Curative effect of preoperative three-dimensional anorectal endosonography in anal fistula surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WANG Yonggang , SUN Yuan

Department of Colorectal and Anal Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning 122000, P. R. China;

Corresponding?author：

WANG Yonggang, Email: 694511469@qq.com

Keywords：

three-dimensional anorectal endosonography; anal fistula; anus function; anorectal manometry

DOI：

10.7507/1007-9424.202004069

Video：

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Objective To investigate effect of preoperative three-dimensional anorectal endosonography (3D-AREUS) in anal fistula surgery.Methods A total of 100 patients with anal fistula who were admitted to the Chaoyang Central Hospital from December 2017 to December 2018 were included prospectively, then were randomly divided into ultrasound group and control group with 50 cases in each group. The preoperative examination was performed by 3D-AREUS in the ultrasound group, and preoperative routine examination, finger examination or probe exploration were performed in the control group. The postoperative recurrence and anal functions were compared between the two groups.Results There were no statistically significant differences in the gender, age, body mass index, anal surgery history, preoperative anal function, etc. between the two groups (P>0.05). The detection rate of branch fistulas in the ultrasound group was significantly higher than that in the control group (P=0.025). For the patients with complex anal fistula, compared with the control group, the location accuracy rate of internal opening was higher (P=0.014), the change value of preoperative and postoperative fecal incontinence score was lower (P=0.039), anorectal pressure status (resting pressure of anal canal, anal systolic pressure, and length of anal high pressure zone) were lower (P<0.05) in the ultrasound group; For the patients with simple anal fistula, which had no significant differences between the ultrasound group and control group (P>0.05). There were 4 cases of recurrence in each group.Conclusions For complex anal fistula, preoperative 3D-AREUS could clarify position of internal opening, presence of branching fistula, and the relationship between fistula and sphincter, so as to make accurate surgical plans, reduce secondary injuries, and retain postoperative anal function of patients.

Citation： WANG Yonggang, SUN Yuan. Curative effect of preoperative three-dimensional anorectal endosonography in anal fistula surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 85-88. doi: 10.7507/1007-9424.202004069 Copy

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2.	Wang Q, He Y, Shen J. The best surgical strategy for anal fistula based on a network meta-analysis. Oncotarget, 2017, 8(58): 99075-99084.
3.	劉斌, 張勇, 曾憲東. 肛門病變術后肛門失禁相關因素分析. 中華胃腸外科雜志, 2011, 14(6): 452-454.
4.	Steele SR, Kumar R, Feingold DL, et al. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum, 2011, 54(12): 1465-1474.
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6.	Sahnan K, Askari A, Adegbola SO, et al. Natural history of anorectal sepsis. Br J Surg, 2017, 104(13): 1857-1865.
7.	Youssef AT. The value of superficial parts and endoanal ultrasonography in evaluating pilonidal disease and exclusion of perianal sepsis. J Ultrasound, 2015, 18(3): 237-243.
8.	Brillantino A, Iacobellis F, Di Sarno G, et al. Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis. Int J Colorectal Dis, 2015, 30(4): 535-542.
9.	Plaikner M, Loizides A, Peer S, et al. Transperineal ultrasonography as a complementary diagnostic tool in identifying acute perianal sepsis. Tech Coloproctol, 2014, 18(2): 165-171.
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11.	李玲華, 高爽, 李炯弘. 三維直腸腔內超聲診斷肛管直腸周圍膿腫的應用價值. 中國超聲醫學雜志, 2016, 32(5): 461-463.
12.	丁克. 三維肛管直腸腔內超聲在肛瘺診治中的應用. 第十三屆全國中西醫結合大腸肛門病學術會議暨第三屆國際結直腸外科論壇論文匯編. 中國中西醫結合學會: 中國中西醫結合學會, 2009: 176.
13.	劉貞吉, 張士榮, 馬媛媛. 三維肛管直腸腔內超聲在肛管直腸周圍膿腫診治中的應用. 中國肛腸病雜志, 2018, 38(10): 32-35.
14.	Cherry DA, Rothenberger DA. Pelvic floor physiology. Surg Clin North Am, 1988, 68(6): 1217-1230.
15.	Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG. Investigation of anorectal function. Br J Surg, 1988, 75(1): 53-55.
16.	Lux N, Athanasiadis S. Functional results following fistulectomy with primary muscle suture in high anal fistula. A prospective clinical and manometric study. Chirurg, 1991, 62(1): 36-41.
17.	Cavanaugh M, Hyman N, Osler T. Fecal incontinence severity index after fistulotomy: a predictor of quality of life. Dis Colon Rectum, 2002, 45(3): 349-353.
18.	Roig JV, Jordán J, García-Armengol J, et al. Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery. Dis Colon Rectum, 2009, 52(8): 1462-1469.
19.	羅敏, 李峨, 李國棟, 等. 肛管直腸壓力測定在肛門功能評估中的價值及臨床應用. 現代中西醫結合雜志, 2012, 21(18): 1946-1947.

