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Impact of three‐dimensional endoanal ultrasound on the outcome of anal fistula surgery: a prospective cohort study
Author(s) -
Ding J.H.,
Bi L.X.,
Zhao K.,
Feng Y.Y.,
Zhu J.,
Zhang B.,
Yin S.H.,
Zhao Y.J.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13108
Subject(s) - medicine , endoanal ultrasound , prospective cohort study , fistula , surgery , anal fistula , cohort , physical examination , anorectal manometry , anal canal , rectum , defecation
Aim The aim of the study was to evaluate the impact of three‐dimensional endoanal ultrasound (3D‐ EAUS ) on postoperative outcome in patients with anal fistula. Method This prospective study compared clinical and functional outcomes of patients with and without preoperative 3D‐ EAUS examination 1 year after anal fistula surgery. Patients were prospectively followed and evaluated by a standardized protocol including physical examination, the Wexner Incontinence Score ( WIS ) and anorectal manometry, at baseline and 1 year after surgery. Results A total of 196 patients were enrolled. There were no significant differences in demographic and operative parameters, except for operation time, between the two groups. At 1 year follow‐up, the overall recurrence rates were 8.8% (9/102) in the 3D‐ EAUS group and 13.8% (13/94) in the examination under anaesthesia ( EUA ) group. In the subgroup of patients with complex fistulae, the recurrence rate was numerically lower in the 3D‐ EAUS group (12.8% vs 22.5%; P = 0.26). The WIS in the EUA group significantly worsened (0.35 ± 0.94 vs 1.07 ± 1.59; P = 0.003) with a decreased the number of fully continent patients (82.5% vs 55%; P = 0.008) while neither the WIS nor the proportion of fully continent patients changed in the 3D‐ EAUS group. Fewer patients in the 3D‐ EAUS group developed incontinence postoperatively (6.7% vs 33.3%; P = 0.012) and they had better maximum resting pressure and maximum squeeze pressure than the EUA group. Conclusions Preoperative use of 3D‐ EAUS had a favourable impact on the outcome of surgical treatment for anal fistulae, especially in those with complex anal fistula. It should be routinely used in the clinical setting.