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Session: ePoster: Benign Anorectal 2 (Sun1230)

EP415 - Transanal Opening of the Intersphincteric Space (TROPIS) With or Without Intersphincteric Fistula Tract Ligation (LIFT) for High Complex Anal Fistula

Sunday, May 11, 2025
1:13 PM – 1:18 PM PT
Location: Monitor 2, Sails Pavilion, Upper Level

    ePoster Presenter(s)

  • Minghao Hsieh, MD, MHA

    attending physician
    China Medical University Hospital, Taiwan
    Taichung, Taichung, Taiwan (Republic of China)

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

    • Author(s)

  • TK

    Tao-Wei Ke, Taiwan colorectal surgeon

    Director
    China medical university hospital
    Taichung, Taichung, Taiwan (Republic of China)

    Disclosure information not submitted.

    • Senior Author(s)

  • WC

    William Tzu-Liang Tzu-Liang Chen, Taiwan colorectal surgeon

    Superintendent
    China medical university hospital
    Taichung, Taichung, Taiwan (Republic of China)

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

All of the relevant financial relationships listed below have been mitigated.
Minghao Hsieh, MD, MHA: This individual has no financial relationships with ineligible companies.
William Tzu-Liang Tzu-Liang Chen, Taiwan colorectal surgeon: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Anal fistulas, particularly complex and high fistulas, are challenging to treat. The ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving technique that has been reported to offer a high short-term healing rate and a low incidence of incontinence. However, LIFT is associated with a higher risk of recurrence, often presenting as an intersphincteric fistula or abscess. On the other hand, the transanal opening of the intersphincteric space (TROPIS) procedure, first introduced in 2017, has demonstrated a success rate of over 90% in treating complex high fistulas. Despite this, many complex fistulas include a tract component in the intersphincteric plane, which resembles an abscess in a closed space. It is well-established that in the presence of sepsis, healing by secondary intention typically yields better outcomes than attempting primary intention healing.

Methods/Interventions: For the reasons mentioned above, this study performed the TROPIS procedure on all patients. If the intersphincteric space was found to contain a fistula tract rather than an infectious abscess, fistula ligation was additionally performed. Conversely, if the intersphincteric space was found to have an infection or abscess, only the TROPIS procedure was conducted without performing LIFT (as there was no fistula to ligate). Finally, the fistula tract between the external opening and the external sphincter was treated with core-out excision

Results/Outcomes: From September 2023 to August 2024, a total of 52 patients with complex fistulas (46 males, 6 females) underwent surgery. Of these, 22 patients received only the TROPIS procedure, while 30 patients received a combination of TROPIS and LIFT. There were 5 recurrences (3 in the TROPIS group and 2 in the TROPIS combined with LIFT group), with an overall healing rate of 90.3%. (TROPIS group:86%, TROPIS + LIFT: 93%).None of the patients experienced incontinence one month after surgery.

Conclusion/Discussion: This protocol is suitable for the vast majority of complex fistulas. The surgery is not difficult and is easy to replicate, with a high success rate and an extremely low risk of incontinence. However, while the short-term success rate is high, the long-term recurrence rate still requires more time for observation. Additionally, increased surgical experience may further improve the success rate for future patients