1. 汪建平. 中華結直腸肛門外科學. 北京: 人民衛生出版社, 2014: 780-781.
2. Wang Q, He Y, Shen J. The best surgical strategy for anal fistula based on a network meta-analysis. Oncotarget, 2017, 8(58): 99075-99084.
3. 劉斌, 張勇, 曾憲東. 肛門病變術后肛門失禁相關因素分析. 中華胃腸外科雜志, 2011, 14(6): 452-454.
4. Steele SR, Kumar R, Feingold DL, et al. Practice parameters for the management of perianal abscess and fistula-in-ano. Dis Colon Rectum, 2011, 54(12): 1465-1474.
5. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1): 77-97.
6. Sahnan K, Askari A, Adegbola SO, et al. Natural history of anorectal sepsis. Br J Surg, 2017, 104(13): 1857-1865.
7. Youssef AT. The value of superficial parts and endoanal ultrasonography in evaluating pilonidal disease and exclusion of perianal sepsis. J Ultrasound, 2015, 18(3): 237-243.
8. Brillantino A, Iacobellis F, Di Sarno G, et al. Role of tridimensional endoanal ultrasound (3D-EAUS) in the preoperative assessment of perianal sepsis. Int J Colorectal Dis, 2015, 30(4): 535-542.
9. Plaikner M, Loizides A, Peer S, et al. Transperineal ultrasonography as a complementary diagnostic tool in identifying acute perianal sepsis. Tech Coloproctol, 2014, 18(2): 165-171.
10. Thomson JP, Parks AG. Anal abscesses and fistulas. Br J Hosp Med, 1979, 21(4): 413-414.
11. 李玲華, 高爽, 李炯弘. 三維直腸腔內超聲診斷肛管直腸周圍膿腫的應用價值. 中國超聲醫學雜志, 2016, 32(5): 461-463.
12. 丁克. 三維肛管直腸腔內超聲在肛瘺診治中的應用. 第十三屆全國中西醫結合大腸肛門病學術會議暨第三屆國際結直腸外科論壇論文匯編. 中國中西醫結合學會: 中國中西醫結合學會, 2009: 176.
13. 劉貞吉, 張士榮, 馬媛媛. 三維肛管直腸腔內超聲在肛管直腸周圍膿腫診治中的應用. 中國肛腸病雜志, 2018, 38(10): 32-35.
14. Cherry DA, Rothenberger DA. Pelvic floor physiology. Surg Clin North Am, 1988, 68(6): 1217-1230.
15. Felt-Bersma RJ, Klinkenberg-Knol EC, Meuwissen SG. Investigation of anorectal function. Br J Surg, 1988, 75(1): 53-55.
16. Lux N, Athanasiadis S. Functional results following fistulectomy with primary muscle suture in high anal fistula. A prospective clinical and manometric study. Chirurg, 1991, 62(1): 36-41.
17. Cavanaugh M, Hyman N, Osler T. Fecal incontinence severity index after fistulotomy: a predictor of quality of life. Dis Colon Rectum, 2002, 45(3): 349-353.
18. Roig JV, Jordán J, García-Armengol J, et al. Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery. Dis Colon Rectum, 2009, 52(8): 1462-1469.
19. 羅敏, 李峨, 李國棟, 等. 肛管直腸壓力測定在肛門功能評估中的價值及臨床應用. 現代中西醫結合雜志, 2012, 21(18): 1946-1947.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Curative effect of preoperative three-dimensional anorectal endosonography in anal fistula surgery

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