International Journal of Surgery.2025; 111(10): 7301. CrossRef
Evaluation of the outcomes of fistulotomy with primary sphincter reconstruction in the management of high trans-sphincteric fistula and supra-sphincteric fistula-in-ano
Basma Hussein Abdelaziz Hassan, Philobater Bahgat Adly Awad, Mostafa Mohamed Abdelaziz, Mohammed Hossam, Mohamed Ali Mohamed Nada
Die Chirurgie.2024; 95(S1): 6. CrossRef
Avoiding Recurrence of Anorectal Abscess: The Impact of Patient Delay in Seeking Medical Attention
Sonu Nimesh Patel, Ria Elizabeth Philip, Dillon Downs, Arthur Alan Topilow, Ramisa Anjum, Glenn Scot Parker
Journal of Coloproctology.2024; 44(04): e253. CrossRef
Ligation of Intersphincteric Fistula Tract (LIFT) for the Treatment of Anal Fistula: A Prospective Observational Study
L.A. Hidalgo-Grau, N. Ruiz-Edo, O. Estrada-Ferrer, E.M. García-Torralbo, M. del Bas-Rubia, P. Clos-Ferrero, E. Bombuy-Giménez
Journal of Coloproctology.2023; 43(01): 024. CrossRef
Surgical treatment of anal fistula
A. Ya. Ilkanich, V. V. Darwin, E. A. Krasnov, F. Sh. Aliyev, K. Z. Zubailov
Сибирский научный медицинский журнал.2023; 43(5): 74. CrossRef
Advancing standard techniques for treatment of perianal fistula; when tissue engineering meets seton
Hojjatollah Nazari, Zahra Ebrahim Soltani, Reza Akbari Asbagh, Amirsina Sharifi, Abolfazl Badripour, Asieh Heirani Tabasi, Majid Ebrahimi Warkiani, Mohammad Reza Keramati, Behnam Behboodi, Mohammad Sadegh Fazeli, Amir Keshvari, Mojgan Rahimi, Seyed Mohsen
Health Sciences Review.2022; 3: 100026. CrossRef
Efficacy and safety of ligation of intersphincteric fistula tract in the treatment of anal fistula
Jiaji Zhang, Xilu Hao, Yican Zhu, Ronggang Luan
Medicine.2021; 100(4): e23700. CrossRef
Efficacy and safety of an innovatively modified cutting seton technique for the treatment of high anal fistula
Jie Jiang, Yang Zhang, Xufeng Ding, Naijin Zhang, Lijiang Ji
Medicine.2021; 100(5): e24442. CrossRef

A Retrospective Analysis and Clinical Review of Fistula-in-Ano.: Lee, Yong Jik , Lee, Mi Ok , Kim, Sung Su , Lee, Young Taek , Park, Yong Ki , Choi, Chang Rock; J Korean Soc Coloproctol. 1999;15(4):321-330.

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Abstract PDF: PURPOSE
The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years.
METHODS
A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately.
RESULTS
The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%).
CONCLUSIONS
The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.

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