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. 2021 Dec;16(4):697-703.
doi: 10.5114/wiitm.2021.104368. Epub 2021 Mar 11.

Treating highly complex anal fistula with a new method of combined intraoperative endoanal ultrasonography (IOEAUS) and transanal opening of intersphincteric space (TROPIS)

Baolei Huang  1 , Xu Wang  1 , Dongxu Zhou  1 , Si Chen  1 , Bai Li  1 , Yilin Wang  1 , Jiandong Tai  1
Affiliations
Free PMC article

Treating highly complex anal fistula with a new method of combined intraoperative endoanal ultrasonography (IOEAUS) and transanal opening of intersphincteric space (TROPIS)

Baolei Huang et al. Wideochir Inne Tech Maloinwazyjne. 2021 Dec.
Free PMC article

Abstract

Introduction: Treatment of highly complex anal fistula is still a profound test for a specialist colorectal surgeon. The reasons are directly related to recurrence and incontinence.

Aim: To evaluate the clinical results of a combined method of intraoperative endoanal ultrasonography (IOEAUS) and transanal opening of the intersphincteric space (TROPIS).

Material and methods: This study retrospectively included 48 patients with complex anal fistula, all of whom underwent new surgical methods. This operation mainly consists of two steps. Firstly, the type of anal fistula was determined by endoanal ultrasonography (EAUS) or magnetic resonance imaging (MRI) before the operation. Then the TROPIS procedure was performed with the help of EAUS, and the decision on whether a drainage seton should be placed depended on the condition of the tract. If there were secondary tracts, they were found and the same was done.

Results: The median follow-up was 12 months. Two (4.1%) patients experienced recurrence. Four (8.3%) patients did not have primary healing. All 6 patients underwent the same procedure again, and three recovered completely. So total successful fistula healing was observed in 45 (93.7%). There were no major complications and no significant deterioration in anal function and incontinence postoperatively.

Conclusions: Combined IOEAUS and TROPIS is an effective procedure in the treatment of highly complex anal fistula, and it may offer a new means for other operations.

Keywords: anal fistula; fecal incontinence; recurrence; transanal opening of intersphincteric space (TROPIS); ultrasonography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CONSORT flowchart showing the flow of patients through the trial
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