Transanal opening of the intersphincteric space (TROPIS): a novel procedure on the horizon to effectively manage high complex anal fistulas.

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.

Garg scoring system to predict long-term healing in cryptoglandular anal fistulas: a prospective validation study.

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.

A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas.

Background: Anal fistulas cause great uncertainty and anxiety in patients and surgeons alike. This is largely because of the inability to accurately confirm postoperative fistula healing, especially long-term healing. There is no scoring system available that can objectively assess cryptoglandular anal fistulas for postoperative healing and can also accurately predict long-term healing.

Increased Risk of Bleeding with Topical Metronidazole in a Postoperative Wound after Anal Fistula and Hemorrhoid Surgery: A Propensity Score-Matched Case-Control Study.

Background: Topical metronidazole (TM) is commonly used in many infective conditions and postoperative wounds including after anorectal surgery. TM was prescribed in patients operated for benign anorectal conditions (anal fistula and hemorrhoids) to hasten wound healing. After the initiation of this protocol, the incidence of postoperative wound bleeding seemed to increase.

A New Anatomical Pathway of Spread of Pus/Sepsis in Anal Fistulas Discovered on MRI and Its Clinical Implications.

Background: In the anal sphincter complex, the intersphincteric space between the internal and external sphincters is the only conventionally recognized pathway for the spread of sepsis. However, there is another unrecognized space discovered on MRI, the "outer-sphincteric space", between the external anal sphincter and its lateral fascia along which pus can spread. An abscess in the intersphincteric space is easily drained into the rectum via the transanal route and is more likely to spread into the supralevator space.

Anal fistula at roof of ischiorectal fossa inside levator-ani muscle (RIFIL): a new highly complex anal fistula diagnosed on MRI.

Background: As experience with anal fistula imaging (MRI) has increased, new pathways of fistula extension have been identified. A recently described pathway is the  'outer-sphincteric space' present between the external anal sphincter and its covering outer fascia. A new type of complex fistula is being described which is present in the outer-sphincteric space and continues superiorly along the lateral border of the external anal sphincter to the infero-lateral surface of the puborectalis and levator-ani.

Role of MRI to confirm healing in complex high cryptoglandular anal fistulas: long-term follow-up of 151 cases.

Aim: Complex fistula-in-ano can recur even after complete clinical healing has occurred. 'Radiological healing' of fistula on MRI correlates well with long-term healing rates but no study has yet objectively quantified this. The aim of this study was to assess the accuracy of anal fistula healing as documented on MRI and to correlate it with long-term healing as evidenced on long-term follow-up.

Perianal Tuberculosis: Lessons Learned in 57 Patients From 743 Samples of Histopathology and Polymerase Chain Reaction and a Systematic Review of Literature.

Background: Few data are published on perianal tuberculosis.

Objective: This study aimed to determine the best method to diagnose tuberculosis in patients with fistula-in-ano and to conduct a systematic review to determine the incidence and characteristics of tuberculosis fistula-in-ano.

Data Sources: The prospective study data and existing literature were derived from PubMed, Google scholar, and Scopus STUDY SELECTION:: Prospective analysis of patients with tuberculous fistula-in-ano treated between 2014 and 2018 was conducted, and a systematic review of studies describing ≥3 patients with tuberculosis fistula-in-ano was completed.

Home Care Neck Traction for a Patient With Neck Pain and Cervical Radiculopathy Symptoms: A Case Report.

Objective: The purpose of this case study is to describe home care traction for a patient with neck pain and radicular symptoms.

Clinical Features: A 30-year old male patient presented with a sharp pain in the left shoulder and lateral side of the left arm. Cervical spine motion was limited on the left side.

Comparison of Preoperative and Postoperative MRI After Fistula-in-Ano Surgery: Lessons Learnt from An Audit of 1323 MRI At a Single Centre.

Aim: Several studies have evaluated the efficacy of preoperative MRI in fistula-in-ano. However, the evaluation of MRI after fistula-in-ano surgery has never been done. The aim was to evaluate the utility of MRI in postoperative period after fistula-in-ano surgery.

Is fistulotomy still the gold standard in present era and is it highly underutilized?: An audit of 675 operated cases.

Aim: Due to fear of incontinence, fistulotomy perhaps remains highly underutilized. The aim was to analyze the efficacy of fistulotomy in a large cohort, to assess the magnitude of underutilization of fistulotomy by current classifications and to identify the subgroup in whom the fistulotomy should be done.

Methods: All consecutive operated patients of fistula-in-ano were included in the study retrospectively.

Understanding and Treating Supralevator Fistula-in-Ano: MRI Analysis of 51 Cases and a Review of Literature.

Background: Supralevator fistulas are highly complex. The delineation of the supralevator fistula has become accurate because of MRI.

Objective: The aim of the study was to analyze the pathophysiology and treatment of different types of supralevator fistulas.

Video-Assisted Anal Fistula Treatment (VAAFT) in Cryptoglandular fistula-in-ano: A systematic review and proportional meta-analysis.

Background: Video-Assisted Anal Fistula Treatment (VAAFT) is a relatively new minimally invasive videoendoscopic procedure for treating fistula-in-ano. We reviewed and performed metaanalysis to evaluate the efficacy of this procedure.

Methods: Studies from the period 2010 to 2016 were searched in PubMed, Medline, Scopus, Embase, Ovid, SCI database, Cochrane Central Register of Controlled Trials (CENTRAL) & Google Scholar database.