Reyes Díaz María Luisa, Hinojosa-Ramirez Fatima, Ramallo Solís Irene María, Jiménez Rodríguez Rosa María, Tortolero Jose Pintor, García Cabrera Ana María, Vázquez Monchul Jorge M, Portilla de Juan Fernando de la
Associate Professor at the University of Seville, Specialist Area Faculty of the Department of General and Digestive Surgery, Specialised Coloproctology Unit, Virgen del Rocío University Hospital, Seville, Spain.
Department of General and Digestive Surgery, Specialised Coloproctology Unit, Virgen del Rocío University Hospital, Seville, Spain.
Cir Esp (Engl Ed). 2025 Mar;103(3):135-142. doi: 10.1016/j.cireng.2024.12.001. Epub 2024 Dec 17.
It is a priority to find surgical techniques that guarantee acceptable healing rates without sequelae in the treatment of complex anal fistula. The concept of the deep intersphincteric space as the origin of perianal sepsis has provided a new perspective, allowing the emergence of techniques such as TROPIS (Transanal Opening of Intersphincteric Space), with few published series to date. The aim of this study is to evaluate the healing rate and complications one year after the TROPIS technique as a treatment for complex anal fistula without hospitalization.
Prospective, observational study from January 2021 to January 2023. Patients with complex anal fistulas who met the inclusion criteria were treated using the TROPIS technique. A one-year follow up review was conducted, assessing healing rates, recurrence, continence, and complications.
A total of 23 patients with cryptoglandular complex perianal fistula were included (87% male, mean age 54.7 ± 9.6 years). 78.3% were treated for recurrent fistulas with an average of 3.3 ± 3.2 previous interventions. At one month, 82.6% of the patients had complete healing. At three, six, and twelve months, complete healing occurred in 63.6%, 61.9%, and 55.6%, respectively. One patient developed an abscess at one month. Continence was altered in 8.7%.
The treatment of cryptoglandular complex anal fistula with this procedure was safe and showed acceptable healing rates.
在复杂肛瘘的治疗中，找到能保证可接受的愈合率且无后遗症的手术技术是当务之急。将深部括约肌间间隙视为肛周脓毒症起源的概念提供了一个新视角，使得诸如经肛门括约肌间间隙开放术（TROPIS）等技术得以出现，不过迄今为止发表的系列报道较少。本研究的目的是评估TROPIS技术作为复杂肛瘘非住院治疗方法一年后的愈合率和并发症情况。
2021年1月至2023年1月的前瞻性观察性研究。符合纳入标准的复杂肛瘘患者采用TROPIS技术进行治疗。进行了为期一年的随访复查，评估愈合率、复发情况、控便能力和并发症。
共纳入23例腺源性复杂肛周肛瘘患者（87%为男性，平均年龄54.7±9.6岁）。78.3%的患者因复发性肛瘘接受治疗，之前平均接受过3.3±3.2次干预。在1个月时，82.6%的患者实现完全愈合。在3个月、6个月和12个月时，完全愈合率分别为63.6%、61.9%和55.6%。1例患者在1个月时出现脓肿。8.7%的患者控便能力发生改变。
采用该手术方法治疗腺源性复杂肛瘘是安全的，且显示出可接受的愈合率。
