Our Summary

This research aimed to find out if a particular type of MRI scan, known as diffusion-weighted magnetic resonance imaging (DW-MRI), could predict the outcome of anal fistula surgery and identify factors that might cause the condition to recur post-surgery.

The researchers looked back at the cases of 117 patients who had this particular scan before their anal fistula surgery. However, they were only able to follow-up with 82 of these patients within two years of their operations.

The MRI scans were analyzed, and the severity of each patient’s fistula was given a score. They also measured something called the apparent diffusion coefficient (ADC), which is a value obtained from the MRI scan. Patients were divided into groups, those with anal fistula only and those with anal fistula and an abscess.

Of the 82 patients, 23 had a recurrence of the anal fistula, and 59 were cured. They found that the ADC value was significantly lower in those patients who had a recurrence and also had a perianal abscess.

Among the patients without abscesses, 15 had a recurrence after surgery. However, there was no significant difference in ADC values between those who had a recurrence and those who did not.

The study also found that the ADC value was significantly related to the MRI findings score. Other factors that increased the risk of a recurrence after surgery included the time interval between the MRI and the operation, having multiple fistula tracks, fatigue, eating too much spicy or greasy food, and having diarrhea.

In conclusion, the researchers suggested that this type of MRI scan could be useful in predicting the outcome of anal fistula surgery. They also identified several risk factors that could cause a recurrence after surgery, including the complexity of the anal fistula and an improper lifestyle.

FAQs

  1. How does the diffusion-weighted magnetic resonance imaging (DW-MRI) scan predict the outcome of anal fistula surgery?
  2. What factors were identified as increasing the risk of anal fistula recurrence post-surgery?
  3. What is the apparent diffusion coefficient (ADC), and what role does it play in predicting the recurrence of anal fistula post-surgery?

Doctor’s Tip

One helpful tip a doctor might give a patient about anal fistula surgery is to follow a healthy lifestyle post-surgery to reduce the risk of recurrence. This includes maintaining a high-fiber diet, staying hydrated, avoiding constipation, and avoiding spicy or greasy foods that can aggravate the area. It is also important to follow any post-operative care instructions given by the surgeon to ensure proper healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended for anal fistula surgery are those who have a recurrent or complex anal fistula that is causing symptoms such as pain, discharge, or infection. Additionally, patients with perianal abscesses may also benefit from surgery to treat the underlying fistula. The findings of this study suggest that DW-MRI scans can be a useful tool in predicting the outcome of surgery and identifying factors that may increase the risk of recurrence. Patients with lower ADC values, perianal abscesses, multiple fistula tracks, and certain lifestyle factors may be at higher risk for recurrence and may require closer monitoring post-surgery.

Timeline

Overall, the timeline of a patient’s experience before and after anal fistula surgery can be summarized as follows:

Before surgery:

  • Patient experiences symptoms of an anal fistula, such as pain, swelling, discharge, and discomfort.
  • Patient undergoes various tests, including physical examination, MRI scan, and possibly other imaging tests.
  • MRI scan is performed to assess the severity and complexity of the anal fistula.
  • Patient is evaluated for potential risk factors that could impact the outcome of surgery.

After surgery:

  • Patient undergoes anal fistula surgery to remove the fistula tract and promote healing.
  • Post-surgery, patient may experience pain, swelling, and discomfort in the anal area.
  • Patient is monitored closely for signs of infection or complications.
  • Follow-up appointments are scheduled to assess the healing process and potential recurrence of the anal fistula.
  • MRI scan may be repeated post-surgery to evaluate the outcome and identify any factors that may contribute to a recurrence.

Overall, the timeline of a patient’s experience before and after anal fistula surgery involves a comprehensive evaluation, surgical intervention, and close monitoring to ensure successful healing and prevent recurrence.

What to Ask Your Doctor

Some questions a patient should ask their doctor about anal fistula surgery include:

  1. What type of MRI scan will be used to assess my anal fistula before surgery?
  2. How will the MRI results impact the surgical approach and outcome?
  3. What is the significance of the apparent diffusion coefficient (ADC) value in predicting the success of the surgery?
  4. What factors increase the risk of a recurrence of the anal fistula post-surgery?
  5. How can lifestyle factors such as diet and bowel habits affect the outcome of the surgery?
  6. Will multiple fistula tracks increase the complexity of the surgery and the risk of recurrence?
  7. How long should I wait between the MRI scan and the surgery for optimal results?
  8. What are the potential complications or side effects of anal fistula surgery?
  9. What is the expected recovery time and post-operative care needed?
  10. Are there any alternative treatment options or therapies available for anal fistula management?

Reference

Authors: Liu X, Wang Z, Ren H, Ren A, Wang W, Yang X, Shi S. Journal: Eur J Radiol. 2020 Nov;132:109294. doi: 10.1016/j.ejrad.2020.109294. Epub 2020 Sep 21. PMID: 33038577