Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study
Purpose This study was conducted to evaluate the validity of a new imaging-guided, anatomy-based classification of anorectal fistulas in defining disease severity and predicting surgical outcomes. Methods This multicenter, retrospective cohort study analyzed data from patients with perianal fistulas...
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Korean Society of Coloproctology
2025-06-01
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| Series: | Annals of Coloproctology |
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| Online Access: | http://coloproctol.org/upload/pdf/ac-2024-00675-0096.pdf |
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| author | Antonio Brillantino Francesca Iacobellis Luigi Marano Adolfo Renzi Pasquale Talento Luigi Brusciano Claudio Gambardella Umberto Favetta Michele Schiano Di Visconte Luigi Monaco Maurizio Grillo Mauro Natale Maglio Fabrizio Foroni Alessio Palumbo Maria Laura Sandoval Sotelo Luciano Vicenzo Elisa Palladino Giovanna Frezza Maria Paola Menna Paolino Mauro Stefano Picardi Mario Massimo Mensorio Vinicio Mosca Vincenzo Bottino Giovanna Ioia Corrado Rispoli Marco Di Serafino Martina Caruso Roberto Ronza Barbara Frittoli Daria Schettini Luca Stoppino Franco Iafrate Giulio Lombardi Carmine Antropoli Salvatore Cappabianca Ludovico Docimo Roberto Grassi Alfonso Reginelli |
| author_facet | Antonio Brillantino Francesca Iacobellis Luigi Marano Adolfo Renzi Pasquale Talento Luigi Brusciano Claudio Gambardella Umberto Favetta Michele Schiano Di Visconte Luigi Monaco Maurizio Grillo Mauro Natale Maglio Fabrizio Foroni Alessio Palumbo Maria Laura Sandoval Sotelo Luciano Vicenzo Elisa Palladino Giovanna Frezza Maria Paola Menna Paolino Mauro Stefano Picardi Mario Massimo Mensorio Vinicio Mosca Vincenzo Bottino Giovanna Ioia Corrado Rispoli Marco Di Serafino Martina Caruso Roberto Ronza Barbara Frittoli Daria Schettini Luca Stoppino Franco Iafrate Giulio Lombardi Carmine Antropoli Salvatore Cappabianca Ludovico Docimo Roberto Grassi Alfonso Reginelli |
| author_sort | Antonio Brillantino |
| collection | DOAJ |
| description | Purpose This study was conducted to evaluate the validity of a new imaging-guided, anatomy-based classification of anorectal fistulas in defining disease severity and predicting surgical outcomes. Methods This multicenter, retrospective cohort study analyzed data from patients with perianal fistulas who underwent surgery between 2017 and 2023. All patients underwent preoperative 3-dimensional endoanal ultrasound, with adjunctive magnetic resonance imaging performed if ultrasound indicated a complex fistula. Imaging examinations were retrospectively evaluated to categorize fistulas according to the Garg classification and the newly proposed classification system. The new classification included 6 severity grades based on the characteristics of the primary tract: submucosal, intersphincteric, low transsphincteric, high transsphincteric, multiple, and suprasphincteric/extrasphincteric. Each grade was further subdivided into 3 subtypes (A, B, C) based on the extension of secondary tracts. Results When compared with the new classification, the Garg classification demonstrated a slightly lower ability to predict the feasibility of fistulotomy in simple fistulas (94.2% vs 99.1%; Fisher exact test, P=0.006). A strong positive correlation was found between the surgery failure rate and the severity grade of the new classification (Spearman rho, 0.90; P<0.001), whereas the Garg classification showed a nonsignificant positive correlation with surgical failure rate (Spearman rho, 0.90; P=0.08). Conclusion The new imaging-guided, anatomy-based classification of anorectal fistulas demonstrates high accuracy in defining disease severity. It represents a valuable tool for preoperative grading of anal fistulas, standardizing the reporting of diagnostic imaging, and improving the communication of findings among healthcare professionals. |
| format | Article |
| id | doaj-art-ac80c3307bb94e48b27f02cbb1ff1eb1 |
| institution | Matheson Library |
| issn | 2287-9714 2287-9722 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Korean Society of Coloproctology |
| record_format | Article |
| series | Annals of Coloproctology |
| spelling | doaj-art-ac80c3307bb94e48b27f02cbb1ff1eb12025-07-02T07:39:41ZengKorean Society of ColoproctologyAnnals of Coloproctology2287-97142287-97222025-06-0141320722010.3393/ac.2024.00675.00962091Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation studyAntonio Brillantino0Francesca Iacobellis1Luigi Marano2Adolfo Renzi3Pasquale Talento4Luigi Brusciano5Claudio Gambardella6Umberto Favetta7Michele Schiano Di Visconte8Luigi Monaco9Maurizio Grillo10Mauro Natale Maglio11Fabrizio Foroni12Alessio Palumbo13Maria Laura Sandoval Sotelo14Luciano Vicenzo15Elisa Palladino16Giovanna Frezza17Maria Paola Menna18Paolino Mauro19Stefano Picardi20Mario Massimo Mensorio21Vinicio Mosca22Vincenzo Bottino23Giovanna Ioia24Corrado Rispoli25Marco Di Serafino26Martina Caruso27Roberto Ronza28Barbara Frittoli29Daria Schettini30Luca Stoppino31Franco Iafrate32Giulio Lombardi33Carmine Antropoli34Salvatore Cappabianca35Ludovico