Wang Ya-Qun, Wang Yan, Jia Xiao-Feng, Yan Qiao-Jing, Zheng Xue-Ping
Anorectal Disease Center, Jiangsu Province traditional Chinese Medicine Innovation Center for Anorectal Disease, Nanjing 211000, Jiangsu Province, China.
Department of Anorectal Surgery, Zhenjiang Hospital Affiliated to Nanjing University of Chinese Medicine (Zhenjiang Hospital of Traditional Chinese Medicine), Zhenjiang 212000, Jiangsu Province, China.
World J Radiol. 2024 Oct 28;16(10):552-560. doi: 10.4329/wjr.v16.i10.552.
High complex anal fistulas are epithelialized tunnels, with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line. Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring. Postoperative loss of anal function can cause physical and mental damage. Transanal opening of the intersphincteric space (TROPIS) is an effective procedure that completely preserves the external anal sphincter. However, its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications. On the basis of our clinical experience, we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.
A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS, which involved sepsis drainage and identification of the internal opening in the intersphincteric space. The patient with the high complex anal fistula recovered well postoperatively, without any postoperative complications or anal dysfunction. Anal function returned to normal after 17 months of follow-up.
The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function. It allows the complete removal of infected anal glands and reduces the risk of postoperative complications. Modified TROPIS the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.
高位复杂性肛瘘是上皮化的管道，主瘘管在深部外括约肌上方穿过，内口靠近齿状线。高位复杂性肛瘘的传统手术方法会切除大部分外括约肌并损伤肛管直肠环。术后肛门功能丧失会造成身心损害。经肛门括约肌间间隙开放术（TROPIS）是一种能完全保留肛门外括约肌的有效术式。然而，其临床应用受到肛瘘内口定位困难和并发症风险高的限制。基于我们的临床经验，我们对TROPIS手术进行了改良以治疗高位复杂性肛瘘。
一名高位复杂性肛瘘位于肛管直肠环上方的患者接受了改良TROPIS手术，该手术包括脓肿引流和在括约肌间间隙识别内口。该高位复杂性肛瘘患者术后恢复良好，无任何术后并发症或肛门功能障碍。随访17个月后肛门功能恢复正常。
改良TROPIS手术是对肛门功能损害最小的肛瘘微创手术。它能彻底清除感染的肛腺并降低术后并发症风险。改良TROPIS括约肌间入路是高位复杂性肛瘘一种保留括约肌的替代性治疗方法。
