Observational studyTechniques in coloproctology2022
Three-dimensional endoanal ultrasound to assess the validity of Goodsall's Rule and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening.
Observational study in Techniques in coloproctology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 9 citations in OpenAlex.
- Transperineal ultrasonography with a high-frequency probe and a three-dimensional end-fire probe for imaging perianal abscesses and locating the internal openings of anal fistulas.Diagnostic and interventional radiology (Ankara, Turkey) · 2026Article
- Accurate Localization of the Internal Opening in a Cryptoglandular Anal Fistula: Complementary Roles of Goodsall's Rule, MRI, and Intraoperative Assessment: A Case Report.Case reports in surgery · 2026Article
- Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study.International journal of colorectal disease · 2025Observational
- Accuracy prediction of Goodsall's rule for anal fistulas of crypotogladular origin, is still standing?Annals of medicine and surgery (2012) · 2024Article
- [34/f-Perianal swelling and pain : Preparation for the medical specialist examination: part 49].Chirurgie (Heidelberg, Germany) · 2023Article
- Anal fistula, there is more than meets the eye!Techniques in coloproctology · 2022Article
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCorrect identification of the internal opening is essential in the management of perianal fistulae. The aim of this study was to assess the validity of Goodsall's Law and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening using 3-dimensional endoanal ultrasound.
methodsAn observational study including patients diagnosed with fistula-in-ano, at our institution from January 2006 to December 2020 was performed. Location and distance from the anal verge of the external opening, internal opening, and the path of the fistulous tract were recorded during physical examination and endoanal ultrasound. Goodsall's and Midline rules were applied to all fistulae according to the location of the external opening. The location of the internal opening as predicted by either rule was then compared to the real location of the internal opening identified during endoanal ultrasound examination.
resultsNine hundred and nine patients [657 (72.3%) males, mean age 50.78 (49.84-51.72) years] were included. 665 (73.2%) of fistulae were transsphinteric. Concordance between predicted internal opening site and the true internal opening location was 0.601 (good match) for Goodsall's rule, and 0.416 (moderate match) for the Midline rule. Goodsall's rule proved to be more predictive in the anterior plane (p < 0.001). Both rules were more likely to make a correct diagnosis in posterior fistulae located 4.5-7.5 mm from the anal verge.
conclusionsBoth Midline and Goodsall's rules are highly predictive of the course of fistula tracts located in the posterior plane, and are lower for anterior located fistulae, female patients and when the external opening is located further from the anal verge.
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