Clinical and diagnostic assessment of Goodsall`s rule in anorectal fistulas

Abstract

The exact identification of the internal opening in the surgical treatment of anorectal fistulae is of basic importance for their radical treatment. The rule of Goodsall enables identification of the internal opening. 184 patients with anorectal fistulae have been studied (145 male è 39 female). According to the type of the fistulae patients were distributed as follows: 86(46.74%) with transsphincteric, 57(30.98%) with extrasphincteric and 41(22.28%) with intrasphincteric. Most of them 126(68.48%) have had posterior external opening, while 58(31.52%) had anterior external opening. The internal opening has been identified in 169(91.85%) cases. The Goodsall`s rule was observed in 131(77.51%) Exception of this rule was registered in 38 patients - 20 cases with transsphincteric fistulae, 12 with extrasphincteric, 5 with re current fistulae and 1 with intersphincteric. 87.30%(110/126) of the posterior anorectal fistulae fulfilled the rule of Goodsall, while the anterior ones this rule was observed in 33/58(56.90%). From the cases with intersphincteric fistulae in 97.56 % there is match with the rule of Goodsall. The Goodsall`s rule predicts the position of the internal opening, according to the localization of the external opening. Exceptions of this rule were in the anterior fistulae and lying more than 3 cm from the anus /sensitivity of 56.90 %/. The Goodsall`s rule demonstrates highest informativity in posterior fistulae/sensitivity was 87.30 %/.