Annali italiani di chirurgia · 2026
Transanal Opening of the Intersphincteric Space to Treat Anal Fistula: A Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Cui Can, Jin Wei, Wu Jiong, Han Chang-Peng, Li Ying, Jin Lei, Yang Hao-Jie, Wang Zhen-Yi
Аннотация
AIM: Transanal opening of the intersphincteric space (TROPIS) is a minimally invasive surgical treatment for anal fistula that not only eliminates the source of infection but also protects anal function to the greatest extent. This systematic review and meta-analysis aims to evaluate the efficacy of TROPIS in the treatment of anal fistula.
METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for information on TROPIS surgery for anal fistulas performed between the inception of each database and 1 November 2024. We used the single-arm studies for analysis, with a total of 918 subjects and a follow-up period ranging from 3 months to 36 months. The analysis focused on the cure rate of different types of anal fistula, postoperative bleeding, infection, and adverse reactions.
RESULTS: This systematic review included six single-arm studies involving a total of 918 patients with anal fistula who underwent TROPIS surgery, with follow-up durations ranging from 3 to 36 months. Among the included studies, all were classified as high quality (score ≥7). This study demonstrated an 80% success rate for the initial operation (95% confidence interval (CI): 0.77-0.83), as well as an 80% success rate specifically for high fistulas (95% CI: 0.77-0.83). The success rate for second operations was 73% (95% CI: 0.47-0.99). For patients with high fistulas who underwent a second procedure, the success rate was 78% (95% CI: 0.40-1.00). The cure rate for anal fistulas accompanied by abscesses was 88%, while the cure rate for anal fistulas without abscesses is the same. For horseshoe fistulas, the cure rate was 87%, whereas it was 88% for non-horseshoe fistulas. The overall cure rate in this study was 88% (95% CI: 0.86-0.90). The rate of intraoperative bleeding was 3%, the postoperative infection rate was 5%, and the overall incidence of adverse reactions was 3%.
CONCLUSIONS: This study demonstrates that TROPIS holds significant potential in the treatment of anal fistulas, particularly for high fistulas, fistulas with associated abscesses, and horseshoe-shaped fistulas, whilst exhibiting a relatively low incidence of incontinence.
METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for information on TROPIS surgery for anal fistulas performed between the inception of each database and 1 November 2024. We used the single-arm studies for analysis, with a total of 918 subjects and a follow-up period ranging from 3 months to 36 months. The analysis focused on the cure rate of different types of anal fistula, postoperative bleeding, infection, and adverse reactions.
RESULTS: This systematic review included six single-arm studies involving a total of 918 patients with anal fistula who underwent TROPIS surgery, with follow-up durations ranging from 3 to 36 months. Among the included studies, all were classified as high quality (score ≥7). This study demonstrated an 80% success rate for the initial operation (95% confidence interval (CI): 0.77-0.83), as well as an 80% success rate specifically for high fistulas (95% CI: 0.77-0.83). The success rate for second operations was 73% (95% CI: 0.47-0.99). For patients with high fistulas who underwent a second procedure, the success rate was 78% (95% CI: 0.40-1.00). The cure rate for anal fistulas accompanied by abscesses was 88%, while the cure rate for anal fistulas without abscesses is the same. For horseshoe fistulas, the cure rate was 87%, whereas it was 88% for non-horseshoe fistulas. The overall cure rate in this study was 88% (95% CI: 0.86-0.90). The rate of intraoperative bleeding was 3%, the postoperative infection rate was 5%, and the overall incidence of adverse reactions was 3%.
CONCLUSIONS: This study demonstrates that TROPIS holds significant potential in the treatment of anal fistulas, particularly for high fistulas, fistulas with associated abscesses, and horseshoe-shaped fistulas, whilst exhibiting a relatively low incidence of incontinence.