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Video

Session: Ongoing Videos

VM48 - Tropis-Plug for the treatment of transsphincteric anal fistulas

ONGOING VIDEOS
Location: ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Jiaqi Jiang

    Physician in Charge
    Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
    Shanghai, Shanghai, China (People's Republic)

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • Zhenyi Wang, MD,PHD (he/him/his)

    Director of Anorectal Medicine Department
    Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
    Shanghai, Shanghai, China (People's Republic)

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Xiangyi Yin, Master's Degree

    Resident doctor
    Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
    Shanghai, Shanghai, China (People's Republic)

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • YL

    Yuchang Lu, Master's Degree

    Resident doctor
    Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
    shanghai, Shanghai, China (People's Republic)

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Jiaqi Jiang: This individual has no financial relationships with ineligible companies.
Zhenyi Wang, n/a: This individual has no financial relationships with ineligible companies.
Xiangyi Yin, Master's Degree: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: The purpose of this video summary is to present a case report of TROPIS-Plug surgery for the treatment of the transsphincteric anal fistula.
TROPIS surgery is a new surgical approach proposed by Professor Garg in 2017, characterized by fully opening the abscess cavity, fully draining pus, and ensuring drainage without damaging the external sphincter muscle. Anal fistula plug filling surgery is a minimally invasive surgical technique that has emerged in recent years. It achieves self repair by filling the fistula tract, closing the fistula tract and repairing the anal fistula. We have combined TROPIS surgery with anal fistula plug to create a surgical method that combines the advantages of both, named TROPIS-Plug surgery.

Methods/Interventions: A 35-year old male, presented with perianal swelling and pain for 1 month.Previous physical health and no history of surgery.Physical examination: A fistula can be seen at a distance of 6cm from the anal margin at point 1 of the lithotomy. A hard cord can be palpated on the surface of the body, leading to the anus, with moderate texture and tenderness (+). MRI of anal fistula (April 18, 2024): The internal opening is located in the 1 o'clock direction of the internal anal sphincter, running downwards in the left direction between the internal and external anal sphincters, penetrating the external anal sphincter, and the fistula reaches the 1 o'clock direction of the perianal skin.
The patient underwent TROPIS-Plug surgery under general anesthesia in the operating room.

Results/Outcomes: The patient was discharged 7 days after surgery and followed up once a week. The wound is healing well; Follow up for 3 months after surgery showed no recurrence. Wexner anal incontinence score: 0.

Conclusion/Discussion: Overall, TROPIS-Plug surgery has shown good results. The patient experienced mild postoperative pain, recovered well, and did not experience anal incontinence. However, it is worth mentioning that there are two aspects of postoperative care that need to be taken seriously: (1) the position between the internal and external sphincters is often deep after surgical exposure. When changing dressing after surgery, it is necessary to clear the wound properly and ensure smooth drainage. (2) After filling the fistula with an anal fistula plug, there is usually still a small gap between the tissue and the filler in the early postoperative period, where some exudate and inflammatory tissue may exist. The method of pressing the local tissue during dressing change can be used to avoid cavity formation and poor wound healing.