Complex anal fistula remains a therapeutic challenge in anorectal surgery, with the core challenge lying in balancing complete eradication of the fistula with preservation of anal sphincter function. Intersphincteric approaches, grounded in the intersphincteric infection theory, enable minimally invasive treatment of complex anal fistula through precise anatomical dissection, and have become a hot topic in clinical practice and research worldwide. This review focuses on the theoretical origins and anatomical basis of intersphincteric approaches, as well as their application and development in the treatment of complex anal fistula. It comprehensively elaborates on the anatomical foundations and technical evolution of this series of procedures, systematically analyzes the technical features and clinical outcomes of Parks procedure and modified Parks seton procedure, ligation of the intersphincteric fistula tract (LIFT), transanal opening of intersphincteric space (TROPIS), and various modified techniques, and discusses future directions in this field, aiming to provide a comprehensive theoretical and practical reference for the clinical management of complex anal fistula.
For patients with inflammatory bowel disease (IBD), surgery remains a necessary treatment modality for a subset of patients, and gut dysbiosis is a common issue in the postoperative setting. However, current postoperative management protocols for IBD patients lack direct and effective interventions targeting gut dysbiosis. Fecal microbiota transplantation (FMT), which has attracted considerable attention as a gut microecology-modulating therapy, offers a promising avenue for managing postoperative gut dysbiosis in IBD. Drawing on the relevant literature, our team reviews the current status of research on FMT in the postoperative management of IBD, and discusses the advantages, key considerations, and challenges associated with its application.
Crohn's disease is a chronic, transmural, and progressive inflammatory bowel disease characterized by cumulative structural damage and a high rate of recurrence. Although biologic agents have achieved considerable success in controlling inflammation, a substantial proportion of patients still require surgical intervention. In recent years, the treat-to-target concept—emphasizing objective control of inflammation and prevention of structural damage—has been progressively incorporated into the comprehensive management framework for Crohn's disease. Accordingly, surgery should no longer be viewed simply as a last resort after medical treatment failure. From the perspective of treat-to-target, this review evaluates the current status and challenges of surgical management in Crohn's disease, explores optimization and individualization of treatment decisions, and analyzes other important clinical management approaches and strategies.
Intestinal stricture is a serious complication of Crohn's disease and a major cause of intestinal dysfunction and surgical intervention. Various treatment options are available for intestinal strictures in Crohn's disease, but patient-specific management should be emphasized. Currently, endoscopic treatment plays an important role in the comprehensive management of intestinal strictures in Crohn's disease and can achieve favorable technical and clinical outcomes in selected patients. Among these, endoscopic balloon dilation is the most evidence-based endoscopic technique. In addition, the efficacy of endoscopic stricturotomy, stent placement, and combined interventions has attracted attention in the field. This review focuses on the clinical practice of endoscopic treatment for intestinal strictures in Crohn's disease, discussing stricture assessment and management, summarizing the current status of endoscopic treatment, and briefly analyzing the challenges and future research directions.
Objectives To investigate the clinical efficacy of LigaSure hemorrhoidectomy combined with Xiaozhiling sclerotherapy in the treatment of mixed hemorrhoids. Methods In this prospective randomized controlled trial, 110 patients with mixed hemorrhoids who underwent surgical treatment at Shanghai Jiading District Hospital of Traditional Chinese Medicine between September 2024 and May 2025 were enrolled and randomly assigned to an observation group (treated with LigaSure hemorrhoidectomy combined with Xiaozhiling sclerotherapy, n=55) and a control group (treated with Milligan Morgan hemorrhoidectomy, n=55) using a random number table method. prospective randomized controlled trial was conducted. The two groups were compared in terms of clinical efficacy, surgery-related indicators (wound healing time, hospital stay, hospitalization costs), and postoperative complication (anal pain, anal bleeding, perianal edema) scores. Results The total clinical effective rates were 100% in the observation group and 94.5% in the control group, with no statistically significant difference (P＞0.05). The observation group had significantly shorter wound healing time and hospital stay than the control group (P＜0.05), while no significant difference was found in hospitalization costs between the two groups (P＞0.05). The observation group also had significantly lower postoperative scores for anal pain, anal bleeding, and perianal edema compared with the control group (P＜0.05), and demonstrated better improvement and faster resolution of anal pain and perianal edema over time. In both groups, scores for anal pain, pain bleeding, and perianal edema initially increased and then decreased over time (P＜0.05). Conclusions LigaSure hemorrhoidectomy combined with Xiaozhiling sclerotherapy achieves clinical efficacy comparable to Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids, while offering advantages of shorter wound healing time, reduced hospital stay, and less postoperative anal pain, anal bleeding, and perianal edema without increasing hospitalization costs. This combined approach provides a valuable reference for the surgical management of mixed hemorrhoids in anorectal practice.
