Application Of Good’sall Rule in Identification of Fistula-In-Ano Direction in Al-Khadra Hospital, Tripoli: Prospective Case Series Study

Abstract

Background and objective. Successful treatment of fistula-in-ano is sometimes challenging due to difficulty in recognizing the internal opening and the course of the fistula tract. Although Goodsall’s rule was accepted in the past, as a method to determine the course of the fistula, recent data have shown conflicting results. However, over the last century, published reports support the midline as the primary (internal) origin of all anal fistulas, thus challenging the predictive accuracy of Goodsall’s Rule and prompting this expansive review. This study aimed to predict the value of goodsall’s rule in describing the relationship of external opening to internal one in the case of fistula-in-ano. Method. A sample of 46 patients with simple fistulae was studied. Hydrogen peroxide was injected through the external opening and the appearance of air bubbles in the anal canal indicated the location of the internal opening. The morphological parameters including the site and number of internal and external opening/s and the course of the tract were recorded. Results. The median age of the participants was 36 (range, 19_ 69) years. The majority (n=37, (80.4%) were males. The overall predictive accuracy of Goodsall’s rule in our patients was (61%). Predictive accuracy was significantly associated with the distance between the external openings and the anal verge with high predictive accuracy seen when this distance was less than 3 cm (69.6%). Predictive accuracy was significantly higher in those with an anterior external opening (71.7%). Conclusion. Although Goodsall’s rule was not accurate in (39%) of all fistulae, it can be used as a guide in locating the fistula