A Single Center Study of 80 Cases of Fistula-in-ano

Background: Anal fistulae, especially the complex and the high ones, are a challenge to treat even for an experienced surgeon. Hence, there is a need to preoperatively evaluate anal fistula to reduce the rate of recurrence. Objective: This study was embarked on to evaluate the natural course of anal fistula and its management. Goodsall’s rule, which predicts the course of fistulous tracts, was also validated in this study. Materials and Methods: A total of 80 patients, who were diagnosed to have fistula-in-ano clinically, were included in this study. All patients underwent conventional or magnetic resonance (MR) fistulogram. The fistulous tracts were preoperatively assessed and compared with the fistulograms. The tracts were sent for histopathological examination and their cause identified. Results: In our study, 90% were <60 years of age with a very high male preponderance (82.5%). A perianal abscess is the major cause of development of anal fistulae with tuberculosis causing 7.5% of the fistulae in our study. Goodsall’s rule was found to be accurate in only about 66% of anterior fistulae and 29% in posterior fistulae. Conclusion: With Goodsall’s rule being inaccurate in predicting the course of fistula, we propose that every case of anal fistula should be evaluated with conventional or MR fistulogram.