Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery

ObjectiveEndoanal ultrasound (EAUS) is a recommended preoperative investigation for fistula-in-ano (FiA) which aims to provide the best chance of healing and preservation of continence function. This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors assoc...

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Published in:BMJ open gastroenterology 2019-01, Vol.6 (1), p.e000279-e000279
Main Authors: Tantiphlachiva, Kasaya, Sahakitrungruang, Chucheep, Pattanaarun, Jirawat, Rojanasakul, Arun
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Language:English
Subjects:
Accuracy
anal incontinence
Anorectal Disease
anorectal disorders
anorectal function
anorectal ultrasound
Clinical outcomes
Colon
Fecal incontinence
Fistula
Hydrogen peroxide
NMR
Nuclear magnetic resonance
Surgeons
Surgery
Tuberculosis
Ultrasonic imaging
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cited_by cdi_FETCH-LOGICAL-b578t-c7163d49423560dbbffb4cfaba855e1373a6906599ff4114e1b38f12dddb41b73
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Sahakitrungruang, Chucheep
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Rojanasakul, Arun
description ObjectiveEndoanal ultrasound (EAUS) is a recommended preoperative investigation for fistula-in-ano (FiA) which aims to provide the best chance of healing and preservation of continence function. This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors associated with clinical outcomes after FiA surgery.DesignRetrospective analysis of subjects with cryptogenic FiA between January 2011 and December 2016, in a tertiary hospital, was performed by comparing EAUS and no-EAUS groups. Postoperative change in St. Mark’s faecal incontinence severity score (cFISS=FISS at 6 months after surgery–FISS before surgery) were compared. General linear model was used to determine factors associated with cFISS. Binary logistic regression was used to assess factors related to clinical outcomes. A p-value of
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This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors associated with clinical outcomes after FiA surgery.DesignRetrospective analysis of subjects with cryptogenic FiA between January 2011 and December 2016, in a tertiary hospital, was performed by comparing EAUS and no-EAUS groups. Postoperative change in St. Mark’s faecal incontinence severity score (cFISS=FISS at 6 months after surgery–FISS before surgery) were compared. General linear model was used to determine factors associated with cFISS. Binary logistic regression was used to assess factors related to clinical outcomes. A p-value of &lt;0.05 is considered significant.Results We enrolled 339 subjects; 109 (M:F 91:18, mean age 41.7±13.6 years) of 115 in EAUS group and 230 in no-EAUS group (M:F 195:35, mean age 42.6±13.0 years). There were higher proportions of recurrent cases (24.8% vs 13.9%, p=0.014) and complex FiA (80.7% vs 50.4%, p=0.001) in EAUS group. Postoperative FISS (mean±SE) were increased in both groups; preoperative versus postoperative FISS were 0.36±0.20 versus 0.59±0.25 in EAUS group (p=0.056) and 0.31±0.12 versus 0.76±0.17 in no-EAUS group (p&lt;0.001). EAUS had significant effects on cFISS in both univariate analysis, F(1,261)=4.053, p=0.045; and multivariate analysis, F(3,322)=3.147, p=0.025, Wilk’s Lambda 0.972. Other associated factors included recurrent fistula (F(3,322)=0.777, p=0.007, Wilk’s Lambda 0.993) and fistula classification (F(3,322)=16.978, p&lt;0.001, Wilk’s Lambda 0.863). After a mean follow-up of 33.6±28.6 weeks, success rate was 63.3%(EAUS) and 60% (no-EAUS), p=0.822. Factors associated with clinical outcomes were fistula complexity, number of tracts, recurrence, number of previous surgery and type of operations. Accuracy of EAUS was 90.8% and not related to clinical outcomes (p=0.522).ConclusionEAUS had favourable effects on functional outcome after FiA surgery while multiple factors were associated with clinical outcomes. EAUS is useful, accurate, inexpensive and can be the first tool for planning of complex and recurrent FiA.</description><identifier>ISSN: 2054-4774</identifier><identifier>EISSN: 2054-4774</identifier><identifier>DOI: 10.1136/bmjgast-2019-000279</identifier><identifier>PMID: 31139426</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd</publisher><subject>Accuracy ; anal incontinence ; Anorectal Disease ; anorectal disorders ; anorectal function ; anorectal ultrasound ; Clinical outcomes ; Colon ; Fecal incontinence ; Fistula ; Hydrogen peroxide ; NMR ; Nuclear magnetic resonance ; Surgeons ; Surgery ; Tuberculosis ; Ultrasonic imaging</subject><ispartof>BMJ open gastroenterology, 2019-01, Vol.6 (1), p.e000279-e000279</ispartof><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b578t-c7163d49423560dbbffb4cfaba855e1373a6906599ff4114e1b38f12dddb41b73</citedby><cites>FETCH-LOGICAL-b578t-c7163d49423560dbbffb4cfaba855e1373a6906599ff4114e1b38f12dddb41b73</cites><orcidid>0000-0002-2991-5920</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopengastro.bmj.com/content/6/1/e000279.