Docimo36Roberto Grassi37Alfonso Reginelli38 Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Department of Health, “A. Cardarelli” Hospital, Naples, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Unit of Surgery, Betania Evangelical Hospital, Naples, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Naples, Italy Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Naples, Italy Department of General and Emergency Radiology, “A. Cardarelli” Hospital, Naples, Italy Italian Working Group on Abdominal and Gastrointestinal Radiology, Italian Society of Medical and Interventional Radiology (SIRM), Milano, Italy Italian Working Group on Abdominal and Gastrointestinal Radiology, Italian Society of Medical and Interventional Radiology (SIRM), Milano, Italy Italian Working Group on Abdominal and Gastrointestinal Radiology, Italian Society of Medical and Interventional Radiology (SIRM), Milano, Italy Italian Working Group on Abdominal and Gastrointestinal Radiology, Italian Society of Medical and Interventional Radiology (SIRM), Milano, Italy Italian Working Group on Abdominal and Gastrointestinal Radiology, Italian Society of Medical and Interventional Radiology (SIRM), Milano, Italy Italian Unitary Society of Colon-Proctology (SIUCP), Reggio Emilia, Italy Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy Italian Working Group on Abdominal and Gastrointestinal Radiology, Italian Society of Medical and Interventional Radiology (SIRM), Milano, ItalyPurpose This study was conducted to evaluate the validity of a new imaging-guided, anatomy-based classification of anorectal fistulas in defining disease severity and predicting surgical outcomes. Methods This multicenter, retrospective cohort study analyzed data from patients with perianal fistulas who underwent surgery between 2017 and 2023. All patients underwent preoperative 3-dimensional endoanal ultrasound, with adjunctive magnetic resonance imaging performed if ultrasound indicated a complex fistula. Imaging examinations were retrospectively evaluated to categorize fistulas according to the Garg classification and the newly proposed classification system. The new classification included 6 severity grades based on the characteristics of the primary tract: submucosal, intersphincteric, low transsphincteric, high transsphincteric, multiple, and suprasphincteric/extrasphincteric. Each grade was further subdivided into 3 subtypes (A, B, C) based on the extension of secondary tracts. Results When compared with the new classification, the Garg classification demonstrated a slightly lower ability to predict the feasibility of fistulotomy in simple fistulas (94.2% vs 99.1%; Fisher exact test, P=0.006). A strong positive correlation was found between the surgery failure rate and the severity grade of the new classification (Spearman rho, 0.90; P<0.001), whereas the Garg classification showed a nonsignificant positive correlation with surgical failure rate (Spearman rho, 0.90; P=0.08). Conclusion The new imaging-guided, anatomy-based classification of anorectal fistulas demonstrates high accuracy in defining disease severity. It represents a valuable tool for preoperative grading of anal fistulas, standardizing the reporting of diagnostic imaging, and improving the communication of findings among healthcare professionals.http://coloproctol.org/upload/pdf/ac-2024-00675-0096.pdfanal fistulaanal fistula classificationfistulotomysphincter-saving proceduremagnetic resonance imaging |
| spellingShingle | Antonio Brillantino Francesca Iacobellis Luigi Marano Adolfo Renzi Pasquale Talento Luigi Brusciano Claudio Gambardella Umberto Favetta Michele Schiano Di Visconte Luigi Monaco Maurizio Grillo Mauro Natale Maglio Fabrizio Foroni Alessio Palumbo Maria Laura Sandoval Sotelo Luciano Vicenzo Elisa Palladino Giovanna Frezza Maria Paola Menna Paolino Mauro Stefano Picardi Mario Massimo Mensorio Vinicio Mosca Vincenzo Bottino Giovanna Ioia Corrado Rispoli Marco Di Serafino Martina Caruso Roberto Ronza Barbara Frittoli Daria Schettini Luca Stoppino Franco Iafrate Giulio Lombardi Carmine Antropoli Salvatore Cappabianca Ludovico Docimo Roberto Grassi Alfonso Reginelli Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study Annals of Coloproctology anal fistula anal fistula classification fistulotomy sphincter-saving procedure magnetic resonance imaging |
| title | Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study |
| title_full | Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study |
| title_fullStr | Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study |
| title_full_unstemmed | Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study |
| title_short | Validation of a novel imaging-guided and anatomy-based classification system for anorectal fistulas: a retrospective clinical evaluation study |
| title_sort | validation of a novel imaging guided and anatomy based classification system for anorectal fistulas a retrospective clinical evaluation study |
| topic | anal fistula anal fistula classification fistulotomy sphincter-saving procedure magnetic resonance imaging |
| url | http://coloproctol.org/upload/pdf/ac-2024-00675-0096.pdf |
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