Use of diagnostic modalities in the treatment of perianal fistula: A retrospective cohort study of 307 patients

Aim: Deciding on the type of fistula and deciding on the most appropriate type of surgery is still a challenge for anal fistula disease. In this study, we aimed to evaluate whether magnetic resonance imaging (MRI), endoscopic examination and co-administration of both in preoperative preparations of anal fistulas are beneficial in this respect. Methods: The study was retrospectively performed in patients treated surgically for perianal fistula between 2008 and 2017. The data of 307 patients operated for anal fistulas were reviewed with hospital records. Patients were grouped under the headings of preoperative MRI and non-MRI, endoscopic and non-endoscopic examination, and both performed and non-performed. The demographic data (age, sex), fistula type (simple or complicated), presence or absence of seton and the type of surgery were recorded. These parameters were compared with the groups. Results: In the preoperative evaluation, 162 (53%) patients had MRI, 83 (27%) patients had endoscopic examination and 60 (20%) patients had both. There was a statistically significant correlation between the presence of preoperative MRI and the need for seton placement (p <0.05 for all). Preoperative MRI, preoperative endoscopy and preoperative both modalities groups didn’t show statistically significant correlation with patient’s demographic data, fistula type and surgical method (p> 0.05 for all). Conclusion: Preoperative modalities such as MRI and endoscopy are not sufficient in determining the type of fistula in an anal fistula and determining the surgical method to be applied. We believe that combining these studies with perioperative examination may be helpful in obtaining more effective results. Also, performing MRI preoperatively may help surgeons for decision of seton placement