What Does My MRI Scan Report Indicate?

Posted on Mon, 24 Apr 2017

Mon, 24 Apr 2017 Answered on

Sat, 13 May 2017 Last reviewed on

Question : Dear Doctor,

I am having peri anal fistula, my MRI confirmed two fistula tracks with length 1.6 and 3.8 cm. I would like to understand my best bet surgery options. Could you please help me with this. Attaching the MRI results.

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
Respected XXXXXXX hi VAAFT followed by Fistulectomy options for you.

Detailed Answer:
Respected XXXXXXX rathnakumar , hi I evaluated your query thoroughly.
* VAAFT ( Video Assisted Anal Fistula Treatment ) best surgery option.
- only method enabling the intraoperative identification of the internal ostium &
fistula canal under visual control.
- as compared to other minimally invasive procedures a comparable recovery
rate.
- without risk of incontinence.
- initial optimistic results but it requires further investigations on a larger group
of patients.
- recurrence documented in 16-18% in a small group study.
* FISTULECTOMY :
- conventional method of time tested results since decades .
- methylene blue type XXXXXXX is injected into the fistulous tracts, cauterised,
excised till depth.
- excellent results in expert hands.
- incontinence in very bad fistulas / damage to internal ostium .
- recurrence varies widely from case to case.
* Seton therapy ( Kshar - XXXXXXX Procedure )
* Best results one can get by Colorectal Surgeons experts in these type of cases
* I would like to know - duration of fistula - treatments taken in past & currently
if any - associated symptoms , severity - life style & working habits in terms
of prolonged sitting - consumption of tobacco / alcohol - MRI report ( not
visible herewith )
Hope this clears your query.
Thanks for using Health Care Magic & reviewing my answer thoroughly.
Wishing you fast and speedy recovery from the same.
Regards dear.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (2 hours later)

Hi Doctor,

Thanks for your reply. I have this for 2 years , no surgery done before. My lifestyle is working in seated position for long time.

I have attached the MRI report if you want I can also attach the video.

Could you assess what is the complication is ? And what type of surgery is best recommended, I have travelled from Canada to XXXXXXX for this I can stay here long enough till complete recovery but can't afford to come often on reoccurrence.

Please advise best option.

Regards
Ganesh

Answered by Dr. Bhagyesh V. Patel (9 hours later)

Brief Answer:
Respected XXXXXXX hi VAAFT is best,recurrence possible in any procedure

Detailed Answer:
Respected XXXXXXX , hi
* Complications include : @ Local - recurrent infection including serous / pus
discharge ,blood staining , tissue discharge with slough - becoming complex
fistula with multiple internal tracks - internal bursting of anal or rectal
mucaosa with stool leakage from fistula opening .
@ Systemic - septicemia in severe infections - fever - rarely carcinoma -
social stigmas - pscyhological - generalised debility with weakness,
anorexia .
* Best option VAAFT for you , till recurrence is concerned its upto case
dependency .Doctor will only perform best of his actions in any institute of the
world, recurrence is certainly destiny which you have to follow in case of hard
luck, but we hope for the best & proceed further keeping faith in almighty God
* Till then I would recommend to avoid sitting on hard surfaces for prolong
periods, avoid driving bike like vehicles .
- in regular working also, you have to use soft cushion to sit to avoid excess
pressure as well as friction to fistula site.
- avoid tight clothings , silky innerwears.
- refrain from smoking / alcohol
- avoid oily / spicy / nonveg stuffs .
- have light diet with high fiber content to avoid hard stools.
- take regular Sitz bath for soothing.
Hope this makes things more clarified for you.
Wishing you best luck for all positive outcomes.
Feel free to ask for any further queries or you can rate the answer and close
the discussion.
Regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Bhagyesh V. Patel (13 hours later)

Thanks for your reply doctor. I have consulted two specialists in XXXXXXX

Surgeon 1: Recommening fistulectomy saying it's safe and reoccurance is only 10%.
Surgery method : two staged surgery stage 1- cutting and cleaning the fistula tracks with stenon. Stage 2- stenon removal promising low chances of incontinence. But he is against VAAFT and have give reasons that VAAFT would create false tracks and the reoccurance probability is 40%

Surgeon 2: VAAFT specialist recommending VAAFT , but recommending three follow ups with a time duration of a month to two to monitor healing. He is against fistulectomy due to the painful procedure and chances of incontinence.

Since both of them are supporting their own expertise and hampering the other approach with its disadvantages. I would like to have a neutral opinion. Could you please shed light on the accuracy of the information provided. It would help me greatly to make a decision.

