Impact of Diagram-assisted MRI Fistulogram on Surgical Outcomes in Fistula-in-ano: A Retrospective Comparative Study

Background and Aims: Magnetic resonance imaging (MRI) Fistulogram plays a pivotal role in the preoperative assessment of fistula-in-ano. However, variability in MRI interpretation and limited radiology-surgery communication may adversely affect surgical planning and outcomes. This study evaluated the impact of diagram-assisted contrast-enhanced MRI (CE-MRI) fistulogram with diffusion-weighted imaging on surgical outcomes in patients with complex fistula-in-ano. Methods: A retrospective comparative study was conducted, including patients with fistula-in-ano managed at a tertiary care centre. Patients were divided into two groups: diagram-assisted versus conventional reports. Operative findings, MRI-surgical concordance, operative time, postoperative complications and recurrence rates were compared between the two groups. Results: Sixty patients were included. Diagram-assisted MRI reporting demonstrated significantly higher MRI-surgical concordance and reduced mean operative time. Postoperative complications were fewer in the diagram-assisted group. Recurrence rates were lower in the diagram-assisted group (10% vs. 18%); however, this difference did not reach statistical significance. Conclusion: Diagram-assisted CE-MRI fistulogram improves radiological-surgical concordance and operative efficiency. Incorporation of schematic reporting may enhance surgical planning in complex fistula-in-ano.