High complex anal fistula managed by the modified transanal opening of the intersphincteric space via the inter-sphincteric approach: A case report.

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING World journal of radiology Pub Date : 2024-10-28 DOI:10.4329/wjr.v16.i10.552
Ya-Qun Wang, Yan Wang, Xiao-Feng Jia, Qiao-Jing Yan, Xue-Ping Zheng
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Abstract

Background: 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.

Case summary: 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.

Conclusion: 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 via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.

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通过括约肌间入路经肛门打开括约肌间隙的改良方法治疗高位复杂性肛瘘:病例报告。
背景:高位复杂性肛瘘是上皮化隧道,主瘘管穿出深外括约肌上方,内口接近齿状线。治疗高位复杂性肛瘘的传统手术会切除大部分外括约肌,并损伤肛门直肠环。术后肛门功能丧失会造成身心伤害。经肛门打开括约肌间隙(TROPIS)是一种有效的手术方法,可完全保留肛门外括约肌。然而,由于瘘管内口的定位难题和并发症的高风险,其临床应用受到了限制。病例摘要:一名患有位于肛门直肠环上方的高位复杂性肛瘘的患者接受了改良TROPIS术,其中包括脓液引流和在括约肌间隙确定内口。高位复杂性肛瘘患者术后恢复良好,未出现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:结论:改良 TROPIS 手术是治疗肛瘘的最微创手术,对肛门功能的影响极小。结论:改良 TROPIS 手术是治疗肛瘘的最微创手术,对肛门功能的影响最小,它可以完全切除受感染的肛腺,降低术后并发症的风险。经括约肌间入路的改良TROPIS手术是治疗高位复杂性肛瘘的另一种保留括约肌的治疗方法。
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来源期刊
World journal of radiology
World journal of radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
自引率
8.00%
发文量
35
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