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Research Paper | Medical Surgical | India | Volume 12 Issue 4, April 2023 | Rating: 4.9 / 10

Predictive Accuracy of Goodsall's Rule for Fistula-in-Ano in Current Scenario

Dr. Subashmehta .K | Dr. R. Sivasubramanian | Dr. F. R. Jenitta Little Sophy | Dr. B. M. Pabithadevi

Abstract: Introduction: Fistula-in-ano is very challenging for a surgeon to treat, because of its complexity in identifying the tract, and this can be achieved only by knowing the primary and secondary opening. The Goodsall's rule enables identification of the internal opening whether anterior or posterior with relation to its external opening. High complication rates after the surgery are due to the presence of secondary paths or flaws in the identification of the primary internal opening. So, there is a necessity in assessing the Goodsall's rule with modern imaging techniques. Objectives: To estimate the predictive accuracy of Goodsall's Rule for Fistula-in-ano. Methods: Thorough clinical history, per rectal examination, proctoscopy, MRI fistulogram and Surgery Results: The predictive accuracy of Goodsall's rule is 64%. Out of 45 patients, 29 patients obeyed Goodsall's rule, 16 patients did not obey Goodsall's rule.16 patients had anterior fistula of which 13 patients obeyed Goodsall's rule which constitutes 81.3% of patients, 26 patients had posterior fistula of which 15 patients obeyed Goodsall's rule which constitutes 57.7% and 3 patients had both anterior and posterior fistulas of which 1 patient obeyed Goodsall's rule. Conclusion: Our study shows Goodsall's rule is of limited use for pre-operative planning of perianal fistula. Goodsall's rule is mostly applicable for anterior fistulous openings, perianal fistula that are closer to the anal verge and with internal openings in their midline. Pre-operative MR fistulogram identifies the internal openings, secondary tracts, relation of the fistulous tract with the anal sphincters precisely.

Keywords: Fistula in ano, Park classification, Goodsall?s rule, MR Fistulogram, St.James university Classification

Edition: Volume 12 Issue 4, April 2023,

Pages: 688 - 690