Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients
Pankaj Garg,1 Gabriele Naldini,2 Vincent De Parades,3 Petr Tsarkov,4 Vipul D Yagnik,5 Kaushik Bhattacharya,6 Baljit Kaur,7 G Mahak8 1Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, Haryana, 134113, India; 2Director of Proctology and Pelvic Floor Multidisciplinary Clinic...
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Dove Medical Press
2025-05-01
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| author | Garg P Naldini G De Parades V Tsarkov P Yagnik VD Bhattacharya K Kaur B Mahak G |
| author_facet | Garg P Naldini G De Parades V Tsarkov P Yagnik VD Bhattacharya K Kaur B Mahak G |
| author_sort | Garg P |
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| description | Pankaj Garg,1 Gabriele Naldini,2 Vincent De Parades,3 Petr Tsarkov,4 Vipul D Yagnik,5 Kaushik Bhattacharya,6 Baljit Kaur,7 G Mahak8 1Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, Haryana, 134113, India; 2Director of Proctology and Pelvic Floor Multidisciplinary Clinical Center, San Rossore Private Hospital Pisa, Pisa, 56127, Italy; 3Department of Medico Surgical Proctology, Institut Léopold Bellan, Hospital Paris Saint Joseph, Paris, 75674, France; 4Professor & Head, Department of Colorectal Surgery, Sechenov First Moscow State Medical University, Moscow, 119991, Russian Federation; 5Professor, Department of Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, 385001, India; 6Associate Professor, Department of Surgery, MGM Medical College and LSK Hospital, Kishanganj, Bihar, 855107, India; 7Department of MRI Imaging, SSRD MRI Center, Chandigarh, 160011, India; 8Chief Research & Scientific Officer, Garg Fistula Research Institute, Panchkula, Haryana, 134113, IndiaCorrespondence: Pankaj Garg, CEO & Chief Colorectal Surgeon, Garg Fistula Research Institute, 1042, Sector-15, Panchkula, Haryana, 134113, India, Fax +0091-9501011000, Email drgargpankaj@yahoo.comBackground: The primary opening of the cryptoglandular fistula-in-ano is generally assumed to be present at the dentate line as the cryptoglandular glands open there. However, no study has ever systematically studied the location of the primary opening.Methods: All fistula-in-ano patients operated-on over two years were screened and those who were never earlier operated on were included. Magnetic Resonance Imaging (MRI) was done on all patients. The primary fistula opening was localized on the MRI and corroborated with the operative findings. The primary opening was categorized at three levels - at the dentate line, above the dentate line, and below the dentate line.Results: 744 anal fistula patients were operated on over two years and 379 patients, who had never been operated on before, were included in the study. 35 patients were excluded (the primary opening could not be localized). In 344 patients (finally analyzed), the primary opening was at the dentate line in 223 patients (64.8%), above the dentate line in 79 (22.9%), and below the dentate line in 42 (12.2%) patients. The primary opening was located above the dentate line in significantly higher numbers in complex fistulas than in simple fistulas (73/102 in complex vs 6/242 in simple fistulas, p< 0.00001).Conclusion: Unlike commonly presumed, the primary opening is located at the dentate line in only two-thirds (64.8%) anal fistulas. In 22.9% it was located above the dentate line and in 12.2%, below the dentate line. This is the first study in which the level of primary opening has been systematically analyzed.Keywords: rectal fistula, anal fistula, MRI, internal opening, primary opening, dentate line |
| format | Article |
| id | doaj-art-db15d90b75b94ffe96b20ddc62e6da60 |
| institution | Matheson Library |
| issn | 1178-7023 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical and Experimental Gastroenterology |
