 Good morning, my name is Dr. Akash from MNR Medical College and the hospital. My topic for paper presentation is role of EMR fish program in preoperative assessment of anorectal fish loss and surgical coordination background and overview anorectal fish loss are a group of pathological conditions affecting thermal part of GIT at the radium. The dentite line of anal canal consists of anal glands in anal crypts. Anal canal is surrounded by the internal ideology of fish loss is obstruction of anal glands. The anorectal fish loss can be fallen types like inter-spin type, trans-spin type, extra-spin type or super-spin type. Magnetic resonance imaging plays a key role in preoperative assessment and helps in recognition of fish loss tracks, secondary infections and relationship of fish loss with the anal splinter complex. Aims and objectives process the role of EMR fish diagram in preoperative assessment of anorectal fish loss to point out the fish loss tracks internal openings under the relationship of perian fish loss with the anal splinter complex to recognize the secondary tracks and other complications like abscesses and to grade the fish loss as per St. James University Hospital classification. To correlate EMR findings with interoperative findings methodology, study design is a cross-section of study design, study place, department of radiology, department of general surgery, MNR medical college, inclusion of the area, all the patients with primary anorectal fish delay, attending department of radiology diagnosis, MNR medical college, patients clinically diagnosed as having perianal fish delay, deferred for EMR imaging by the surgery department. Inclusion criteria, patients with aneurysmal clips or intraorbital fragments and electrically or mechanically activated implants including cardiac base makers, bio stimulators, neuro stimulators, cochlear implants and hearing aids within the body and other contraindications of EMR imaging to be excluded. Patients with claustrophobia, postoperative patients and pregnant patients are also excluded. St. James University Hospital classification, Grade A diagram we are showing interspindal fish loss and diagram we show you interspindal fish loss with horseshoe extension. Diagram three that is C, E showing interspindal fish loss with interspindal papses, B shows transplateric fish delay and E transplanted spintaric fistula with ischial anal papses that is here and grade five is supra elevator extension. This is a, this is a diagram EMR images of patient one corona t2 images showing supra spintaric fistula that is grade five. Here is a supra spintaric fistula and here is an external opening. This is a patient two axiom t2 and steel images showing transplateric fistula. Here is a fish loss chart opening outside and patient three showing the corona t2 image which is a interspindal fish loss that is grade one and here is a fish loss chart. It is an external opening. Results, demographic characteristics age less than 30 years, 31 years, 31 to 40, 41 to 50, 51 to 60, more than 60 years is taken account. Total number of patients is given 7, 20, 19, 8 and 6 respectively. Six of the patients, main patients are 39 and female are 21. External openings, number of patients and percentage, single external opening showing is seen in 50 patients that is approximately 86.67 percentage and multiple external openings is seen in 8 patients. Seen in 51, single internal opening is seen in 51 patients, multiple internal openings are seen in 6 patients and others include 3. Secondary traps, number in 16 patients and absent in 44 patients, number of patients with secondary traps based on surgical findings are 20 and absent are 40. A marine surgery concordance is 80% sensitivity and 100% specificity. Secondary traps, grade one fish loss has approximately 20 patients and grade two is seen in 11 patients. Grade four is seen in 8 patients, grade five is seen in 5 patients. Same chance gradient with according to age distribution that is less than 30 years, 31 to 40, 41 to 50, 51 to 60 and more than 60 years. Grade one is seen in 3, 4, 8, 3, 2 of age respectively and grade two is seen in 0, 6, 2, 1, 2, grade 3 is seen in 4, 3, 7, 1, 1, grade 4 is seen in 0, 6, 1, 1, 0, grade 5 is seen in 0, 1, 1, sentence grade according to and a sex distribution of patients, grade 1 is seen in 13 men and 3 is seen in 7 females, grade 2 is seen in 5 men and 6 females, grade 3 is seen in 12 men and 4 females, grade 4 is seen in 5 men, grade 5 is seen in 4 men and 1 female. Now, sentence grade and number of patients surgical correlation in grade one approximately 30, grade one fish loss and surgical correlation is 100%, grade 2 has seen in 11 patients, surgical correlation is also 100% here, grade 3 is seen in 6 patients and surgical correlation is 99%, grade 4 is seen in 8 patients which is seen in 100 patients, grade 5 is seen in 5 patients which is seen in 99% patients. Now, sentence grade and category, number of graded patients graded as per UNA, number of patients with concordant surgical findings, number of patients not operated and UNA surgical concordance and grade 1 is seen in 20 patients graded as per UNA, and surgical findings are 15, 4 patients preoperative categories as grade 2, number of patients not operated is 1, MRI and surgical concordance sensitivity is 100% specificity is 91.66%, grade 2 shows seen in 11 patients as per UNA and surgical concordance findings are seen in 11 patients and number of patients not operated is 0, sensitivity and specificity both are 100% here, grade 3 is seen in 16%, 16 patients, number of patients with concordant surgical findings are 15, number of patients not operated as 1, surgical MRI concordance is sensitivity and specificity of 100%, grade 4 seen in 8 patients as per UNA findings and surgical concordance are 8 and sensitivity and specificity is 100%, grade 5, number of patients as per UNA reading is 5 and number of patients with surgical findings are 4, one patient is not operated and sensitivity and specificity is 100% here. Correlation between the MRI findings and surgical findings was significant in the study with a P value of 0.008. Discussion, a total of 60 patients who were referred for the MRI fission program to MNR particular biology hospital, they were followed up to surgery and the operator findings were correlated with the preoperative MRI findings. 60 patients included in the study, 39 patients were MN, is 65% and 21 patients were MN that is 35%, among the 60 patients included in the study group, the most prevalent type of fission was inter-sputtering type followed by intran-sputtering type. In our study, when the fission was tracked and analyzed, majority of the patients that is 52 out of 60 had a sequence and analyzing when analyzing the internal opening, it was single in majority of patients and the operator findings were well correlated with the study with regard to the site of opening. The study where young and fish class are classified on the basis of Saint James University Hospital classification, this revealed that grade 1 fish class were commonest which was following 20 patients, the second most common type is grade 3 fish class which was following 16 patients, among those that were inside famous inter-sputtering fish class that is grade 1 or commonest followed by trans-sputtering type that is grade 3. In our study, it was observed that inter-sputtering and trans-sputtering fish class are common in the age group of 30 to 50 years, extra-sputtering fish class secondary to other etymologies are common in age group above 40. In our study, 16 out of 60 patients had secondary cracks in our study, abscesses were identified in 11 out of 60 patients. Conclusions vary under fission, though an uncommon problem may be chronic and recurrent, it may present numerous complications like secondary cracks and abscess cavities. In complete evaluation of these complications can result in a residual and recurrent disease, so complete pre-operative evaluation of perianal fission is warranted also to prevent the injury to external organs and resulted fecal incontinence. It is necessary to establish the relationship of splinter with the fission of slag, the MRA satisfies all these needs of surgeons and helps in planning of surgery. MRA provides either anatomic details of fission and also identifies secondary cracks and abscesses, correct identification of perianal fission and proper planning of fission are necessary for ensuring optimum surgical outcome. The references. Thank you. Thank you for providing this opportunity.