Garg P, Kaur B, Yagnik VD, Dawka S, Menon GR. Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans. World J Gastroenterol 2021; 27(33): 5460-5473 [PMID: 34588745 DOI: 10.3748/wjg.v27.i33.5460]
Corresponding Author of This Article
Pankaj Garg, MBBS, MS, Associate Professor, Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, House No 1042, Sector-15, Panchkula 134113, Haryana, India. drgargpankaj@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Therapeutic and Diagnostic Guidelines
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is 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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Sep 7, 2021; 27(33): 5460-5473 Published online Sep 7, 2021. doi: 10.3748/wjg.v27.i33.5460
Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans
Pankaj Garg, Baljit Kaur, Vipul D Yagnik, Sushil Dawka, Geetha R Menon
Pankaj Garg, Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula 134113, Haryana, India
Pankaj Garg, Department of Colorectal Surgery, Indus International Hospital, Mohali 140201, Punjab, India
Baljit Kaur, Department of Radiology, SSRD Magnetic Resonance Imaging Institute, Chandigarh 160011, Chandigarh, India
Vipul D Yagnik, Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan 384265, Gujarat, India
Sushil Dawka, Department of Surgery, SSR Medical College, Belle Rive, Mauritius
Geetha R Menon, Department of Statistics, Indian Council of Medical Research, New Delhi 110029, New Delhi, India
Author contributions: Garg P conceived and designed the study, collected, and analyzed the data, revised the data, finally approved and submitted the manuscript (guarantor of the review); Kaur B and Yagnik VD collected, and analyzed the data, revised the data, finally approved and submitted the manuscript; Dawka S critically analyzed the data, reviewed and edited the manuscript, finally approved and submitted the manuscript; Menon GR analyzed the data, revised the data, finally approved and submitted the manuscript.
Conflict-of-interest statement: None of the authors, Garg P, Kaur B, Yagnik VD, Dawka S and Menon GR, have any conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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 and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pankaj Garg, MBBS, MS, Associate Professor, Surgeon, Department of Colorectal Surgery, Garg Fistula Research Institute, House No 1042, Sector-15, Panchkula 134113, Haryana, India. drgargpankaj@yahoo.com
Received: May 8, 2021 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
Abstract
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.