Answered by Dr. Bhagyesh V. Patel (54 minutes later)

Brief Answer:
Respected Ganeshkumar, hi all details demanded I have given.

Detailed Answer:
Respected Ganeshkumar, hi I evaluated your further doubts.
*Surgical treatment of anal fistula is a balancing act aimed at eradicating disease,
preserving continence , limiting the morbidity of intervention & chances of
reccurence.
*Fistulectomy - not totally safe, there are chances of iatrogenic injury to
sphincter
- reccurence rate varies from case to case ( it`s not like 10 % fixed, it may
be 20-24 % in case of complex horse shoe fistulas.
- not everything done under vision at depth ( which is drawback )
- more tissue excision done to be on safer side so more recovery time in terms
of wound healing
- two stage surgery is acceptable for better outcomes
- relative costing is less as compared to VAAFT
- decades old time tested surgery so majority of surgeons are familiar with it &
more confident for it
*VAAFT : - does not affect sphincter efficiency
- comparable recovery rate is observed without risk of incontinence
- it is the only method enabling the intraoperative identification of the internal
ostium and fistula canal under visual control
- reccurence is 16-18 % in small group of study
- costly
- would create false tracks is not true on the contrary it stops surgeon from
creating false tracks as it is under direct video monitoring.
- long term data of follow ups are not yet available
@ FINAL CONCLUSION :
I rate VAAFT more in comparison to Open Fistulectomy as neutral opinion
You have to keep following points in mind :
- Surgeon`s VAAFT procedures performed, experience, review of his operated
patients by meeting them personally & sharing experience is the best method
to get all the evidences
- cost factor consideration
- recurrence would be in both methods depending on your destiny , so be
mentally prepared for the same in advance . ( I wish you don`t have
reccurence but it`s not in anybody`s hands )
- both are performed under Anaesthesia so no one is painful per-operative
- in experts hands there are least chances of incontinence even in Fistulectomy
so never get scarred for that also
- titrate both methods from angle of advantages & disadvantages then whatever
decision is coming from your soul & mind would be final definately
- follow up requirements & your possible stay in XXXXXXX also matters to great
extent
Hope I am helpful in your time of need.
May God help you to decide best for you.
Thanks regards take care.
Would love to know follow up before leaving XXXXXXX
Best of luck dear .

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Bhagyesh V. Patel (46 minutes later)

Thanks a lot doctor.

Could you please recommend any doctor in XXXXXXX who can perform both fistulectomy and VAAFT. so that he could physically examine my case and advise the best option. Appreciate your help Doctor.

Answered by Dr. Bhagyesh V. Patel (8 hours later)

Brief Answer:
Respected Ganeshkumar, hi XXXXXXX , New XXXXXXX the best option for you.

Detailed Answer:
Respected Ganeshkumar, hi good morning.
*I would strongly recommend XXXXXXX New XXXXXXX , best centre in Inida, known
for its excellence worldwide with highest quality standards and most
experienced Surgeons of XXXXXXX , people are coming across the globe there
for best results.
*There you have to reach Gastrosurgery department either Colorectal Surgeon
You will get all the types of Surgeries you want dear.
Hope this helps you.
Regards dear best wishes for all positive outcomes.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Bhagyesh V. Patel (36 minutes later)

Dear Doctor

Thanks a lot for your suggestions, I have tried XXXXXXX before but there is a huge waiting 3-4 months. However I have consulted DR. Asish Bhanot for VAAFT and DR. Deep Goel from BLK but they only do fistulectomy. I am open to any other surgeons too, if I can get the surgery quickly. Please advise

Thanks a lot again.

Answered by Dr. Bhagyesh V. Patel (1 hour later)

Brief Answer:
Respected Ganeshkumar,time to decide&act upon,welcometo XXXXXXX

Detailed Answer:
Respected Ganeshkumar, hi
*It`s not so that you are going to be cured only through VAAFT dear , if
Surgeon performing VAAFT , will only close internal opening & rest track is
left as such it will tremendously increase your chances of recurrence at any
best institute also.
*Now decide as early as possible for best outcomes as internal pathology
is making its way in variety of directions.
*As I have told already fistulectomy in expert hands have equivalent good
results, even definately can decide for Fistulectomy also instead of waiting
for only VAAFT .
*Here in XXXXXXX XXXXXXX we have best Gastrosurgeons performing even
combined techniques for more better prospects instead of going for solo one
& making outcome more good , recurrence to as less as possible.

Thanks regards.

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Above answer was peer-reviewed by : Dr. Remy Koshy