Dawka Sushil, Yagnik Vipul D, Kaur Baljit, Menon Geetha R, Garg Pankaj
Department of Surgery, SSR Medical College, Belle Rive, Mauritius.
Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Center, Patan, India.
Ann Coloproctol. 2024 Oct;40(5):490-497. doi: 10.3393/ac.2022.00346.0049. Epub 2022 Oct 11.
Complex anal fistulas can recur after clinical healing, even after a long interval which leads to significant anxiety. Also, ascertaining the efficacy of any new treatment procedure becomes difficult and takes several years. We prospectively analyzed the validity of Garg scoring system (GSS) to predict long-term fistula healing.
In patients operated for cryptoglandular anal fistulas, magnetic resonance imaging was performed preoperatively and at 3 months postoperatively to assess fistula healing. Scores as per the GSS were calculated for each patient at 3 months postoperatively and correlated with long-term healing to check the accuracy of the scoring system.
Fifty-seven patients were enrolled, but 50 were finally included (7 were excluded). These 50 patients (age, 41.2±12.4 years; 46 men) were followed up for 12 to 20 months (median, 17 months). Forty-seven patients (94.0%) had complex fistulas, 28 (56.0%) had recurrent fistulas, 48 (96.0%) had multiple tracts, 20 (40.0%) had horseshoe tracts, 15 (32.0%) had associated abscesses, 5 (10.0%) were suprasphincteric, and 8 (16.0%) were supralevator fistulas. The GSS could accurately predict long-term healing (high positive predictive value, 31 of 31 [100%]) but was not very accurate in predicting nonhealing (negative predictive value, 15 of 19 [78.9%]). The sensitivity in predicting healing was 31 of 35 (88.6%).
GSS accurately predicts long-term fistula with a high positive predictive value (100%) but is less accurate in predicting nonhealing. This scoring system can help allay anxiety in patients and facilitate the early validation of innovative procedures for anal fistulas.
复杂肛瘘在临床愈合后可能复发，即使在很长一段时间后也会导致严重焦虑。此外，确定任何新治疗方法的疗效都很困难，需要数年时间。我们前瞻性分析了加尔格评分系统（GSS）预测肛瘘长期愈合的有效性。
对行隐窝腺性肛瘘手术的患者，在术前及术后3个月进行磁共振成像，以评估肛瘘愈合情况。术后3个月为每位患者计算GSS评分，并与长期愈合情况进行关联，以检验评分系统的准确性。
共纳入57例患者，但最终纳入50例（排除7例）。这50例患者（年龄41.2±12.4岁；男性46例）随访12至20个月（中位数17个月）。47例（94.0%）为复杂肛瘘，28例（56.0%）为复发性肛瘘，48例（96.0%）有多条瘘管，20例（40.0%）有马蹄形瘘管，15例（32.0%）伴有脓肿，5例（10.0%）为括约肌上肛瘘，8例（16.0%）为肛提肌上肛瘘。GSS能够准确预测长期愈合（高阳性预测值，31/31[100%]），但在预测未愈合方面不太准确（阴性预测值，15/19[78.9%]）。预测愈合的敏感性为35例中的31例（88.6%）。
GSS能以高阳性预测值（100%）准确预测肛瘘长期愈合情况，但在预测未愈合方面准确性较低。该评分系统有助于缓解患者焦虑，并促进肛瘘创新治疗方法的早期验证。
