CC BY 4.0 · Journal of Coloproctology 2024; 44(04): e229-e233
DOI: 10.1055/s-0044-1793855
Original Article

Correlation of the Anatomy of the Intersphincteric Anal Fistula with Sex: An Analysis through Anorectal Three-Dimensional Ultrasound

Graziela Olivia da Silva Fernandes
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
,
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
,
Rosilma Gorete Lima Barreto
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
,
Maura Tarcianny Oliveira Cajazeiras
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
,
Nikolay Coelho da Mota
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
,
Yana Pavan
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
,
Marcelo Travassos Pinto
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
,
Letícia Freitas de Aquino
2   Universidade Federal do Maranhão, São Luís, MA, Brazil
,
João Batista Pinheiro Barreto
1   Coloproctology Service, Hospital Universitário, Universidade Federal do Maranhão (HU-UFMA), São Luís, MA, Brazil
› Institutsangaben

Abstract

Introduction Anal fistula surgery is often associated with continence disorders due to transection of the anal sphincter muscles. A comprehensive understanding of the anatomy of the anal canal and fistula can help prevent this outcome.

Objective To correlate the anatomy of the intersphincteric anal fistula with the patient's sex using three-dimensional endoanal ultrasound (3D-EAUS).

Materials and Methods The present is a retrospective observational study, involving an analysis of the medical records of patients seen at the Coloproctology Service of a Public Tertiary Hospital in the state of Maranhão, Brazil, from July 2016 to December 2022. Patients were categorized by sex and assessed for the position of the internal opening (IO), distance from the IO to the anal margin, and amount and percentage of internal anal sphincter (IAS) muscle compromised by the fistulous tract.

Results Intersphincteric fistulae were more common in men. The average age among men was of 46.46 years, and, among women, it was of 38.17 years. There was a difference between the sexes in terms of the duration of compromised IAS, which was longer among men. The percentage of compromised IAS was higher in males. The IO was located at a greater distance from the anal margin in male patients compared to female ones.

Conclusion Male patients with intersphincteric anal fistula had the internal fistulous opening positioned more distant from the anal margin, with a greater length and percentage of the IAS muscle compromised by the fistulous tract compared to female patients with the same condition.



Publikationsverlauf

Eingereicht: 20. Februar 2024

Angenommen: 06. September 2024

Artikel online veröffentlicht:
18. Dezember 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • References

  • 1 Corman M, Nicholls RJ, Fazio VW. Corman's Colon and Rectal Surgery. Philadelphia: Wolters Kluwer; 2015
  • 2 Beck DE, Wexner SD, Hull TL. et al. The ASCRS Manual of Colon and Rectal Surgery. New York, NY: Springer; 2014
  • 3 Vasilevsky CA. Anorectal Abscess and Fistula. Springer eBooks; 2013. Nov 8; 245-272
  • 4 Azevedo A, Horta D. Revista Portuguesa de Coloproctologia janeiro/abril 2020 Recomendações Abcessos e fistulas perianais [Internet]. Available from: https://www.spcoloprocto.org/uploads/rec3_fistulas-e-abcessos.pdf
  • 5 Buchen GM. Análise das características anatômicas relacionadas à fístula perianal utilizando ultrassom anorretal tridimensional. [Fortaleza]: Universidade Federal do Ceará; 2014
  • 6 Murad-Regadas SM, Regadas FSP. Dias Mont'Alverne RE, da Silva Fernandes GO, de Souza MM, Frota NA, Ferreira DG. Impact of Internal Anal Sphincter Division on Continence Disturbance in Female Patients. Dis Colon Rectum 2023; 66 (12) 1555-1561
  • 7 Alshiek J, Murad-Regadas SM, Mellgren A. et al; Members of the Expert Panel on Dynamic Ultrasound Imaging of Defecatory Disorders of the Pelvic Floor. Consensus definitions and interpretation templates for dynamic ultrasound imaging of defecatory pelvic floor disorders : Proceedings of the consensus meeting of the pelvic floor disorders consortium of the american society of colon and rectal surgeons, the society of abdominal radiology, the international continence society, the American urogynecologic society, the international urogynecological association, and the society of gynecologic surgeons. Int Urogynecol J 2023; 34 (03) 603-619
  • 8 Fugita FR, dos Santos CHM, da Silva Ribeiro CO. Epidemiological profile of patients with fistula in ano. J Coloproctol (Rio J) 2020; 40 (01) 1-7
  • 9 Sahnan K, Askari A, Adegbola SO. et al. Natural history of anorectal sepsis. Br J Surg 2017; 104 (13) 1857-1865
  • 10 Murad-Regadas SM, Regadas FS, Rodrigues LV. et al. Anatomic characteristics of anal fistula on three-dimensional anorectal ultrasonography. Dis Colon Rectum 2011; 54 (04) 460-466
  • 11 Yassin NA, Hammond TM, Lunniss PJ, Phillips RK. Ligation of the intersphincteric fistula tract in the management of anal fistula. A systematic review. Colorectal Dis 2013; 15 (05) 527-535
  • 12 Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 2000; 20 (03) 623-635 , discussion 635–637
  • 13 Borges PHL, Zambonato MB. O papel do ultrassom endoanal tridimensional na avaliação da fístula anal. J Coloproctol (Rio J) 2018; 38: 66
  • 14 Regadas FSP, Murad-Regadas SM, Lima DMR. et al. Anal canal anatomy showed by three-dimensional anorectal ultrasonography. Surg Endosc 2007; 21 (12) 2207-2211
  • 15 Murad-Regadas SM, Regadas FS, Rodrigues LV, Holanda EdeC, Barreto RG, Oliveira L. The role of 3-dimensional anorectal ultrasonography in the assessment of anterior transsphincteric fistula. Dis Colon Rectum 2010; 53 (07) 1035-1040