Annals of Coloproctology

Technical Note

Anorectal benign disease

Botulinum injection technique to reduce spasms in refractory anal fissures and after anal fistula or hemorrhoid surgery: Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya; Ann Coloproctol. 2024;40(6):610-612. Published online December 2, 2024; DOI: https://doi.org/10.3393/ac.2023.00696.0099

7,153 View
202 Download

PDF Supplementary Material

Letter to the Editor

Achieving a high cure rate in complex anal fistulas: understanding the conceptual role of the Garg cardinal principles: Pankaj Garg, Nicola Clemente, James C. W. Khaw; Ann Coloproctol. 2024;40(5):521-523. Published online October 25, 2024; DOI: https://doi.org/10.3393/ac.2024.00430.0061

1,018 View
35 Download
2 Web of Science
3 Citations

PDF

Citations

Citations to this article as recorded by

Transanal Opening of the Intersphincteric Space (TROPIS) Is Effective in Managing High Complex as It Is Based on Garg Cardinal Principles
Pankaj Garg, Nicola Clemente, James C. W. Khaw
Digestive Diseases and Sciences.2025;[Epub] CrossRef
Transanal Opening of the Intersphincteric Space Is a Concept Based on Garg Cardinal Principles
Pankaj Garg, Kaushik Bhattacharya, Vipul D Yagnik, G Mahak
Journal of the American College of Surgeons.2025; 240(5): 837. CrossRef
Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula
Yang-Tao Chen, Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang
Surgery Open Science.2025;[Epub] CrossRef

Review

Anorectal benign disease

Recent advances in the diagnosis and treatment of complex anal fistula: Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak; Ann Coloproctol. 2024;40(4):321-335. Published online August 30, 2024; DOI: https://doi.org/10.3393/ac.2024.00325.0046

20,507 View
913 Download
5 Web of Science
7 Citations

Abstract PDF

Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.

Citations

Citations to this article as recorded by

Understanding the anatomical basis of anorectal fistulas and their surgical management: exploring different types for enhanced precision and safety
Asim M. Almughamsi, Yasir Hassan Elhassan
Surgery Today.2025; 55(4): 457. CrossRef
Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study
Tamer A. A. M. Habeeb, Massimo Chiaretti, Igor A. Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, M
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Evaluating the predictive superiority of Garg's classification for surgical decision-making in perianal fistula management
Naresh Lodhi, Dileep Thakur, Amrendra Verma, Uday Somashekar, Deepti Bala Sharma, Dhananjaya Sharma
Tropical Doctor.2025; 55(2): 124. CrossRef
Tuberculosis in anal fistula: incidence, clinical insights, and diagnostic challenges
Tariq Akhtar Khan, Mohammad Ali, Krishna Pada Saha, M. Nashir Uddin, M. Lutful Kabir Khan, Nunjirul Muhsenin, Nazmun Nahar, Sawantee Joarder, M. Kuddus Ali Khan
International Surgery Journal.2025; 12(5): 717. CrossRef
From the Editor: Uniting expertise, a new era of global collaboration in coloproctology
In Ja Park
Annals of Coloproctology.2024; 40(4): 285. CrossRef
Surgeon oriented reporting template for magnetic resonance imaging and endoanal ultrasound of anal fistulas enhances surgical decision-making
Si-Ze Wu
World Journal of Radiology.2024; 16(12): 712. CrossRef
Abbreviations Anonymous: A Coloproctologist’s Guide to Sanity
Kaushik Bhattacharya
Indian Journal of Colo-Rectal Surgery.2024; 7(1): 1. CrossRef

Technical Note

Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas: Pankaj Garg, Anvesha Mongia; Ann Coloproctol. 2024;40(1):74-81. Published online October 24, 2023; DOI: https://doi.org/10.3393/ac.2022.01263.0180

