Wang YQ, Wang Y, Jia XF, Yan QJ, Zheng XP. High complex anal fistula managed by the modified transanal opening of the intersphincteric space via the inter-sphincteric approach: A case report. World J Radiol 2024; 16(10): 552-560 [DOI: 10.4329/wjr.v16.i10.552]
Corresponding Author of This Article
Qiao-Jing Yan, PhD, Doctor, Colorectal Disease Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Daming Road, Nanjing 210000, Jiangsu Province, China. njlf666@163.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Oct 28, 2024; 16(10): 552-560 Published online Oct 28, 2024. doi: 10.4329/wjr.v16.i10.552
High complex anal fistula managed by the modified transanal opening of the intersphincteric space via the inter-sphincteric approach: A case report
Ya-Qun Wang, Yan Wang, Xiao-Feng Jia, Qiao-Jing Yan, Xue-Ping Zheng
Ya-Qun Wang, Yan Wang, Qiao-Jing Yan, Xue-Ping Zheng, Anorectal Disease Center, Jiangsu Province traditional Chinese Medicine Innovation Center for Anorectal Disease, Nanjing 211000, Jiangsu Province, China
Ya-Qun Wang, Department of Anorectal Surgery, Zhenjiang Hospital Affiliated to Nanjing University of Chinese Medicine (Zhenjiang Hospital of Traditional Chinese Medicine), Zhenjiang 212000, Jiangsu Province, China
Yan Wang, Department of Anorectal Surgery, Yangzhou Jiangdu Hospital of Traditional Chinese Medicine, Yangzhou 225200, Jiangsu Province, China
Xiao-Feng Jia, Department of Imaging, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing 211000, Jiangsu Province, China
Qiao-Jing Yan, Xue-Ping Zheng, Colorectal Disease Center, Nanjing Hospital of Chinese Medicine affiliated to Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
Co-corresponding authors: Qiao-Jing Yan and Xue-Ping Zheng.
Author contributions: Wang YQ and Wang Y were responsible for clinical data collection, patient postoperative management and manuscript writing; Jia XF was assigned for imaging guidance and preoperative evaluation; Yan QJ and Zheng XP were responsible for the development of the patient's surgical plan and treatment, leadership responsibility for the research activity planning. All authors reviewed the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qiao-Jing Yan, PhD, Doctor, Colorectal Disease Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Daming Road, Nanjing 210000, Jiangsu Province, China. njlf666@163.com
Received: April 26, 2024 Revised: September 8, 2024 Accepted: September 13, 2024 Published online: October 28, 2024 Processing time: 185 Days and 4.3 Hours
Abstract
BACKGROUND
High complex anal fistulas are epithelialized tunnels, with the main fistula piercing above the deep external sphincter and the internal opening approaching the dentate line. Conventional surgical procedures for high complex anal fistulas remove most of the external sphincter and damage the anorectal ring. Postoperative loss of anal function can cause physical and mental damage. Transanal opening of the intersphincteric space (TROPIS) is an effective procedure that completely preserves the external anal sphincter. However, its clinical application is limited by challenges in the localization of the internal opening of a fistula and the high risk of complications. On the basis of our clinical experience, we modified the TROPIS procedure for the treatment of treating high complex anal fistulas.
CASE SUMMARY
A patient with a high complex anal fistula located above the anorectal ring underwent modified TROPIS, which involved sepsis drainage and identification of the internal opening in the intersphincteric space. The patient with the high complex anal fistula recovered well postoperatively, without any postoperative complications or anal dysfunction. Anal function returned to normal after 17 months of follow-up.
CONCLUSION
The modified TROPIS procedure is the most minimally invasive surgery for anal fistulas that minimally impairs anal function. It allows the complete removal of infected anal glands and reduces the risk of postoperative complications. Modified TROPIS via the intersphincteric approach is an alternative sphincter-preserving treatment for high complex anal fistulas.
Core Tip: High complex anal fistulas are a type of perianal infectious diseases barely to spontaneously heal. Surgical procedures usually impair the anal function. Trans-anal opening of inter-sphincteric space (TROPIS) is an effective surgical procedure to treat high anal fistulas, although there exist demerits. We created a modified TROPIS via polishing up the surgical approach, identification of internal opening and management of fistulas, which greatly simplified the surgical procedures, and largely reduced postoperative complications. We believed that the modified TROPIS is suitable for treating high complex anal fistulas in Asian people with a narrower anal canal.
