Complex anal fistulas are difficult to treat.The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement.Due to this,several sphincter-sp...Complex anal fistulas are difficult to treat.The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement.Due to this,several sphincter-sparing procedures have been developed in the last two decades.Though moderately successful in simple fistulas(50%-75%healing rate),the healing rates in complex fistulas for most of these procedures has been dismal.Only two procedures,ligation of intersphincteric fistula tract and transanal opening of intersphincteric space have been shown to have good success rates in complex fistulas(60%-95%).Both of these procedures preserve continence while achieving high success rates.In this opinion review,I shall outline the history,compare the pros and cons,indications and contraindications and future application of both these procedures for the management of complex anal fistulas.展开更多
BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphinct...BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.Incontinence was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid incontinence.However,regular KE led to a significant reduction in incontinence(both in the number of affected patients and the severity of scores in these patients).展开更多
经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)是治疗复杂性肛瘘的新术式,该术式通过经肛入路,使用电刀切开括约肌间瘘管上的黏膜和内括约肌,不切断外括约肌,彻底搔刮干净所有瘘管,清除外括约肌两侧的感染,...经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)是治疗复杂性肛瘘的新术式,该术式通过经肛入路,使用电刀切开括约肌间瘘管上的黏膜和内括约肌,不切断外括约肌,彻底搔刮干净所有瘘管,清除外括约肌两侧的感染,具有手术操作简单、术后创面愈合快、患者疼痛小、肛门功能恢复良好等优点,值得临床推广。但关于TROPIS的术后并发症及具体处理措施较少见文献报道,笔者团队曾收治1例TROPIS术后腹膜后感染(罕见并发症)的病例,现将其治疗过程及并发症处理方案报告如下,与同道交流。展开更多
复杂性肛瘘患者肛周反复发生破溃及感染,严重影响生活质量,由于治疗难度较大,需要手术医师权衡如何在提高手术成功率的同时降低术后大便失禁风险。近年来,经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)作为...复杂性肛瘘患者肛周反复发生破溃及感染,严重影响生活质量,由于治疗难度较大,需要手术医师权衡如何在提高手术成功率的同时降低术后大便失禁风险。近年来,经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)作为一种保留括约肌的手术方式逐渐应用于复杂性肛瘘的治疗。本文将从TROPIS治疗复杂性肛瘘的理论基础及操作流程、有效性及安全性、应用范围等方面进行综述,以期为复杂性肛瘘的治疗提供参考。展开更多
文摘Complex anal fistulas are difficult to treat.The main reasons for this are a higher recurrence rate and the risk of disrupting the continence mechanism because of sphincter involvement.Due to this,several sphincter-sparing procedures have been developed in the last two decades.Though moderately successful in simple fistulas(50%-75%healing rate),the healing rates in complex fistulas for most of these procedures has been dismal.Only two procedures,ligation of intersphincteric fistula tract and transanal opening of intersphincteric space have been shown to have good success rates in complex fistulas(60%-95%).Both of these procedures preserve continence while achieving high success rates.In this opinion review,I shall outline the history,compare the pros and cons,indications and contraindications and future application of both these procedures for the management of complex anal fistulas.
文摘BACKGROUND The transanal opening of intersphincteric space(TROPIS)procedure,performed to treat complex anal fistulas,preserves the external anal sphincter(EAS)but involves partial incision of the internal anal sphincter(IAS).AIM To ascertain the incidence of incontinence after the division of the IAS as is done in TROPIS and to evaluate whether regular Kegel exercises(KE)in the postoperative period can prevent incontinence due to IAS division.METHODS Patients operated on for high complex fistulas and having no preoperative continence problem(score=0)were included in the study.All patients were operated on by the TROPIS procedure and were recommended KE(pelvic contraction exercises)50 times/day.KE were commenced on the 10^(th)postoperative day and continued for 1 year.Incontinence was evaluated objectively(by modified Vaizey’s scores)in the immediate postoperative period(Pre-KE group)and on long-term follow-up(Post-KE group).The incontinence scores in both groups were compared to evaluate the efficacy of KE.RESULTS Of 102 anal fistula patients operated on between July 2018 and July 2020 were included in this study.There were 90 males,the mean age was 42.3±12.8,and the median follow-up was 30 mo(18-42 mo).Three patients were lost to follow-up.There were 65 recurrent fistulas,92 had multiple tracts,42 had associated abscess,46 had horseshoe fistula and 34 were supralevator fistulas.All were magnetic resonance imaging-documented high fistulas(>1/3 EAS involved).Overall incontinence occurred in 31%patients(Pre-KE group)with urge and gas incontinence accounting for the majority of cases(28.3%).The mean incontinence scores in the Pre-KE group were 1.19±1.96(in 31 patients,solid=0,liquid=7,gas=8,urge=24)and in the Post-KE group were 0.26±0.77(in 13 patients,solid=0,liquid=2,gas=3,urge=10)(P=0.00001,t-test).CONCLUSION Division of the IAS led to incontinence,mainly urge incontinence,and also to a mild degree of gas and liquid incontinence.However,regular KE led to a significant reduction in incontinence(both in the number of affected patients and the severity of scores in these patients).
文摘经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)是治疗复杂性肛瘘的新术式,该术式通过经肛入路,使用电刀切开括约肌间瘘管上的黏膜和内括约肌,不切断外括约肌,彻底搔刮干净所有瘘管,清除外括约肌两侧的感染,具有手术操作简单、术后创面愈合快、患者疼痛小、肛门功能恢复良好等优点,值得临床推广。但关于TROPIS的术后并发症及具体处理措施较少见文献报道,笔者团队曾收治1例TROPIS术后腹膜后感染(罕见并发症)的病例,现将其治疗过程及并发症处理方案报告如下,与同道交流。
文摘复杂性肛瘘患者肛周反复发生破溃及感染,严重影响生活质量,由于治疗难度较大,需要手术医师权衡如何在提高手术成功率的同时降低术后大便失禁风险。近年来,经肛括约肌间切开术(transanal opening of intersphincteric space,TROPIS)作为一种保留括约肌的手术方式逐渐应用于复杂性肛瘘的治疗。本文将从TROPIS治疗复杂性肛瘘的理论基础及操作流程、有效性及安全性、应用范围等方面进行综述,以期为复杂性肛瘘的治疗提供参考。