3,908 View
286 Download
5 Web of Science
11 Citations

Abstract PDF

Anal fistulas, especially complex and high fistulas, are difficult to manage. The transanal opening of the intersphincteric space (TROPIS) procedure was first described in 2017, and a high success rate of over 90% was reported in high complex fistulas. Since then, more studies and even a meta-analysis have corroborated the high efficacy of this procedure in high fistulas. Conventionally, the main focus was to close the internal (primary) opening for the fistula to heal. However, most complex fistulas have a component of the fistula tract in the intersphincteric plane. This component is like an abscess (sepsis) in a closed space (2 muscle layers). It is a well-known fact that in the presence of sepsis, healing by secondary intention leads to better results than attempting to heal by primary intention. Therefore, TROPIS is the first procedure in which, instead of closing the internal opening, the opening is widened by laying open the fistula tract in the intersphincteric plane so that healing can occur by secondary intention. Although the drainage of high intersphincteric abscesses through the transanal route was described 5 decades ago, the routine utilization of TROPIS for the definitive management of high complex fistulas was first described in 2017. The external anal sphincter (EAS) is completely spared in TROPIS, as the fistula tract on either side of the EAS is managed separately—inner (medial) to the EAS by laying open the intersphincteric space and outer (lateral) to the EAS by curettage or excision.

Citations

Citations to this article as recorded by

Perianal fistula a silent epidemic that face proctology and coloproctology in public health
Alida Vallejo-López , Josefina Ramírez-Amaya , Cesar Noboa-Terán
Salud, Ciencia y Tecnología.2025; 5: 1360. CrossRef
TROPIS is effective in managing complex anal fistulas with additional supralevator rectal opening (ASRO) by Garg phenomenon
Nicola Clemente, James C.W. Khaw, Yuliya Medkova, Pankaj Garg
Cirugía Española (English Edition).2025; : 800101. CrossRef
Response to the Letter to the Editor regarding our article on efficacy one year after the TROPIS Technique for the treatment of complex anal fistula
Fernando de la Portilla de Juan, María Luisa Reyes Díaz, Fátima Hinojosa Ramirez
Cirugía Española (English Edition).2025; : 800119. CrossRef
Respuesta a la carta al editor sobre nuestro artículo «Eficacia al año de la técnica TROPIS en la fístula perianal compleja»
Fernando de la Portilla de Juan, María Luisa Reyes Díaz, Fátima Hinojosa Ramirez
Cirugía Española.2025; 103(6): 800119. CrossRef
Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula
Yang-Tao Chen, Zhao-Chu Wang, Ya-Meng Xie, Xun Wang, Xu-Xiong Wu, Yang Li, Rong Shi, Jing Wang
Surgery Open Science.2025;[Epub] CrossRef
TROPIS is effective in managing complex anal fistulas with additional supralevator rectal opening (ASRO) by Garg phenomenon
Nicola Clemente, James C.W. Khaw, Yuliya Medkova, Pankaj Garg
Cirugía Española.2025; 103(6): 800101. CrossRef
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Achieving a high cure rate in complex anal fistulas: understanding the conceptual role of the Garg cardinal principles
Pankaj Garg, Nicola Clemente, James C. W. Khaw
Annals of Coloproctology.2024; 40(5): 521. CrossRef
Comparative Evaluation Between Cutting of the Intersphincteric Space vs Cutting Seton in High Anal Fistula: A Randomized Controlled Trial
Jiawei Qin, Yanlan Wu, Xueping Zheng, Kunlan Wu, Gongjian Dai, Yanyan Tan, Xu Yang, Yuqing Sun
Journal of the American College of Surgeons.2024; 239(6): 563. CrossRef
Invited Commentary: The Quest for the Panacea Treatment for Anal Fistula
Steven D Wexner
Journal of the American College of Surgeons.2024; 239(6): 573. CrossRef

Letters to the Editor

Newer procedures need to demonstrate efficacy in high complex anal fistulas: Pankaj Garg; Ann Coloproctol. 2023;39(4):371-372. Published online March 15, 2023; DOI: https://doi.org/10.3393/ac.2022.01109.0158

