PMID- 33517706
OWN - NLM
STAT- MEDLINE
DCOM- 20220526
LR  - 20220526
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 88
IP  - 6
DP  - 2022 Jun
TI  - Transanal Opening of Intersphincteric Space for Fistula-in-Ano.
PG  - 1131-1136
LID - 10.1177/0003134821989048 [doi]
AB  - BACKGROUND: The role of the intersphincteric space in the pathogenesis of 
      fistula-in-ano is being increasingly recognized. Submucosal and intersphincteric 
      rectal abscesses have been surgically managed by laying open and draining the 
      intersphincteric space as well as by the modified ligation of intersphincteric 
      fistula tract (LIFT) procedure. In 2017, the transanal opening of 
      intersphincteric space (TROPIS) technique was reported for the treatment of high, 
      complex anal fistulae. AIM: We aim to investigate the advantages of performing 
      the TROPIS procedure in patients with fistula-in-ano. METHODS: This was a 
      prospective cohort study investigating the outcomes in patients who had undergone 
      a procedure using the TROPIS technique for the treatment of fistula-in-ano. 
      Preoperative magnetic resonance imaging scans and electronic colonoscopies were 
      performed on all patients. A clinical database evaluating the following variables 
      was constructed: age, gender, body mass index (BMI), previous fistula surgery, 
      type of fistula, postoperative complications, duration of follow-up, success 
      rate, and incontinence scores pre- and postoperatively. RESULTS: The TROPIS 
      procedure was performed on 41 patients with fistula-in-ano with a follow-up time 
      of 6-23 months. The characteristics of the patients were as follows: 36 males, 6 
      females, mean age 38.6+/-13.2 years, and mean BMI 23.5+/-3.9 kg.m(-2). All patients 
      (41) had transsphincteric fistulae, and 90.2% (37) had high fistula. Of the 41 
      patients, 22% (9) had recurrent fistulae, 29.27% (12) had horseshoe fistulae, 
      7.3% (3) had supralevator fistulae, and 14.6% (6) had an associated abscess. The 
      fistula healed completely in 85.3% (35) of patients and failed to heal in 14.7% 
      (6) of patients, and the healing of high fistula was 86.5% (32). Of those 
      patients who had not healed completely, 2 were found to have contracted 
      iatrogenic infections due to foreign residues and underwent surgery with the 
      passing of a loose seton. The additional 4 patients who had not healed underwent 
      a fistulotomy and healed completely thereafter. There were no significant changes 
      in incontinence scores. The incontinence scores were .15 +/- .36 preoperatively and 
      .22 +/- .47 3 months postoperatively (t = -1.438, P = .16). CONCLUSIONS: The TROPIS 
      technique is a novel sphincter-preserving procedure, which can be effectively 
      used in treating fistula-in-ano.
FAU - Li, Yu-Bo
AU  - Li YB
AD  - Colorectal Surgery Division, 248924The First Affiliated Hospital of Guangxi 
      University of Chinese Medicine, Nanning, Guangxi, China.
FAU - Chen, Ju-Hua
AU  - Chen JH
AD  - Colorectal Surgery Division, 105809Affiliated Hospital of Jinggangshan 
      University, Ji'an, Jiangxi, China.
FAU - Wang, Meng-di
AU  - Wang MD
AD  - Colorectal Surgery Division, 248924The First Affiliated Hospital of Guangxi 
      University of Chinese Medicine, Nanning, Guangxi, China.
FAU - Fu, Jun
AU  - Fu J
AD  - Colorectal Surgery Division, 248924The First Affiliated Hospital of Guangxi 
      University of Chinese Medicine, Nanning, Guangxi, China.
FAU - Zhou, Bing-Chuan
AU  - Zhou BC
AD  - Colorectal Surgery Division, 248924The First Affiliated Hospital of Guangxi 
      University of Chinese Medicine, Nanning, Guangxi, China.
FAU - Li, De-Gang
AU  - Li DG
AD  - Colorectal Surgery Division, 248924The First Affiliated Hospital of Guangxi 
      University of Chinese Medicine, Nanning, Guangxi, China.
FAU - Zeng, Hai-Qing
AU  - Zeng HQ
AD  - Colorectal Surgery Division, 248924The First Affiliated Hospital of Guangxi 
      University of Chinese Medicine, Nanning, Guangxi, China.
FAU - Pang, Li-Ming
AU  - Pang LM
AD  - Colorectal Surgery Division, The People Hospital of Guangxi Zhuang Autonomous 
      Region, Nanning, Guangxi, China.
LA  - eng
PT  - Journal Article
DEP - 20210130
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
CIN - Am Surg. 2022 Feb;88(2):319-320. PMID: 33847169
MH  - Abscess/etiology
MH  - Anal Canal/surgery
MH  - *Anus Diseases/etiology
MH  - Female
MH  - Humans
MH  - Ligation/methods
MH  - Male
MH  - Prospective Studies
MH  - *Rectal Fistula/etiology/surgery
MH  - Recurrence
MH  - Treatment Outcome
EDAT- 2021/02/02 06:00
MHDA- 2022/05/27 06:00
CRDT- 2021/02/01 05:29
PHST- 2021/02/02 06:00 [pubmed]
PHST- 2022/05/27 06:00 [medline]
PHST- 2021/02/01 05:29 [entrez]
AID - 10.1177/0003134821989048 [doi]
PST - ppublish
SO  - Am Surg. 2022 Jun;88(6):1131-1136. doi: 10.1177/0003134821989048. Epub 2021 Jan 
      30.