With 10% of its patients being foreign nationals, why has the proctology department of this hospital in Shanghai gained international recognition?

After undergoing five surgeries in the United States without success in treating his anal fistula, 35-year-old Tom came to Shanghai University of Traditional Chinese Medicine Affiliated Longhua Hospital for treatment upon a friend’s recommendation.

Tom is not an isolated case. Approximately 10% of the outpatient patients in the hospital’s proctology department are foreign nationals. On December 16, reporters from The Paper learned that the annual outpatient volume of the proctology department exceeds 70,000 visits, with over 3,000 surgeries performed for anal fistulas each year, of which 45% are complex cases.

Longhua Hospital stated that the increase in foreign patients in the proctology department is partly due to the growing acceptance of traditional Chinese medicine (TCM) overseas. Currently, Longhua Hospital is the only TCM hospital among the 13 public hospitals in Shanghai designated as international medical tourism pilot units. Additionally, the proctology department is a specialty of Longhua Hospital, recognized as a national clinical key specialty and a clinical base for TCM proctology in Shanghai.

Recently, the proctology department at Longhua Hospital treated a Chinese patient named Tom, who works in Silicon Valley, USA. He suffered from a complex anal fistula and had undergone five surgeries in the U.S. without achieving a cure. Recently, he was successfully treated in Shanghai using a combination of Western and traditional Chinese medicine.

According to Longhua Hospital, in October 2023, Tom noticed swelling and pain around his anus, which initially was an abscess that later developed into an anal fistula. He sought examination and treatment at a local hospital, but his prognosis was not promising. The drainage in the affected area was not smooth, and there were issues with the wound either not healing or reopening. From October 2023 to October 2024, Tom underwent five surgeries in the U.S. Although the local hospital took care to preserve his anal function and employed some minimally invasive techniques, such as mucosal flap advancement, Tom’s anal fistula remained unresolved, significantly impacting his life and work.

Upon a friend’s recommendation, Tom decided to return to China for treatment. In October 2024, he visited the Haipai TCM Gu’s Proctology Clinic at Longhua Hospital. Dr. Wang Chen explained that for conditions like anal fistulas, the team typically combines techniques such as anal fistula endoscopy, flap advancement, and laser treatment with their unique methods like “thread dragging therapy,” “medicated thread therapy,” and “cotton pad compression therapy,” achieving good results.

An anal fistula is a cavity structure left after an abscess around the anal rectum ruptures or after incision drainage. Dr. Wang described it as similar to a mouse creating a new tunnel in the wall of an existing tunnel, which may or may not have an exit, referred to as a fistula. During bowel movements, a small amount of feces may enter this fistula, leading to infection. If left untreated, anal fistula patients are prone to recurrent infections, pus discharge, swelling and pain, as well as itching and eczema around the anal skin.

Dr. Wang performed surgery on Tom, who had a complex anal fistula, using the hospital’s innovative “thread dragging therapy.” This method preserves the muscles and tissues near the patient’s anus. Medicated ointment is applied to the thread, which is then dragged into the fistula to allow the medication to erode the wall of the fistula. Once the pus is eroded, the doctor flushes the cavity to clean out the pus and uses techniques to promote granulation tissue growth.

Dr. Wang explained that this process is called “debriding and promoting granulation.” As new granulation tissue gradually fills the cavity, it shrinks, and the doctor removes the thread while applying cotton pads to compress and promote healing of the fistula. Currently, “thread dragging therapy” has been recognized as a suitable technique for promotion by the National Administration of Traditional Chinese Medicine. In October, after a series of combined treatments, Tom was discharged after achieving full recovery.

The recurrence rate of anal fistulas in Crohn’s disease has been reduced to 15%. Proctological diseases are common clinical conditions, with a survey by the Chinese Medical Association indicating that the prevalence of proctological diseases in China is as high as 50.1%, including hemorrhoids, anal fistulas, and anal fissures.

There is a growing number of patients with a specific type of anal fistula, namely those with Crohn’s disease. Crohn’s disease is a type of inflammatory bowel disease that can affect the entire digestive tract, from the mouth and esophagus to the stomach, small intestine, large intestine, and perianal area. Patients typically experience abdominal pain, diarrhea, weight loss, fever, and fatigue, and may also have extraintestinal manifestations affecting joints, skin, eyes, and oral mucosa, as well as local symptoms like perianal abscesses or fistulas.

Dr. Wang noted that the clinical manifestations of anal fistulas in Crohn’s disease are diverse and complex, making treatment challenging and severely impacting patients’ quality of life and mental health. Additionally, the recurrence rate of anal fistulas in Crohn’s disease is high, with expert consensus indicating that 35% to 59% of patients may experience a recurrence within two years.

The combination of Western and traditional Chinese medicine has shown good efficacy for anal fistulas in Crohn’s disease. Dr. Wang stated that data from the proctology department at Longhua Hospital indicates that the healing rate for Crohn’s disease anal fistulas treated with the Haipai TCM Gu’s combined approach can reach 80%, with a recurrence rate of about 15%, which is now at a very low level.

Longhua Hospital reported that in recent years, its proctology surgical team has conducted extensive clinical and basic research, developing targeted TCM formulations such as promoting healing granules, effectively shortening the healing time of anal fistula surgical wounds and reducing scar formation, thereby improving patients’ treatment outcomes and quality of life.

Professor Wang Chen, the director of the proctology department at Longhua Hospital, stated that as the spectrum of diseases evolves, the proctology field faces an increasing number of complex cases. In addition to pelvic floor diseases, the classification of common anal fistula diseases has become more refined, with rising incidences of complex anal fistulas such as perianal lesions in Crohn’s disease, anal fistulas in infants and young children, rectovaginal fistulas, and rectourethral fistulas. For these conditions, a combination of Western and traditional Chinese medicine can maximize patient benefits.