2,486 View
67 Download

PDF

Local plus oral antibiotics and strict avoidance of constipation is effective and helps prevents surgery in most cases of anal fissure: Pankaj Garg, Vipul D. Yagnik, Kaushik Bhattacharya; Ann Coloproctol. 2023;39(2):188-189. Published online November 29, 2022; DOI: https://doi.org/10.3393/ac.2022.00731.0104

10,879 View
171 Download

PDF

Original Article

Anorectal benign disease

Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study: Sushil Dawka, Vipul D. Yagnik, Baljit Kaur, Geetha R. Menon, Pankaj Garg; Ann Coloproctol. 2024;40(5):490-497. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00346.0049

3,258 View
119 Download
5 Web of Science
5 Citations

Abstract PDF

Purpose
Complex anal fistulas can recur after clinical healing, even after a long interval which leads to significant anxiety. Also, ascertaining the efficacy of any new treatment procedure becomes difficult and takes several years. We prospectively analyzed the validity of Garg scoring system (GSS) to predict long-term fistula healing.
Methods
In patients operated for cryptoglandular anal fistulas, magnetic resonance imaging was performed preoperatively and at 3 months postoperatively to assess fistula healing. Scores as per the GSS were calculated for each patient at 3 months postoperatively and correlated with long-term healing to check the accuracy of the scoring system.
Results
Fifty-seven patients were enrolled, but 50 were finally included (7 were excluded). These 50 patients (age, 41.2±12.4 years; 46 men) were followed up for 12 to 20 months (median, 17 months). Forty-seven patients (94.0%) had complex fistulas, 28 (56.0%) had recurrent fistulas, 48 (96.0%) had multiple tracts, 20 (40.0%) had horseshoe tracts, 15 (32.0%) had associated abscesses, 5 (10.0%) were suprasphincteric, and 8 (16.0%) were supralevator fistulas. The GSS could accurately predict long-term healing (high positive predictive value, 31 of 31 [100%]) but was not very accurate in predicting nonhealing (negative predictive value, 15 of 19 [78.9%]). The sensitivity in predicting healing was 31 of 35 (88.6%).
Conclusion
GSS accurately predicts long-term fistula with a high positive predictive value (100%) but is less accurate in predicting nonhealing. This scoring system can help allay anxiety in patients and facilitate the early validation of innovative procedures for anal fistulas.

Citations

Citations to this article as recorded by

Recent Advances in the Understanding and Management of Anal Fistula from India
Vipul D. Yagnik, Sandeep Kumar, Anshul Thakur, Kaushik Bhattacharya, Sushil Dawka, Pankaj Garg
Indian Journal of Surgery.2024; 86(6): 1105. CrossRef
Rectovaginal Fistulas Not Involving the Rectovaginal Septum Should Be Treated Like Anal Fistulas: A New Concept and Proposal for a Reclassification of Rectovaginal Fistulas
Pankaj Garg, Laxmikant Ladukar, Vipul Yagnik, Kaushik Bhattacharya, Gurleen Kaur
Clinical and Experimental Gastroenterology.2024; Volume 17: 97. CrossRef
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Annals of Coloproctology.2024; 40(4): 321. CrossRef
Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review
Alireza Teymouri, Amir Keshvari, Ali Ashjaei, Seyed Mohsen Ahmadi Tafti, Faeze Salahshour, Faezeh Khorasanizadeh, Amirhosein Naseri
Health Science Reports.2023;[Epub] CrossRef
Pankaj Garg: A Community Doctor to a Master Innovator to a Global Icon
David N. Armstrong, Iwona Sudoł-Szopińska, Vincent de Parades, Francesco Litta, Manuel Limbert, Khaw C. W. James
Global Journal of Medical, Pharmaceutical, and Biomedical Update.2023; 18: 16. CrossRef

First
Prev
Page of 1
Next
Last

Search