The management of complex anorectal fistulas is associated with potential
risk of fecal incontinence and recurrences. Understanding type and height of
the fistulous tract has clinical relevance for colorectal surgeons in order
to select the optimal surgical approach. History and physical examination
along with selective imaging to delineate the anatomy of the fistula are
critical to individualize the patient?s treatment. Three-dimensional endoanal
ultrasound provides an accurate and reproducible assessment of perianal
sepsis and in many cases, the result is not different from that of MRI. Due
to higher panoramicity, multiplanar reconstruction allows to visualize the
fistula tracts in the context of the surrounding structures. Ultrasound has
several important advantages: relative ease of use, minimal discomfort,
cost-effectiveness, relatively non-time consuming, and wide availability in
the clinical setting. This modality has a favourable impact on the outcome of
surgical treatment for complex anal fistulas reducing the recurrence rate,
minimizing postoperative complications and preserving anal continence.
Fecal diversion in complex anal fistulas: Is there a way to avoid it?
