A comparative analysis of MRI fistulography and X-ray fistulography correlated with operative findings in the management of fistula in Ano

Background

Fistula in ano is a chronic anorectal condition whose surgical success depends on accurate preoperative mapping of the primary tract, internal opening, secondary extensions and abscesses. X-ray fistulography is inexpensive and widely available but has poor soft-tissue resolution, whereas MRI fistulography offers superior anatomical detail. Aims and Objective: To compare the diagnostic accuracy of MRI and X-ray fistulography in delineating fistula-in-ano anatomy using operative findings as the reference standard, and to assess their impact on postoperative complications and recurrence. Materials and Methods: This hospital-based comparative observational study was conducted in the Department of General Surgery, Maharani Laxmi Bai Medical College, Jhansi, from April 2025 to March 2026. Ninety-two adult patients with fistula in ano scheduled for surgery were evaluated by MRI fistulography (n=42) or X-ray fistulography (n=50), and imaging findings were correlated with intraoperative observations. Data were analysed using descriptive statistics and the Chi-square test; p<0.05 was considered significant.