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Utility of Endoanal Ultrasonography in Assessment of Primary and Recurrent Anal Fistulas and for Detection of Associated Anal Sphincter Defects

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Tridimensional endoanal ultrasonography (3D-EAUS) has been used for the assessment of various anorectal lesions. Previous studies have reported good accuracy of 3D-EAUS in preoperative assessment of fistula-in-ano (FIA). This study aimed to assess the diagnostic utility of 3D-EAUS in preoperative evaluation of primary and recurrent FIA and its role in detection of associated anal sphincter (AS) defects.

Patients and Methods

Prospectively collected data of patients with FIA who were investigated with 3D-EAUS were reviewed. The findings of EAUS were compared with the intraoperative findings, the reference standard, to find the degree of agreement regarding the position of the internal opening (IO) and primary tract (PT), and presence of secondary tracts using kappa (k) coefficient test. A subgroup analysis was performed to compare the accuracy and sensitivity of EAUS for primary and recurrent FIA.

Results

Of the patients, 131 were included to the study. EAUS had an overall accuracy of 87, 88.5, and 89.5% in detection of IO, PT, and AS defects, respectively. There was very good concordance between the findings of EAUS and intraoperative findings for the investigated parameters (kappa = 0.748, 0.83, 0.935), respectively. Accuracy and sensitivity of EAUS in recurrent FIA were insignificantly lower than primary cases. EAUS detected occult AS defects in 5.3% of the patients studied.

Conclusion

The diagnostic utility of 3D-EAUS was comparable in primary and recurrent FIA. 3D-EAUS was able to detect symptomatic and occult AS defects with higher accuracy than clinical examination.

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Authors and Affiliations

  1. General Surgery Department, Mansoura Faculty of Medicine, Mansoura City, Egypt

    Sameh Hany Emile, Alaa Magdy, Mohamed Youssef, Waleed Thabet, Mahmoud Abdelnaby, Waleed Omar & Wael Khafagy

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  1. Sameh Hany Emile
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  2. Alaa Magdy
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  3. Mohamed Youssef
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  4. Waleed Thabet
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  5. Mahmoud Abdelnaby
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  6. Waleed Omar
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  7. Wael Khafagy
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Contributions

Sameh Emile designed, performed EAUS, wrote, and critically revised the manuscript. Mohamed Youssef and Waleed Thabet shared in putting the study concept, collected the data, and drafted the manuscript. Alaa Magdy and Mahmoud Abdelnaby shared in the data analysis and interpretation, writing, and critical revision of the manuscript. Waleed Omar and Wael Khafagy revised and interpreted the results, drafted, and critically revised the manuscript.

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Correspondence to Sameh Hany Emile.

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Emile, S.H., Magdy, A., Youssef, M. et al. Utility of Endoanal Ultrasonography in Assessment of Primary and Recurrent Anal Fistulas and for Detection of Associated Anal Sphincter Defects. J Gastrointest Surg 21, 1879–1887 (2017). https://doi.org/10.1007/s11605-017-3574-z

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  • DOI: https://doi.org/10.1007/s11605-017-3574-z

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