Vural Argın, Mehmet Arif Usta
Medical Science and Discovery - 2025;12(11):311-315
Objective: Perianal fistulas are a common yet complex anorectal condition requiring precise anatomical assessment and tailored surgical management. Magnetic resonance imaging (MRI) is increasingly utilized for guiding preoperative surgical planning. This study, therefore, aim ed to evaluate the clinical characteristics, the diagnostic performance of MRI, and the postoperative outcomes in patients who underwent surgical treatment for perianal fistulas. Methods: A retrospective analysis was conducted on 111 patients who underwent perianal fistula surgery between January 2018 and January 2020. Demographic data, fistula classification (Parks and St. James's), surgical techniques, recurrence, morbid ity, and Wexner incontinence scores were recorded. The diagnostic accuracy of MRI was calculated using intraoperative findings as the reference standard. Results: The median patient age was 45 years, with a strong male predominance (87 patients, 78.4%). The most common fistula type was intersphincteric (70 patients, 63.1%), followed by tran ssphincteric (33 patients, 29.7%) and suprasphincteric (8 patients, 7.2%). Seton placement was the most frequently performed surgical intervention (72.1%) [Düzeltme Gerekli - Ana Metin Kontrolü]. Postoperative fecal incontinence was observed in 7.2% of pat ients, and the recurrence rate was 8.1%. MRI demonstrated the highest diagnostic accuracy for suprasphincteric fistulas (sensitivity 100%, specificity 99%). Intersphincteric fistulas also showed high sensitivity (96%) but lower specificity (67.5%). Transsp hincteric fistulas, however, demonstrated the lowest sensitivity (68.9%). Conclusion: Conclusion: MRI is confirmed as a highly effective tool in the preoperative evaluation of perianal fistulas, particularly for identifying suprasphincteric tracts. Surgica l treatment is generally safe, yielding acceptable rates of recurrence and continence impairment. Further prospective studies are warranted to validate these findings and optimize treatment strategies.