| spelling | doaj-art-db15d90b75b94ffe96b20ddc62e6da602025-06-25T21:33:51ZengDove Medical PressClinical and Experimental Gastroenterology1178-70232025-05-01Volume 18Issue 1121137103482Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 PatientsGarg P0Naldini G1De Parades V2Tsarkov PYagnik VD3Bhattacharya K4Kaur B5Mahak G6Colorectal SurgeryColon and Rectal SurgeryMedical and surgical departmentGeneral SurgerySurgeryRadiologySurgical ResearchPankaj Garg,1 Gabriele Naldini,2 Vincent De Parades,3 Petr Tsarkov,4 Vipul D Yagnik,5 Kaushik Bhattacharya,6 Baljit Kaur,7 G Mahak8 1Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, Haryana, 134113, India; 2Director of Proctology and Pelvic Floor Multidisciplinary Clinical Center, San Rossore Private Hospital Pisa, Pisa, 56127, Italy; 3Department of Medico Surgical Proctology, Institut Léopold Bellan, Hospital Paris Saint Joseph, Paris, 75674, France; 4Professor & Head, Department of Colorectal Surgery, Sechenov First Moscow State Medical University, Moscow, 119991, Russian Federation; 5Professor, Department of Surgery, Banas Medical College and Research Institute, Palanpur, Gujarat, 385001, India; 6Associate Professor, Department of Surgery, MGM Medical College and LSK Hospital, Kishanganj, Bihar, 855107, India; 7Department of MRI Imaging, SSRD MRI Center, Chandigarh, 160011, India; 8Chief Research & Scientific Officer, Garg Fistula Research Institute, Panchkula, Haryana, 134113, IndiaCorrespondence: Pankaj Garg, CEO & Chief Colorectal Surgeon, Garg Fistula Research Institute, 1042, Sector-15, Panchkula, Haryana, 134113, India, Fax +0091-9501011000, Email drgargpankaj@yahoo.comBackground: The primary opening of the cryptoglandular fistula-in-ano is generally assumed to be present at the dentate line as the cryptoglandular glands open there. However, no study has ever systematically studied the location of the primary opening.Methods: All fistula-in-ano patients operated-on over two years were screened and those who were never earlier operated on were included. Magnetic Resonance Imaging (MRI) was done on all patients. The primary fistula opening was localized on the MRI and corroborated with the operative findings. The primary opening was categorized at three levels - at the dentate line, above the dentate line, and below the dentate line.Results: 744 anal fistula patients were operated on over two years and 379 patients, who had never been operated on before, were included in the study. 35 patients were excluded (the primary opening could not be localized). In 344 patients (finally analyzed), the primary opening was at the dentate line in 223 patients (64.8%), above the dentate line in 79 (22.9%), and below the dentate line in 42 (12.2%) patients. The primary opening was located above the dentate line in significantly higher numbers in complex fistulas than in simple fistulas (73/102 in complex vs 6/242 in simple fistulas, p< 0.00001).Conclusion: Unlike commonly presumed, the primary opening is located at the dentate line in only two-thirds (64.8%) anal fistulas. In 22.9% it was located above the dentate line and in 12.2%, below the dentate line. This is the first study in which the level of primary opening has been systematically analyzed.Keywords: rectal fistula, anal fistula, MRI, internal opening, primary opening, dentate linehttps://www.dovepress.com/is-primary-opening-of-fistula-in-ano-always-at-dentate-line-correlatio-peer-reviewed-fulltext-article-CEGRectal fistulaanal fistulaMRIinternal openingprimary openingdentate line |
| spellingShingle | Garg P Naldini G De Parades V Tsarkov P Yagnik VD Bhattacharya K Kaur B Mahak G Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients Clinical and Experimental Gastroenterology Rectal fistula anal fistula MRI internal opening primary opening dentate line |
| title | Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients |
| title_full | Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients |
| title_fullStr | Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients |
| title_full_unstemmed | Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients |
| title_short | Is Primary Opening of Fistula-in-Ano Always at Dentate Line: Correlation Between MRI and Operative Findings in 379 Patients |
| title_sort | is primary opening of fistula in ano always at dentate line correlation between mri and operative findings in 379 patients |
| topic | Rectal fistula anal fistula MRI internal opening primary opening dentate line |
| url | https://www.dovepress.com/is-primary-opening-of-fistula-in-ano-always-at-dentate-line-correlatio-peer-reviewed-fulltext-article-CEG |
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