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‘Laying open’ our operative and MRI reports for critical analysis to improve surgical planning for patients with anal fistula (AF)

Vanessa Cubas, Pradeep Janardhanan, Kamila Rakhimova, Soumendu Ghosh, Steve Ward
University hospitals Birmingham, Birmingham, United Kingdom


Introduction: Failure to appreciate the anatomy of AF leads to recurrence. Successful treatment requires accurate pre-operative clinical assessment and often imaging (MRI). Information is conveyed by operation notes and MRI reports. The key elements of AF anatomy to be assessed and recorded, have been defined. Proformas have been designed to ensure that key information is not overlooked. We assessed our operation notes and MRI reports for completeness of the detail required.

Methods: Retrospective observational study of day-case operations for AF between September and December 2022. The St Marks AF proforma and minimum dataset for MRI reporting were used as standards.

Results: 56 cases were included, 40 underwent MRI. MRI reported AF classification, path and internal opening in 95%, 95% and 90% cases respectively. External opening and track length were reported in 47.5% and 29% cases. Operation notes described the primary tract, internal and external openings in 80%, 71% and 69% cases respectively. The relation of the internal opening to the dentate line was described in 40% cases and diagrams were provided in 5% cases.

Conclusion: MRI reports most of the key elements of AF anatomy, but there is still room for improvement. MRI proformas augment report completeness. Operation notes omitted key elements of AF anatomy, reducing the information available to subsequent surgeons for future operations. We have introduced electronic operative noting software that permits the drawing of AF in 3-dimensions and mandates specification of key AF elements. If selected for oral presentation, we will present a video of the software.