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TROPIS Procedure in Complex Anal Fistulas: Single-Center Long-Term Results.

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Transanal opening of the intersphincteric space (TROPIS) shows promise for complex anal fistulas, preserving continence. However, this study found higher recurrence rates than international data, emphasizing careful patient selection and follow-up.

Keywords:
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Area of Science:

  • Colorectal Surgery
  • Gastroenterology
  • Surgical Innovation

Background:

  • Transanal opening of the intersphincteric space (TROPIS) is a sphincter-preserving approach for complex anal fistulas.
  • Limited long-term real-world outcome data exists for TROPIS.
  • This study evaluates the long-term efficacy and safety of TROPIS.

Purpose of the Study:

  • To assess long-term recurrence and continence outcomes following TROPIS.
  • To compare real-world TROPIS outcomes with existing literature.
  • To identify factors influencing TROPIS success in complex anal fistulas.

Main Methods:

  • Retrospective single-center cohort study of 28 patients undergoing TROPIS (2020-2023).
  • Analysis of demographic data, fistula type (Parks classification), operative details, healing times, and continence (Wexner score).
  • Mean follow-up of 680 days, with recurrence defined as fistula reappearance after initial healing.

Main Results:

  • The majority of patients (75%) had transsphincteric fistulas.
  • Average healing time was 36 days, with no early recurrence.
  • A 32.1% recurrence rate was observed after 90 days, with 17.8% reporting persistent mild incontinence long-term; no major incontinence occurred.

Conclusions:

  • TROPIS is a safe, sphincter-preserving technique for complex anal fistulas with acceptable healing.
  • Higher recurrence rates in this cohort necessitate careful patient selection and surgical expertise.
  • Long-term follow-up is crucial for managing TROPIS outcomes in complex anal fistula treatment.