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Original Article
Anorectal benign disease
- The management of complex fistula in ano by transanal opening of the intersphincteric space (TROPIS): short-term results
- Shrivats Mishra, Dileep S. Thakur, Uday Somashekar, Amrendra Verma, Dhananjay Sharma
- Ann Coloproctol. 2024;40(5):474-480. Published online March 31, 2023
- DOI: https://doi.org/10.3393/ac.2022.01018.0145
- 7,190 View
- 293 Download
- 7 Web of Science
- 7 Citations
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Abstract
PDF - 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. -
Citations
Citations to this article as recorded by
- Transanal Opening of the Intersphincteric Space (TROPIS) Is Effective in Managing High Complex as It Is Based on Garg Cardinal Principles
Pankaj Garg, Nicola Clemente, James C. W. Khaw
Digestive Diseases and Sciences.2025; 70(6): 2219. CrossRef - Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula
Yang-Tao Chen, Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang
Surgery Open Science.2025; 27: 15. CrossRef - Long-term Outcomes of Primary Fistula Closure With Platelet-Rich Plasma: A Prospective Study
María Luisa Reyes Díaz, Fátima Hinojosa Ramírez, Rocío Olmo Santiago, Irene M. Ramallo-Solís, Rosa M. Jiménez Rodríguez, José Pintor Tortolero, Jorge M. Vázquez-Monchul, Ana M. García Cabrera, Fernando de la Portilla de Juan
Diseases of the Colon & Rectum.2025; 68(8): 992. CrossRef - Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024; 86(6): 1105. CrossRef - Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef - Structured magnetic resonance imaging and endoanal ultrasound anal fistulas reporting template (SMART): An interdisciplinary Delphi consensus
Iwona Sudoł-Szopińska, Pankaj Garg, Anders Mellgren, Antonino Spinelli, Stephanie Breukink, Francesca Iacobellis, Małgorzata Kołodziejczak, Przemysław Ciesielski, Jenssen Christian, Giulio Aniello Santoro
World Journal of Gastrointestinal Surgery.2024; 16(10): 3288. CrossRef - Botulinum injection technique to reduce spasms in refractory anal fissures and after anal fistula or hemorrhoid surgery
Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya
Annals of Coloproctology.2024; 40(6): 610. CrossRef
- Transanal Opening of the Intersphincteric Space (TROPIS) Is Effective in Managing High Complex as It Is Based on Garg Cardinal Principles
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