title: Effect of MRI on clinical outcome of recurrent fistula-in-ano.
abstract: Recurrent fistula-in-ano is usually due to sepsis missed at surgery, which can be identified by MRI. We aimed to establish the therapeutic effect of MRI in patients with fistula-in-ano. We did MRI in 71 patients with recurrent fistula, with further surgery done at the discretion of the surgeon. Surgery and MRI agreed in 40 patients, five (13%) of whom had further recurrence, compared with 16 (52%) of 31 in whom surgery and MRI disagreed (p=0.0005). Further recurrence in all 16 was at the site predicted by MRI. For surgeons who always acted on MRI, further recurrences arose in four of 25 (16%) operations versus eight of 14 (57%) operations for those who ignored imaging (p=0.008). Surgery guided by MRI reduces further recurrence of fistula-in-ano by 75% and should be done in all patients with recurrent fistula.
authors.affiliation: Department of Surgery, St Mark's Hospital, Northwick Park, HA1 3UJ, London, .
authors.forename: Gordon
authors.initials: G
authors.lastname: Buchanan
authors.forename: Steve
authors.initials: S
authors.lastname: Halligan
authors.forename: Andrew
authors.initials: A
authors.lastname: Williams
authors.forename: C Richard G
authors.initials: CR
authors.lastname: Cohen
authors.forename: Danilo
authors.initials: D
authors.lastname: Tarroni
authors.forename: Robin K S
authors.initials: RK
authors.lastname: Phillips
authors.forename: Clive I
authors.initials: CI
authors.lastname: Bartram
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000145:classification / Q000517:prevention & control / Q000601:surgery*; D012086:Reoperation; D055502:Secondary Prevention; D016896:Treatment Outcome