Published online Sep 7, 2021. doi: 10.3748/wjg.v27.i33.5460
Peer-review started: May 8, 2021
First decision: June 12, 2021
Revised: June 12, 2021
Accepted: August 5, 2021
Article in press: August 5, 2021
Published online: September 7, 2021
Processing time: 117 Days and 16.6 Hours
Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of anal fistulas. There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery. However, the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken. Incidentally, there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period. In this article, we discuss the challenges faced while interpreting the postoperative MRI, the timing of the postoperative MRI, the utility of MRI in the postoperative period for the management of anal fistulas, the importance of the active involvement and experience of the treating clinician in interpreting MRI scans, and the latest advancements in the field.
Core Tip: Magnetic resonance imaging (MRI) plays a pivotal role in the preoperative management of anal fistulas, but there are little data on postoperative MRI. There are no existing guidelines available to the operating surgeon and the radiologist regarding the challenges faced, utility, timing, and other aspects of MRI interpretation of anal fistulas in the postoperative period. This is the first paper on this theme and presents the first guidelines to be formulated for postoperative MRI in anal fistula management. These guidelines are based on an extensive experience of interpreting 2404 MRI scans in 1719 patients, including 685 postoperative MRIs in 411 patients.