Annals of Coloproctology

Display

Sort by :

Case Report

Anorectal benign disease

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature: Nalini Kanta Ghosh, Ashok Kumar; Ann Coloproctol. 2024;40(Suppl 1):S1-S5. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.00752.0107

3,968 View
128 Download

Abstract PDF: The malignant transformation of chronic fistula in ano is rare, accounting for 3% to 11% of all anal canal malignancies. It results from long-standing inflammation and chronic irritation. No guidelines are available for the management of these cases. We herein present a case report of a 55-year-old man who presented with a history of constipation, perianal pain, and discharging fistula in ano of 4-year duration and underwent fistula surgery with recurrence. Biopsy of the fistulous tract revealed adenocarcinoma. He received neoadjuvant chemoradiotherapy, followed by abdominoperineal excision including excision of the fistulous tract. After 18 months of follow-up, he is free of recurrence. We present this case with a review of the literature, highlighting the management strategies.

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

5,707 View
317 Download
10 Web of Science
13 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; 103(6): 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; 103(6): 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; 27: 15. 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
Transanal opening of intersphincteric space (TROPIS) treatment for high complex anal fistula: a systematic review and meta-analysis
Pengfei Zhou, Jingen Lu, Yanting Sun, Jiawen Wang
International Journal of Surgery.2025; 111(10): 7301. CrossRef
The Management of the Intersphincteric Component of Anal Fistula Tract Is Pivotal in Response to “A Pilot Study of Porcine Acellular Bladder Matrix Filling in the Treatment of Anal Fistulas”
Pankaj Garg, Vipul Yagnik, Kaushik Bhattacharya
ANZ Journal of Surgery.2025;[Epub] 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

Original Articles

The Ligation of Intersphincteric Fistula Tract Technique: A Preliminary Experience: Pasquale Cianci, Nicola Tartaglia, Alberto Fersini, Libero Luca Giambavicchio, Vincenzo Neri, Antonio Ambrosi; Ann Coloproctol. 2019;35(5):238-241. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2018.08.16.1

8,570 View
151 Download
8 Web of Science
11 Citations

Abstract PDF

Purpose
Surgery is the only treatment for anal fistula. Many surgical techniques have been described. The aim of this study was to communicate the authors’ preliminary experience in the use of a recently proposed, simplified technique.
Methods
This was a prospective study of 28 patients admitted from January 13, 2016 through July 20, 2017. Patients were managed with the ligation of intersphincteric fistula tract (LIFT) technique and results were observed and documented, including recurrence rate, incontinence rate, and other postoperative complications.
Results
A total of 28 patients were studied. The mean operation time was 31 minutes (range, 23–44 minutes), and there were no intra- and postoperative complications. The overall complete healing rate was 85.7%, and the recurrence rate was 14.2%. Follow-up was conducted at 1, 3, and 6 months.
Conclusion
Many surgical techniques have been described for the treatment of anal fistula. The correct choice of surgical technique out of available procedures is the most important factor for proper treatment and reducing the risk of recurrence or incontinence. In the authors’ experience, the LIFT technique is simple and easy to learn, and is a good choice for the treatment of simple anal fistula; however, a tailored surgery remains the gold standard for this condition.

