Role of MRI Fistulogram in Preoperative assessment of Fistula-in-ano and its Clinical correlation: An Observational study

Abstract

Background: Fistula-in-ano, characterized by an abnormal connection between the anal canal and the surrounding skin, poses significant clinical challenges due to its high risk of recurrence and complications. Effective surgical intervention requires precise preoperative assessment to eradicate the fistula while preserving anal sphincter function. Conventional diagnostic methods often fail to provide the necessary anatomical detail, particularly in complex cases with multiple tracts or abscesses. Objective: To evaluate the effectiveness of MR fistulography in the preoperative assessment of anorectal fistulas, focusing on grading and clinical correlation. Methods: A prospective observational study was conducted in the Department of General Surgery at Aarupadai Veedu Medical College and Hospital, Puducherry, involving 60 patients aged 18–60 years (mean age: 39; SD: 8.3) with various forms of fistula-in-ano. Patients with contraindications to MRI were excluded. Each participant underwent an MR fistulogram using a 1.5-Tesla MRI system, employing various sequences to obtain detailed images of the fistulous tracts and their relationship to the anal sphincter complex. Data were analyzed using SPSS v23.0, with statistical significance set at p < 0.05. Results: The study included 60 patients with an average age of 39 ± 8.3 years, with the majority (73.3%) from rural areas. Clinical symptoms included pain (23.3%), discharge (90%), itching (25%), and fever (8.3%). Common comorbidities were diabetes mellitus (26.7%) and hypertension (8.3%). Most fistulas were classified as low anal (88.3%) with single external openings (86.7%). MRI predominantly categorized fistulas as grade 1 (60%), which significantly influenced surgical planning. Fistulectomy was the primary procedure performed (86.7%). Conclusion: MR fistulography proves to be highly effective in the preoperative evaluation of fistula-in-ano, showing a strong correlation with clinical findings and improving surgical management. Its ability to provide detailed imaging enhances diagnostic accuracy, optimizes surgical planning, and improves patient outcomes, establishing it as an essential tool for managing complex anorectal fistulas.