Comment on the systematic review of TROPIS for anal fistula

We read with interest the recent systematic review and meta-analysis by Chen et al. evaluating the outcomes of the Transanal Opening of Intersphincteric Space (TROPIS) technique compared with conventional treatments for anal fistula. The authors should be congratulated for assembling a large dataset of 24 studies involving 2813 patients and for applying a comprehensive analytic approach across multiple clinically relevant outcomes [1]. Their findings, particularly the apparent advantages of TROPIS in efficacy, recurrence, continence preservation, and complication rates, are noteworthy and reinforce the growing enthusiasm for this sphincter-sparing technique.