DOI: 10.1097/js9.0000000000002880 ISSN: 1743-9159

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
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Background:

The transanal opening of intersphincteric space (TROPIS) is a new surgical modality for treating anal fistulas. This procedure involves a transanal incision between the sphincters to promote drainage, excision of the infected areas, and maintenance of sphincter patency. In this meta-analysis, we evaluated the efficacy and safety of TROPIS in treating high complex anal fistula.

Methods:

We searched the PubMed (NLM), LISTA (EBSCO), and Web of Science Core Collection (Clarivate) databases for all related clinical research literature on highly complex anal fistulas treated with TROPIS from the time of database creation to 2024.12.31, with inclusion restricted to studies published in English. All included articles follow the PICO principle. Data on surgical one-time cure rate, recurrence rate after the first surgery, final cure rate, and occurrence of adverse events were extracted for further analysis.

Results:

Six studies involving 499 patients were included. The heterogeneity test revealed no heterogeneity, and results for one-time cure rate showed I2 = 0.00% < 50%, and Q test P = 0.81 > 0.1 (effect size [ES] = 0.80, 95% confidence interval [CI] (0.77, 0.84), Z = 45.96, P = 0.00), where the one-time cure rate was 80%; recurrence rate after first surgery I2 = 0.00% < 50%, and Q test P = 0.81 > 0.1 (ES = 0.20, 95% CI (0.16, 0.23), Z = 17.49, P = 0.00), and the recurrence rate is 20%; final cure rate I2 = 0.00% < 50%, and Q test P = 0.82 > 0.1 (ES = 0.89, 95% CI (0.86, 0.92), Z = 51.21, P = 0.00), and the final cure rate was 89%. No adverse events were reported in any of the patients. Sensitivity analyses showed excellent stability of the surgical cure results in all studies. No publication bias was detected in any of the included studies.

Conclusions:

The TROPIS procedure for highly complex anal fistulas exhibits a high one-time cure rate, low recurrence rate, and high overall cure rate and is not associated with any adverse events.

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