Introduction: Treatment of highly complex anal fistula is still a profound test for a specialist colorectal surgeon. The reasons are directly related to recurrence and incontinence. Aim: To evaluate the clinical results of a combined method of intraoperative endoanal ultrasonography (IOEAUS) and transanal opening of the intersphincteric space (TROPIS). Material and methods: This study retrospectively included 48 patients with complex anal fistula, all of whom underwent new surgical methods. This operation mainly consists of two steps. Firstly, the type of anal fistula was determined by endoanal ultrasonography (EAUS) or magnetic resonance imaging (MRI) before the operation. Then the TROPIS procedure was performed with the help of EAUS, and the decision on whether a drainage seton should be placed depended on the condition of the tract. If there were secondary tracts, they were found and the same was done. Results: The median follow-up was 12 months. Two (4.1%) patients experienced recurrence. Four (8.3%) patients did not have primary healing. All 6 patients underwent the same procedure again, and three recovered completely. So total successful fistula healing was observed in 45 (93.7%). There were no major complications and no significant deterioration in anal function and incontinence postoperatively. Conclusions: Combined IOEAUS and TROPIS is an effective procedure in the treatment of highly complex anal fistula, and it may offer a new means for other operations.
Aromaticity is a key concept in organic chemistry. It dated back to Faraday's discovery of benzene in 1825 and Kekulé's famous alternating-double-bond structure of 1865, and is still evolving in recent years. At present, some examples of anti-Hückel's rule have been proposed gradually, including Möbius aromaticity rule and Baird's rule. In particular, scientists put forward new concepts of 3D aromaticity and global aromaticity. This review not only introduces the experimental and theoretical criteria of aromaticity, but also summarizes several new aromaticity systems through porphyrin nanoring, macrocyclic polyradical and polycyclic π-conjugated system. In addition, it covers the applications of aromaticity and briefly discussed recent progress on the concepts of aromaticity.
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