{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:47:15Z","timestamp":1789469235008,"version":"build-2803163510"},"reference-count":13,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transanal opening of the intersphincteric space (TROPIS) has recently emerged as a sphincter\u2010preserving option for the treatment of complex anal fistulas. Although high success rates have been reported in large international series, data on long\u2010term real\u2010world outcomes remain limited. This study aimed to evaluate long\u2010term results of TROPIS, focusing on recurrence and continence, and to compare them with existing literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective single\u2010center cohort included 28 patients who underwent the TROPIS procedure between 2020 and 2023. Demographic data, Parks classification of fistula, operative details, recurrence rates, healing times, and continence outcomes were analyzed. Recurrence was defined as the reappearance of fistula after initial complete healing. Continence was assessed using the Wexner score. Patients were followed with a mean follow\u2010up of 680\u2009\u00b1\u2009120\u2009days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age was 42.6\u2009years. According to Parks' classification, 21 patients (75%) had transsphincteric, 5 (17.9%) extrasphincteric, and 2 (7.1%) complex transsphincteric (horseshoe variant). The average healing time was 36\u2009days. No recurrence occurred within the first 90\u2009days; thereafter, 9 patients (32.1%) developed recurrence (median 225\u2009days, range 90\u2013660). Early postoperative mild incontinence occurred in 42.9% of patients, but only 5 (17.8%) reported persistent mild symptoms at long\u2010term follow\u2010up. No major incontinence was recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TROPIS appears to be a safe, sphincter\u2010preserving technique for complex anal fistulas, providing acceptable healing with preserved continence. However, recurrence rates in this cohort were higher than those reported internationally, underscoring the need for careful patient selection, surgical expertise, and adequate long\u2010term follow\u2010up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70397","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T13:05:12Z","timestamp":1764335112000},"page":"556-561","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["<scp>TROPIS<\/scp>\n                    Procedure in Complex Anal Fistulas: Single\u2010Center Long\u2010Term Results"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9146-3742","authenticated-orcid":false,"given":"Hikmet","family":"Pehlevan\u2010\u00d6zel","sequence":"first","affiliation":[{"name":"General Surgery Department Ankara Bilkent City Hospital  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5285-4878","authenticated-orcid":false,"given":"Zeynep Nur","family":"Yurdakul","sequence":"additional","affiliation":[{"name":"General Surgery Department Ankara Bilkent City Hospital  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2933-3170","authenticated-orcid":false,"given":"H\u00fcseyin Fahri","family":"Martl\u0131","sequence":"additional","affiliation":[{"name":"General Surgery Department Ankara Bilkent City Hospital  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4669-0962","authenticated-orcid":false,"given":"Sabiha Nur","family":"\u00d6zmen","sequence":"additional","affiliation":[{"name":"General Surgery Department Amasya Sabuncuo\u011flu \u015eerefeddin Training Hospital  Amasya T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0712-3153","authenticated-orcid":false,"given":"Sadettin","family":"Er","sequence":"additional","affiliation":[{"name":"General Surgery Department Ankara Bilkent City Hospital  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9249-1502","authenticated-orcid":false,"given":"Erdin\u00e7","family":"\u00c7etinkaya","sequence":"additional","affiliation":[{"name":"General Surgery Department Ankara Bilkent City Hospital  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8786-6269","authenticated-orcid":false,"given":"Tezcan","family":"Ak\u0131n","sequence":"additional","affiliation":[{"name":"General Surgery Department Ankara Bilkent City Hospital  Ankara 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