The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results.

IF 3 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Coloproctology Pub Date : 2024-10-01 Epub Date: 2023-03-31 DOI:10.3393/ac.2022.01018.0145
Shrivats Mishra, Dileep S Thakur, Uday Somashekar, Amrendra Verma, Dhananjay Sharma
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Abstract

Purpose: Many methods have been used to treat complex fistulas, but no single technique has been considered standard. Damage to the sphincter may sometimes be unavoidable, and incontinence may be an important cause of morbidity. This study aimed to validate the results of transanal opening of the intersphincteric space (TROPIS), as a technique that avoids damaging the anal sphincter, in patients with complex fistula in ano.

Methods: A prospective study was conducted among 35 consecutive patients with complex fistula in ano. After a preoperative magnetic resonance fistulogram, TROPIS was performed in all patients. The St. Mark's incontinence score was assessed preoperatively and postoperatively at 3 months.

Results: The tracts were intersphincteric in 16 patients, transsphincteric in 10, extrasphincteric in 2, and horseshoe in 3. Four patients had recurrent tracts (3 transsphincteric and 1 intersphincteric). A defined follow-up schedule was used. Curettage was done if postoperative pus drainage from the wound was noted. The fistula healed in 29 patients (82.89%) following TROPIS. The remaining 6 patients received curettage, with healing in 3 (overall healing rate, 91.4%). Patients who received curettage were followed for 3 months, and the outcome was labeled as healed or failed. The mean preoperative incontinence score was 0. One patient developed incontinence to gas postoperatively in week 2, but there was no significant change in the scores at 3 months postoperatively. The mean postoperative incontinence score was 0.02.

Conclusion: TROPIS is an effective method for the treatment of complex fistula in ano, with minimal risk for incontinence.

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通过经肛门开放括约肌间隙(TROPIS)治疗阿诺复杂性瘘管:短期效果。
目的:治疗复杂性瘘管的方法很多,但没有一种技术被认为是标准的。对括约肌的损伤有时可能无法避免,而尿失禁可能是发病的重要原因。本研究旨在验证经肛门括约肌间隙开放术(TROPIS)的效果,该技术可避免损伤肛门括约肌,适用于肛门复杂性瘘管患者:对连续 35 例复杂性肛瘘患者进行了前瞻性研究。在术前磁共振瘘管造影后,对所有患者进行了 TROPIS 术。术前和术后 3 个月对圣马克尿失禁评分进行评估:结果:16 例患者的尿道为括约肌间型,10 例为跨括约肌型,2 例为括约肌外型,3 例为马蹄型。4名患者的肠道复发(3例为跨括约肌型,1例为括约肌间型)。采用了明确的随访时间表。如果术后发现伤口有脓液流出,则进行刮宫。29 名患者(82.89%)在接受 TROPIS 术后瘘管愈合。其余 6 名患者接受了刮除术,其中 3 人痊愈(总痊愈率为 91.4%)。对接受刮宫术的患者进行了为期 3 个月的随访,并将结果标记为愈合或失败。一名患者在术后第 2 周出现排气失禁,但术后 3 个月的评分没有明显变化。术后尿失禁平均得分为 0.02:TROPIS是治疗肛门复杂性瘘管的有效方法,尿失禁风险极低。
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CiteScore
3.30
自引率
3.20%
发文量
73
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