Perianal fistula is a chronic inflammation of Perianal tissues which is usually caused by an abscess. The need to reduce the complications such as recurrence, incontinence or both (incontinence recurrence) was felt with a suitable preoperative plan of surgery in management of complex Perianal fistulas and also to avoid unnecessary wide exploratory dissection through sphincter.

Aim: To study the usefulness of Magnetic Resonance Fistulography in patients with complex Perianal fistulas.

Objective: To relate the pre-op-magnetic resonance findings, intra operative findings and to find out the complications in complex fistula during 6 months follow up.

Material and Methods: The hospital based Descriptive Observational Department of Surgery and Radiology, S.M.S. Hospital where 60 cases were considered in final analysis between age group 18-85 years in either sex, patients with symptomatic complex Perianal fistulas attending surgical OPD patients whom MRI Fistulography cannot be performed. Detailed history with clinical examination (Digital Rectal Examination and Proctoscopy Preoperatively MRI Fistulography) was done.

Results: 96.67% of each case for intra-operative and pre-operative MRI Fistulography where internal opening was accessed is considered here. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI in Horse Shoe Fistula were 87.50%, 94.2%, 70%, 98% and 93.33% respectively. Comparison of tract length and in positions of external openings in pre-operative MRI and intra-operative was found not significant. Complication associated with fistula 11.67% (n=7) patients were incontinence and 26.67% cases were discharge at 1st week of the operation and at 1st month incontinence was also observed in 4 cases (6.67%).

Conclusion: Pre-operative MRI Fistulography is a key to success of appropriate management in complex Perianal fistula.

Keywords: Pre operative, Magnetic Resonance Fistulography, complex Perianal fistulas intra-operative

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Dr Ankit Sharma

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