Background: Sphincter-preserving surgery is a treatment option for complex fistula in ano (FIA). However, the healing rate was still not satisfactory. The Transanal Opening of the Intersphincteric
Space (TROPIS) procedure involved cutting the internal sphincter to drain the intersphincteric infection. It had a high healing rate and a low risk of incontinence.
Methods: Complex FIA patients who underwent surgery at Rajavithi Hospital between January 2017 and September 2023 were retrospectively reviewed. The primary outcomes were the rates of fistula healing and recurrence between TROPIS and traditional LIFT. Incontinence after treatment was evaluated for TROPIS.
Results: One hundred twenty eight (128) patients who had undergone TROPIS (n=30) and LIFT (n=98) were included. The results showed that TROPIS had a similar healing rate (80.0% vs. 83.7%, p=0.782) compared to LIFT. However, these procedures might have a lower recurrence rate (12.5% vs. 29.3%, p=0.116), which was more notable in the posterior semi-horseshoe type (7.7% vs. 36%, p=0.086). Additionally, the incidence of incontinence was relatively low in the TROPIS group.
Conclusion: The TROPIS procedure showed promise as a feasible alternative for complicated cases of FIA. Robust large-scale studies were necessary to definitively establish its efficacy