Citations

Citations to this article as recorded by

Ligation of intersphincteric fistula tract for complex fistula in ano at a tertiary care centre in Northern India: A 3-year prospective study
Musharraf Husain, Mir Mujtaba Ahmad, Tajamul Rashid, Ajay Kumar Thakral
Journal of Clinical Sciences.2025; 22(1): 27. CrossRef
Is the ligation of the intersphincteric fistula tract (LIFT) procedure truly a sphincter preserving procedure for anal fistula? A scoping review of the literature
Ian Jse-Wei Tan, Bei En Siew, Jerrald Lau, Carol Pei Ling Yap, Stephanie Marie May Ee Soon, Ker-Kan Tan
European Journal of Medical Research.2025;[Epub] 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; 27: 15. CrossRef
Transanal opening of intersphincteric space (TROPIS) treatment for high complex anal fistula: a systematic review and meta-analysis
Pengfei Zhou, Jingen Lu, Yanting Sun, Jiawen Wang
International Journal of Surgery.2025; 111(10): 7301. CrossRef
Evaluation of the outcomes of fistulotomy with primary sphincter reconstruction in the management of high trans-sphincteric fistula and supra-sphincteric fistula-in-ano
Basma Hussein Abdelaziz Hassan, Philobater Bahgat Adly Awad, Mostafa Mohamed Abdelaziz, Mohammed Hossam, Mohamed Ali Mohamed Nada
Die Chirurgie.2024; 95(S1): 6. CrossRef
Avoiding Recurrence of Anorectal Abscess: The Impact of Patient Delay in Seeking Medical Attention
Sonu Nimesh Patel, Ria Elizabeth Philip, Dillon Downs, Arthur Alan Topilow, Ramisa Anjum, Glenn Scot Parker
Journal of Coloproctology.2024; 44(04): e253. CrossRef
Ligation of Intersphincteric Fistula Tract (LIFT) for the Treatment of Anal Fistula: A Prospective Observational Study
L.A. Hidalgo-Grau, N. Ruiz-Edo, O. Estrada-Ferrer, E.M. García-Torralbo, M. del Bas-Rubia, P. Clos-Ferrero, E. Bombuy-Giménez
Journal of Coloproctology.2023; 43(01): 024. CrossRef
Surgical treatment of anal fistula
A. Ya. Ilkanich, V. V. Darwin, E. A. Krasnov, F. Sh. Aliyev, K. Z. Zubailov
Сибирский научный медицинский журнал.2023; 43(5): 74. CrossRef
Advancing standard techniques for treatment of perianal fistula; when tissue engineering meets seton
Hojjatollah Nazari, Zahra Ebrahim Soltani, Reza Akbari Asbagh, Amirsina Sharifi, Abolfazl Badripour, Asieh Heirani Tabasi, Majid Ebrahimi Warkiani, Mohammad Reza Keramati, Behnam Behboodi, Mohammad Sadegh Fazeli, Amir Keshvari, Mojgan Rahimi, Seyed Mohsen
Health Sciences Review.2022; 3: 100026. CrossRef
Efficacy and safety of ligation of intersphincteric fistula tract in the treatment of anal fistula
Jiaji Zhang, Xilu Hao, Yican Zhu, Ronggang Luan
Medicine.2021; 100(4): e23700. CrossRef
Efficacy and safety of an innovatively modified cutting seton technique for the treatment of high anal fistula
Jie Jiang, Yang Zhang, Xufeng Ding, Naijin Zhang, Lijiang Ji
Medicine.2021; 100(5): e24442. CrossRef

Diagnosis and Management of a Cryptoglandular Actinomycotic Fistula-in-Ano: An Update on 7 New Cases and a Review of the Literature: Axel Egal, Isabelle Etienney, Heym Beate, Jean Francois Fléjou, Charles André Cuenod, Patrick Atienza, Pierre Bauer; Ann Coloproctol. 2018;34(3):152-156. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.07.23

5,809 View
104 Download
3 Web of Science
3 Citations

Abstract PDF

Purpose
Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001.
Methods
This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris.
Results
From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m²). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years.
Conclusion
Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.

Citations

Citations to this article as recorded by

Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire™): a qualitative study
Jeffrey D. McCurdy, Patrick Crooks, Chad Gwaltney, Robert Krupnick, Kathy-Ann Cadogan, Chitra Karki
Journal of Patient-Reported Outcomes.2024;[Epub] CrossRef
Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature
Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith
Annals of Coloproctology.2021; 37(5): 269. CrossRef

The Clinical Features and Charateristics of anal Cancer Arising from Chronic Fistula-in-ano.: Son, Byung Ho , Han, Won Kon , Kim, Heung Dae , Kim, Kwang Yun; J Korean Soc Coloproctol. 2002;18(6):373-378.

1,322 View
10 Download

Abstract PDF: PURPOSE
The incidence of unhealed chronic fistula is about 7% and the cancer can occur in the longstanding unhealed fistula. The most of the cancer is mucinous adenocarcinoma. The report is diverse about treatment, adjuvant chemotherapy and prognosis. The purpose of this study is review of the clinical characteristics and survival of the anal cancer arising from chronic fistula-in-ano.
METHODS
The number of patients was 10. The diagnosis is made under pathological examination at the Kanbuk Samsung Hospital from 1983 to 2000. The retrograde study was done with patients' records and telephone questionnaire. The survival rate was calculated with Kaplan-Meier method.
RESULTS
All patients were male. The patients had symptoms of anal discharge and anal swelling suggesting the anal fistula. The patients had history of anal surgery. The external openings were multiple. Seven patients had mucinous adenocarcinoma. The prognosis was poor. Among 8 patients' follow-up data, except one patient, 7 patients died within 43 months.
CONCLUSIONS
The anal cancer can occur in longstanding unhealed fistula. In our series, all patients were male, and they had multiple opening fistula. The patient who had small size tumor have only survived. Through meticulous exploring and deep biopsy of the fistula, early detection is best method to treat the anal cancer arising from chronic fistula-in-ano.

A Retrospective Analysis and Clinical Review of Fistula-in-Ano.: Lee, Yong Jik , Lee, Mi Ok , Kim, Sung Su , Lee, Young Taek , Park, Yong Ki , Choi, Chang Rock; J Korean Soc Coloproctol. 1999;15(4):321-330.

1,293 View
12 Download

Abstract PDF: PURPOSE
The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years.
METHODS
A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately.
RESULTS
The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%).
CONCLUSIONS
The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.

First
Prev
Page of 1
Next
Last

Search