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopengastro.bmj.com/content/6/1/e000279.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27526,27527,27901,27902,53766,53768,55325,77570,77601,77629,77655</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31139426$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tantiphlachiva, Kasaya</creatorcontrib><creatorcontrib>Sahakitrungruang, Chucheep</creatorcontrib><creatorcontrib>Pattanaarun, Jirawat</creatorcontrib><creatorcontrib>Rojanasakul, Arun</creatorcontrib><title>Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery</title><title>BMJ open gastroenterology</title><addtitle>BMJ Open Gastro</addtitle><addtitle>BMJ Open Gastroenterol</addtitle><addtitle>BMJ Open Gastroenterol</addtitle><description>ObjectiveEndoanal ultrasound (EAUS) is a recommended preoperative investigation for fistula-in-ano (FiA) which aims to provide the best chance of healing and preservation of continence function. This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors associated with clinical outcomes after FiA surgery.DesignRetrospective analysis of subjects with cryptogenic FiA between January 2011 and December 2016, in a tertiary hospital, was performed by comparing EAUS and no-EAUS groups. Postoperative change in St. Mark’s faecal incontinence severity score (cFISS=FISS at 6 months after surgery–FISS before surgery) were compared. General linear model was used to determine factors associated with cFISS. Binary logistic regression was used to assess factors related to clinical outcomes. A p-value of &lt;0.05 is considered significant.Results We enrolled 339 subjects; 109 (M:F 91:18, mean age 41.7±13.6 years) of 115 in EAUS group and 230 in no-EAUS group (M:F 195:35, mean age 42.6±13.0 years). There were higher proportions of recurrent cases (24.8% vs 13.9%, p=0.014) and complex FiA (80.7% vs 50.4%, p=0.001) in EAUS group. Postoperative FISS (mean±SE) were increased in both groups; preoperative versus postoperative FISS were 0.36±0.20 versus 0.59±0.25 in EAUS group (p=0.056) and 0.31±0.12 versus 0.76±0.17 in no-EAUS group (p&lt;0.001). EAUS had significant effects on cFISS in both univariate analysis, F(1,261)=4.053, p=0.045; and multivariate analysis, F(3,322)=3.147, p=0.025, Wilk’s Lambda 0.972. Other associated factors included recurrent fistula (F(3,322)=0.777, p=0.007, Wilk’s Lambda 0.993) and fistula classification (F(3,322)=16.978, p&lt;0.001, Wilk’s Lambda 0.863). After a mean follow-up of 33.6±28.6 weeks, success rate was 63.3%(EAUS) and 60% (no-EAUS), p=0.822. Factors associated with clinical outcomes were fistula complexity, number of tracts, recurrence, number of previous surgery and type of operations. Accuracy of EAUS was 90.8% and not related to clinical outcomes (p=0.522).ConclusionEAUS had favourable effects on functional outcome after FiA surgery while multiple factors were associated with clinical outcomes. EAUS is useful, accurate, inexpensive and can be the first tool for planning of complex and recurrent FiA.</description><subject>Accuracy</subject><subject>anal incontinence</subject><subject>Anorectal Disease</subject><subject>anorectal disorders</subject><subject>anorectal function</subject><subject>anorectal ultrasound</subject><subject>Clinical outcomes</subject><subject>Colon</subject><subject>Fecal incontinence</subject><subject>Fistula</subject><subject>Hydrogen peroxide</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tuberculosis</subject><subject>Ultrasonic imaging</subject><issn>2054-4774</issn><issn>2054-4774</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>DOA</sourceid><recordid>eNqNkktrFEEUhRtRTBjzCwRpcOOmk3pX90aQEDUQyEZ3QlGPW2MP3V1jPQL599ZkxjFxIVlVUfecj3Nv3aZ5i9E5xlRcmHmz1il3BOGhQwgRObxoTgnirGNSspeP7ifNWUqbqsGcMkL6180JrYyBEXHa_LjyHmxObfDtNkLYQtR5vIMWFhf0oqe2TDnqFMri2rC0viw2j2FXCCXbMEOrfYbYPmj9mHKZdJtKXEO8f9O88npKcHY4V833z1ffLr92N7dfri8_3XSGyz53VmJBHauBKBfIGeO9YdZro3vOAVNJtRiQ4MPgPcOYATa095g45wzDRtJVc73n1sgbtY3jrOO9CnpUDw8hrpWOebQTKBAasGOcyDoZR6jGglvjeyl6L6jnlfVxz9oWM4OzsNT2pyfQp5Vl_KnW4U4JjgQiO8CHAyCGXwVSVvOYLEyTXiCUpAihuOdMIlql7_-RbkKJdZBVVb8IccnqZFYN3atsDClF8McwGKndMqjDMqjdMqj9MlTXu8d9HD1_vr4KzveC6n4m8eKv4Rj0f47fL0bQng</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Tantiphlachiva, Kasaya</creator><creator>Sahakitrungruang, Chucheep</creator><creator>Pattanaarun, Jirawat</creator><creator>Rojanasakul, Arun</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-2991-5920</orcidid></search><sort><creationdate>20190101</creationdate><title>Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery</title><author>Tantiphlachiva, Kasaya ; Sahakitrungruang, Chucheep ; Pattanaarun, Jirawat ; Rojanasakul, Arun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b578t-c7163d49423560dbbffb4cfaba855e1373a6906599ff4114e1b38f12dddb41b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Accuracy</topic><topic>anal incontinence</topic><topic>Anorectal Disease</topic><topic>anorectal disorders</topic><topic>anorectal function</topic><topic>anorectal ultrasound</topic><topic>Clinical outcomes</topic><topic>Colon</topic><topic>Fecal incontinence</topic><topic>Fistula</topic><topic>Hydrogen peroxide</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Tuberculosis</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tantiphlachiva, Kasaya</creatorcontrib><creatorcontrib>Sahakitrungruang, Chucheep</creatorcontrib><creatorcontrib>Pattanaarun, Jirawat</creatorcontrib><creatorcontrib>Rojanasakul, Arun</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; 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Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMJ open gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tantiphlachiva, Kasaya</au><au>Sahakitrungruang, Chucheep</au><au>Pattanaarun, Jirawat</au><au>Rojanasakul, Arun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery</atitle><jtitle>BMJ open gastroenterology</jtitle><stitle>BMJ Open Gastro</stitle><stitle>BMJ Open Gastroenterol</stitle><addtitle>BMJ Open Gastroenterol</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>6</volume><issue>1</issue><spage>e000279</spage><epage>e000279</epage><pages>e000279-e000279</pages><issn>2054-4774</issn><eissn>2054-4774</eissn><abstract>ObjectiveEndoanal ultrasound (EAUS) is a recommended preoperative investigation for fistula-in-ano (FiA) which aims to provide the best chance of healing and preservation of continence function. This study aims are (1) to assess effect of EAUS on functional outcome and (2) to determine factors associated with clinical outcomes after FiA surgery.DesignRetrospective analysis of subjects with cryptogenic FiA between January 2011 and December 2016, in a tertiary hospital, was performed by comparing EAUS and no-EAUS groups. Postoperative change in St. Mark’s faecal incontinence severity score (cFISS=FISS at 6 months after surgery–FISS before surgery) were compared. General linear model was used to determine factors associated with cFISS. Binary logistic regression was used to assess factors related to clinical outcomes. A p-value of &lt;0.05 is considered significant.Results We enrolled 339 subjects; 109 (M:F 91:18, mean age 41.7±13.6 years) of 115 in EAUS group and 230 in no-EAUS group (M:F 195:35, mean age 42.6±13.0 years). There were higher proportions of recurrent cases (24.8% vs 13.9%, p=0.014) and complex FiA (80.7% vs 50.4%, p=0.001) in EAUS group. Postoperative FISS (mean±SE) were increased in both groups; preoperative versus postoperative FISS were 0.36±0.20 versus 0.59±0.25 in EAUS group (p=0.056) and 0.31±0.12 versus 0.76±0.17 in no-EAUS group (p&lt;0.001). EAUS had significant effects on cFISS in both univariate analysis, F(1,261)=4.053, p=0.045; and multivariate analysis, F(3,322)=3.147, p=0.025, Wilk’s Lambda 0.972. Other associated factors included recurrent fistula (F(3,322)=0.777, p=0.007, Wilk’s Lambda 0.993) and fistula classification (F(3,322)=16.978, p&lt;0.001, Wilk’s Lambda 0.863). After a mean follow-up of 33.6±28.6 weeks, success rate was 63.3%(EAUS) and 60% (no-EAUS), p=0.822. Factors associated with clinical outcomes were fistula complexity, number of tracts, recurrence, number of previous surgery and type of operations. Accuracy of EAUS was 90.8% and not related to clinical outcomes (p=0.522).ConclusionEAUS had favourable effects on functional outcome after FiA surgery while multiple factors were associated with clinical outcomes. EAUS is useful, accurate, inexpensive and can be the first tool for planning of complex and recurrent FiA.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd</pub><pmid>31139426</pmid><doi>10.1136/bmjgast-2019-000279</doi><orcidid>https://orcid.org/0000-0002-2991-5920</orcidid><oa>free_for_read</oa></addata></record>
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subjects Accuracy
anal incontinence
Anorectal Disease
anorectal disorders
anorectal function
anorectal ultrasound
Clinical outcomes
Colon
Fecal incontinence
Fistula
Hydrogen peroxide
NMR
Nuclear magnetic resonance
Surgeons
Surgery
Tuberculosis
Ultrasonic imaging
title Effects of preoperative endoanal ultrasound on functional outcome after anal fistula surgery
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