Z J Zhang, M S Ali, R Hegde, R H Jugo, T A Zhang, S H Kurtzman
{"title":"改良的经肛门打开括约肌间隙（TROPIS）：与结扎括约肌间瘘管束（LIFT）相比，一种安全有效的经括约肌内瘘手术。","authors":"Z J Zhang, M S Ali, R Hegde, R H Jugo, T A Zhang, S H Kurtzman","doi":"10.1007/s10151-025-03193-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>For treating complex transsphincteric fistula, a two-stage approach is usually administered: an initial seton placement followed by a sphincter-sparing procedure. However, success rates are not optimal. This study aimS to describe the modified transanal opening of the intersphincteric space (TROPIS), a single-staged procedure for managing transsphincteric fistula with or without concurrent anorectal abscess, and to compare its efficacy with the LIFT.</p><p><strong>Methods: </strong>Thirty-six patients who presented with mid-high transsphincteric fistula with or without associated anorectal abscess and consented to the procedure from 2020 to 2023 were managed with modified TROPIS. The primary outcome measures were recurrent fistulas and fecal continence. These results were compared with our previous study data of 24 patients who underwent LIFT procedure from 2011 to 2013.</p><p><strong>Results: </strong>Thirty-six patients received modified TROPIS; nine (25.0%) had an associated ischiorectal abscess. At the 8-month and 14-month follow-up, zero patients experienced fistula recurrence or fecal incontinence. In comparison with our previous study, 24 patients with transsphincteric fistula with or without associated abscess were treated with initial seton placement, then LIFT. With a follow-up range of 14-36 months, five (20.8%) patients presented with recurrent fistulas; no patients experienced fecal incontinence. These results were statistically significant.</p><p><strong>Conclusions: </strong>Our results reflect that modified TROPIS is a safe, simple, and effective procedure for treating patients with transsphincteric fistula with or without associated abscess. Patients healed with no fistula recurrence, which is significant in comparison with previous patients treated with LIFT. Modified TROPIS does not require an initial seton placement for managing transsphincteric fistula with associated abscess.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"153"},"PeriodicalIF":2.9000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310903/pdf/","citationCount":"0","resultStr":"{\"title\":\"Modified transanal opening of the intersphincteric space (TROPIS): a safe and effective procedure for transsphincteric fistula-in-ano in comparison with ligation of intersphincteric fistula tract (LIFT).\",\"authors\":\"Z J Zhang, M S Ali, R Hegde, R H Jugo, T A Zhang, S H Kurtzman\",\"doi\":\"10.1007/s10151-025-03193-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>For treating complex transsphincteric fistula, a two-stage approach is usually administered: an initial seton placement followed by a sphincter-sparing procedure. However, success rates are not optimal. This study aimS to describe the modified transanal opening of the intersphincteric space (TROPIS), a single-staged procedure for managing transsphincteric fistula with or without concurrent anorectal abscess, and to compare its efficacy with the LIFT.</p><p><strong>Methods: </strong>Thirty-six patients who presented with mid-high transsphincteric fistula with or without associated anorectal abscess and consented to the procedure from 2020 to 2023 were managed with modified TROPIS. The primary outcome measures were recurrent fistulas and fecal continence. These results were compared with our previous study data of 24 patients who underwent LIFT procedure from 2011 to 2013.</p><p><strong>Results: </strong>Thirty-six patients received modified TROPIS; nine (25.0%) had an associated ischiorectal abscess. At the 8-month and 14-month follow-up, zero patients experienced fistula recurrence or fecal incontinence. In comparison with our previous study, 24 patients with transsphincteric fistula with or without associated abscess were treated with initial seton placement, then LIFT. With a follow-up range of 14-36 months, five (20.8%) patients presented with recurrent fistulas; no patients experienced fecal incontinence. These results were statistically significant.</p><p><strong>Conclusions: </strong>Our results reflect that modified TROPIS is a safe, simple, and effective procedure for treating patients with transsphincteric fistula with or without associated abscess. Patients healed with no fistula recurrence, which is significant in comparison with previous patients treated with LIFT. Modified TROPIS does not require an initial seton placement for managing transsphincteric fistula with associated abscess.</p>\",\"PeriodicalId\":51192,\"journal\":{\"name\":\"Techniques in Coloproctology\",\"volume\":\"29 1\",\"pages\":\"153\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-07-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12310903/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Techniques in Coloproctology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10151-025-03193-5\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-025-03193-5","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Modified transanal opening of the intersphincteric space (TROPIS): a safe and effective procedure for transsphincteric fistula-in-ano in comparison with ligation of intersphincteric fistula tract (LIFT).
Purpose: For treating complex transsphincteric fistula, a two-stage approach is usually administered: an initial seton placement followed by a sphincter-sparing procedure. However, success rates are not optimal. This study aimS to describe the modified transanal opening of the intersphincteric space (TROPIS), a single-staged procedure for managing transsphincteric fistula with or without concurrent anorectal abscess, and to compare its efficacy with the LIFT.
Methods: Thirty-six patients who presented with mid-high transsphincteric fistula with or without associated anorectal abscess and consented to the procedure from 2020 to 2023 were managed with modified TROPIS. The primary outcome measures were recurrent fistulas and fecal continence. These results were compared with our previous study data of 24 patients who underwent LIFT procedure from 2011 to 2013.
Results: Thirty-six patients received modified TROPIS; nine (25.0%) had an associated ischiorectal abscess. At the 8-month and 14-month follow-up, zero patients experienced fistula recurrence or fecal incontinence. In comparison with our previous study, 24 patients with transsphincteric fistula with or without associated abscess were treated with initial seton placement, then LIFT. With a follow-up range of 14-36 months, five (20.8%) patients presented with recurrent fistulas; no patients experienced fecal incontinence. These results were statistically significant.
Conclusions: Our results reflect that modified TROPIS is a safe, simple, and effective procedure for treating patients with transsphincteric fistula with or without associated abscess. Patients healed with no fistula recurrence, which is significant in comparison with previous patients treated with LIFT. Modified TROPIS does not require an initial seton placement for managing transsphincteric fistula with associated abscess.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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