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Title: | Comparison of hydrogen peroxide instillation with Goodsall's rule for fistula in-ano |
Authors: | Deen, K.I. Gunawardena, P.A.H.A. |
Keywords: | Diagnostic Techniques, Digestive System Hydrogen Peroxide-administration and dosage Hydrogen Peroxide-diagnostic use Rectal Fistula-diagnosis Rectal Fistula-surgery |
Issue Date: | 2001 |
Publisher: | Wiley-Blackwell Pub. Asia |
Citation: | ANZ Journal of Surgery; 71(8): pp.472-74 |
Abstract: | BACKGROUND: Identification of the internal opening is an essential step in the management of fistula-in-ano. The predictive accuracy of Goodsall's rule is compared with instillation of hydrogen peroxide for fistulas-in-ano. METHODS: Thirty-five patients (32 male, three female; median age 42 years; range: 6 months-70 years) were studied. Hydrogen peroxide solution was injected into the external opening of the fistula track and effervescence was observed at the internal opening within the anal canal. A fistula track was either excised or incised. Setons were placed within high fistulas. RESULTS: There were 24 simple fistulas, compared to 11 complex fistulas (horseshoe, n = 4; abscess, n = 4). Eighteen external openings were anterior and 17 were posterior. Thirty-four of 35 (97%) internal openings were identified. Only 20 internal openings were in accordance with Goodsall's rule (positive predictive value: 59%). Predictive accuracy was greater for anterior external openings (13 of 18 (72%)) versus posterior external openings (six of 17 (41%); P = 0.016). For recurrent fistulas, seven of 17 fistula tracks had an internal opening in accordance with Goodsall's rule, resulting in a positive predictive value of 41%. (Positive predictive value: anterior 67% vs posterior 12.5%; P = 0.0009.) CONCLUSION: The overall predictive accuracy of Goodsall's rule was poor chiefly because of poor predictive accuracy in posterior and recurrent fistulas. The use of Goodsall's rule alone in decision-making before surgical intervention is not recommended. |
URI: | http://repository.kln.ac.lk/handle/123456789/1481 |
ISSN: | 1445-1433 (Print) 1445-2197 (Electronic) |
Appears in Collections: | Journal/Magazine Articles |
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