{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:57:04Z","timestamp":1792180624291,"version":"4.4.0"},"reference-count":25,"publisher":"FapUNIFESP (SciELO)","issue":"suppl 1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Gastroenterol."],"abstract":"<jats:p>ABSTRACT  BACKGROUND:  There is no a clear knowledge concerning the division of any part of the anal sphincter complex and the effect of this procedure on the function of the anal canal during the treatment of perianal fistula.  OBJECTIVE:  To evaluate the usefulness of 3D anorectal ultrasound in the assessment of anal fistula, quantifying the length of the sphincter muscle to be transected, selecting patients for different approaches and identifying healing, failure or recurrence after the surgical treatment.  METHODS:  A prospective study included patients with primarily cryptogenic transsphincteric anal fistula assessed by fecal Incontinence score, tri-dimensional anorectal ultrasound and anal manometry before and after surgery. Based on 3D-AUS, patients with \u226550% external sphincter or external sphincter+puborectalis muscle involvement in males and \u226540% external sphincter or external sphincter+puborectalis muscle in females were referred for the ligation of the intersphincteric tract (LIFT) or seton placement and subsequent fistulotomy; and with &lt;50% involvement in males and &lt;40% in females were referred to one-stage fistulotomy. After surgery, the fibrosis (muscles divided) and residual muscles were measured and compared with the pre-operative.  RESULTS:  A total of 73 patients was included. The indication for the LIFT was significantly higher in females (47%), one-stage fistulotomy was significantly higher in the males (46%) and similar in seton placement. The minor postoperative incontinence was identified in 31% of patients underwent sphincter divided and were similar in both genders. The 3D-AUS identified seven failed cases.  CONCLUSION:  The 3D ultrasound was shown to be an effective method in the preoperative assessment of anal fistulas by quantifying the length of muscle to be divided, as the results were similar at the post-operative, providing a safe treatment approach according to the gender and percentage of muscle involvement. Additionally, 3D ultrasound successfully identified the healing tissue and the type of failure or recurrence.<\/jats:p>","DOI":"10.1590\/s0004-2803.201800000-42","type":"journal-article","created":{"date-parts":[[2018,8,4]],"date-time":"2018-08-04T15:36:32Z","timestamp":1533396992000},"page":"18-24","source":"Crossref","is-referenced-by-count":17,"title":["CAN THREE-DIMENSIONAL ANORECTAL ULTRASONOGRAPHY BE INCLUDED AS A DIAGNOSTIC TOOL FOR THE ASSESSMENT OF ANAL FISTULA BEFORE AND AFTER SURGICAL TREATMENT?"],"prefix":"10.1590","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9905-6981","authenticated-orcid":false,"given":"Sthela Maria","family":"MURAD-REGADAS","sequence":"first","affiliation":[{"name":"Universidade Federal do Cear\u00e1,  Brazil; Universidade Federal do Cear\u00e1,  Brazil; Hospital S\u00e3o Carlos,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Sergio P","family":"REGADAS FILHO","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Carlos,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erico de Carvalho","family":"HOLANDA","sequence":"additional","affiliation":[{"name":"Universidade Federal do Cear\u00e1,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara Burlamaqui","family":"VERAS","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Carlos,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adjra da Silva","family":"VILARINHO","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Carlos,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoel S","family":"LOPES","sequence":"additional","affiliation":[{"name":"Universidade Federal do Cear\u00e1,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2018,8,6]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1097\/DCR.0000000000000733","article-title":"Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula","volume":"59","author":"Vogel JD","year":"2016","journal-title":"Dis Colon Rectum"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1046\/j.1463-1318.2001.00241.x","article-title":"Endoanal ultrasound or magnetic resonance imaging for preoperative assessment of anal fistula: a comparative study","volume":"3","author":"Gustafsson UM","year":"2001","journal-title":"Colorectal Dis"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1097\/00042737-200412000-00014","article-title":"Hydrogen peroxide-enhanced three dimensional endoanal ultrasonography and endoanal magnetic resonance imaging in evaluating perianal fistulas: agreement and patient preference","volume":"16","author":"West RL","year":"2004","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1148\/radiol.2333031724","article-title":"Clinical examination, endosonography, and MR imaging in preoperative assessment of fistula in ano: comparison with outcome-based reference standard","volume":"233","author":"Buchanan GN","year":"2004","journal-title":"Radiology"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1007\/DCR.0b013e3181dce163","article-title":"The role of 3-Dimensional anorectal ultrasonography in the assessment of anterior transsphincteric fistula","volume":"53","author":"Murad-Regadas SM","year":"2010","journal-title":"Dis Colon Rectum"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/BF02054434","article-title":"Anal fistula surgery: factors associated with recurrence and incontinence","volume":"39","author":"Garcia-Aguilar J","year":"1996","journal-title":"Dis Colon Rectum"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1007\/BF02257781","article-title":"Continence disorders after anal fistulotomy","volume":"37","author":"van Tets WF","year":"1994","journal-title":"Dis Colon Rectum"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1007\/s10350-008-9354-9","article-title":"Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of criptoglandular origin","volume":"51","author":"Van Koperen PJ","year":"2008","journal-title":"Dis Colon Rectum"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1007\/DCR.0b013e3181a80e24","article-title":"Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery","volume":"52","author":"Roing JV","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF02050307","article-title":"Etiology and management of fecal incontinence","volume":"36","author":"Jorge JMN","year":"1993","journal-title":"Dis Colon Rectum"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.amjsurg.2008.11.002","article-title":"Male cryptoglandular fistula surgery outcomes: a retrospective analysis","volume":"197","author":"Kondylis PD","year":"2009","journal-title":"AmJ Surg"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1007\/BF02052593","article-title":"Is simple fistula-in-ano simple?","volume":"37","author":"Sangwan YP","year":"1994","journal-title":"Dis Colon Rectum"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"2167","DOI":"10.1007\/s10350-005-0199-1","article-title":"Prospective, multicenter evaluation of highly concentrated fibrin glue in the treatment of complex cryptogenic perianal fistulas","volume":"48","author":"Zmora O","year":"2000","journal-title":"Dis Colon Rectum"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1007\/s00464-007-9339-0","article-title":"Anal canal anatomy showed by three-dimensional anorectal ultrasonography","volume":"21","author":"Regadas FSP","year":"2007","journal-title":"Surg Endoscopy"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s00384-008-0444-x","article-title":"The surgical management of fistula-in-ano in a specialist colorectal unit","volume":"23","author":"Davies M","year":"2008","journal-title":"Int J Colorectal Dis"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/j.1463-1318.2008.01713.x","article-title":"Incontinence rates after cutting seton treatment for anal fistula","volume":"11","author":"Ritchie RD","year":"2009","journal-title":"Colorectal 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Coloproctol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1002\/bjs.1800810947","article-title":"Factors affecting continence after surgery for anal fistula","volume":"81","author":"Lunniss PJ","year":"1994","journal-title":"Br J Surg"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s10350-004-6181-5","article-title":"Fecal incontinence severity index after fistulotomy: a predictor of quality of life","volume":"45","author":"Cavanaugh M","year":"2002","journal-title":"Dis Colon Rectum"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/j.1463-1318.2008.01713.x","article-title":"Incontinence rates after cutting seton treatment for anal fistula","volume":"11","author":"Ritchie RD","year":"2009","journal-title":"Colorectal Dis"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1097\/DCR.0b013e31822d7ddd","article-title":"Advancement flap repair: a good option for complex 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