What Does The Following MRI Report When Diagnosed With Anal Fistula Indicate?

Posted on Wed, 26 Apr 2017

Wed, 26 Apr 2017 Answered on

Sat, 13 May 2017 Last reviewed on

Question : Dear Doctor,

This is in regards to the case you have consulted about peri anal fistula. I have reached XXXXXXX and I have taken an MRI which has accesses two fistulas one 1.6cm and another 3.8 cm. I have consulted two surgeons

Surgeon 1: Blk hospital New XXXXXXX Dr. Deep Goel , he is suggesting fistulectomy but Teo staged surgery. Stage 1 removal of both fistula tracks and stenon placement stage 2: stenon removal. He has suggested rest time of 3 weeks from stage 1 to stage 2 and after stage 2 he said no much rest is required. However when I enquired about VAAFT he said VAAFT procedure has a reoccurance rate of 40 to 50% and has the possibility to miss secondary tracks and I can also introduce false tracks.

Surgeon 2: Dr Asish Bhanot XXXXXXX , he is a VAAFT specialist, when he physically examined me he beloved that both the fistulas internal opening are close to each other and the cavity could be bigger he said this before he could favour any surgery procedure. So he suggested VAAFT and fistulectomy might not heal the big cavity and could potentially cause reoccurance and also he pointed out the pain associated with it. However for VAAFT he suggested 3 stage follow up. Stage 1: surgery via VAAFT stage 2: he said something like evaluation of the wound and dressing but under anesthesia 3) dressing. He is saying VAAFT has 90% success rate.

Firstly I don't know whether they data they throw are right. Secondly each of them talks about the advantages of their approach and sell themselves by calling out the disadvantages of another. Could you please shed some light about the authenticity of the information I have acquired, and please provide your neutral option I have attached my MRI report.

Thanks a lot

Appreciate your help on this.

Answered by Dr. Ramesh Kumar (3 hours later)

Brief Answer:
Attach MRI the report, please.

Detailed Answer:
Hello dear,

Kindly attach the report of MRI here at the reports section.
There is no report attached to the question.
Please attach the report so that I can guide you further.

Awaiting....
Regards!

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ramesh Kumar (3 hours later)

Dear Doctor,

For some reason the website is not working while uploading the attachment. I have reported the problem to the website. In mean while do you have an email where i can send this report to ?

Regards
Xxxx

Answered by Dr. Ramesh Kumar (5 minutes later)

Brief Answer:
Follow up.

Detailed Answer:
Hi XXXXXXX
Please XXXXXXX me the documents at-
YYYY@YYYY
Waiting!

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

Follow up: Dr. Ramesh Kumar (33 minutes later)

Dear Doctor,

Thanks for agreeing to see the report
. I have sent the report via email mentioned.

Regards
Xxxx

Answered by Dr. Ramesh Kumar (1 hour later)

Brief Answer:
VAAFT is the procedure of choice for you.

Detailed Answer:
Hello XXXXXXX
Have gone through reports of your MRI and the pictures attached by you.

In my opinion i agree with surgeon 2.
Video-assisted anal fistula treatment (VAAFT) is a novel minimally invasive and sphincter-saving technique for treating complex fistulas.

As per the standard data of NCBI(National centre of biotechnological information) a facility funded by XXXXXXX govt data's are-
"
From May 2006 to May 2011, 136 patients were operated using VAAFT. Ninety-eight patients were followed up for a minimum of 6 months.
1)No major complications occurred. In most cases, both short-term and long-term postoperative pain was acceptable.
2)Primary healing was achieved in 72 patients (73.5%) within 2–3 months of the operation.
3)Sixty-two patients were followed up for more than 1 year. The percentage of the patients healed after 1 year was 87.1%.

These are the data's published by NCBI on its registered site.These data's are followed by almost every institute of gastroenterology world wide.

Conclusion-
"The main feature of the VAAFT technique is that the procedure is performed entirely under direct endoluminal vision. With this approach, the internal opening can be found in 82.6% of cases. Moreover,As fistuloscopy has already identified a possible secondary tracts its easy to close them. The VAAFT technique is sphincter-saving, and the surgical wounds are extremely small.

So i would suggest you to go for VAAFT.

This is not my opinion. It's published by NCBI. So there is no scope of personal biasing.
You can check the validity of thios data personally by visiting NCBI.
Hope you got your answers.
Follow ups are welcome and appreciated.

Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Ramesh Kumar (1 hour later)

Dear Doctor,

Thanks a lot for your opinion it really helped me. Today I am going to consult Dr adarsh choudry from medanta - the surgeon you recommended. I will keep you posted with details.

Thanks a lot again, really appreciate your help.

Answered by Dr. Ramesh Kumar (15 minutes later)

Brief Answer:
Follow up with his advice.

Detailed Answer:
Hello again.
Good luck and follow up with what he advice's you.
Medanta is one of the top notch hospital in asia and i think will give you the best suggestion.
Regards.

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

Follow up: Dr. Ramesh Kumar (19 hours later)

Thanks a ton Doctor. I had a consultation with Dr adarsh choudhary, I really got a peace of mind after talking to him he had imbibed a lot of confidence. He suggested that if the track is straigh without much curves he said they would go with VAAFT. Otherwise they would choose other options like fistulectomy or anything which best suits it but it could only be determined in operation theatre. But he promised whatever approach they take they would only take an approach which doesn't affect the spinchter much.

Thanks again to you for your wonderful consultation and reference.

Answered by Dr. Ramesh Kumar (2 hours later)

Brief Answer:
Follow up.

Detailed Answer:
Hi XXXXXXX
I am glad to know that finally you are satisfied by your primary consultant.Don't worry you are in safe hands now. Final decision about nature of surgery can only be made by your primary surgeon. Adarsh has a great hand in surgery so now you need not to worry at all.

When you are in a developing country rule of thumb is always go for the best hospital because they are the one having the best talents.

Wish you great luck and keep me intimated.
I wish you a very fast and safe recovery.

Regards,
Kumar!

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Kampana