Abstract
Background. Acute or chronic rectal fistulas make up to 30% of proctologic pathology and are accompanied by significant impairment of patients` lives. In recent years, the role of matrix metalloproteinases in the pathogenesis of many diseases has grown rapidly. The most widely expressed protease in inflamed tissues is matrix metalloproteinase-9 (MMP-9).Objectives. To identify and analyze changes in the level of MMP-9 in the serum of patients with extrasphincteric fistulas of the rectum, depending on the method of surgery.Methods. The study involved 28 patients with extrasphincteric rectal fistulas, who undergone surgery in the proctology department of Poltava Regional Clinical Hospital and the surgical department of the 3rd city clinical hospital in Poltava from 2010 to 2018. The patients were divided into 2 groups according to the method of surgical treatment. Quantitative determination of MMP-9 in blood serum was performed.Results. In the main group, the average value of MMP-9 before surgery was 14.90 ± 0.15 ng/ml, a month later it decreased to 7.73 ± 0.37 ng/ml (pË‚0.0001), and after three months, the average value of MMP-9 was determined at 2.41 ± 0.13 ng/ml (pË‚0.0001). In the comparison group, the initial average value was 15.00 ± 0.08 ng/ml, which decreased to 11.89 ± 0.26 ng/ml (pË‚0.0001), and three months after surgery it decreased to 4.14 ± 0.17 ng/ml (pË‚0.0001).Conclusion. The use of MMP-9 levels in blood serum before and after surgery has determined that the method of treatment of extrasphincteric fistulas using the drug Tachocomb is less traumatic and reduces the healing time of postoperative wounds compared to the ligature method.  Â
Highlights
The presence of acute or chronic rectal fistula is a common surgical pathology that occurs in 20-30% of cases, which is accompanied by frequent recurrences, impaired anorectal function, and significantly impairs the quality of life of the patient
Extrasphincteric fistulas most often occur proximal to the rectum and are usually the result of a procedure or acute paraproctitis and lead to irreversible destruction of the sphincter, perianal tissues, the emergence of chronic paraproctitis [1]
The study involved 28 patients with extrasphincteric fistulas of the rectum of varying severity, who were hospitalized in the proctology department of Poltava Regional Clinical Hospital and the surgical department of the 3rd city clinical hospital in Poltava from 2010 to 2018
Summary
The presence of acute or chronic rectal fistula is a common surgical pathology that occurs in 20-30% of cases, which is accompanied by frequent recurrences, impaired anorectal function, and significantly impairs the quality of life of the patient. Extrasphincteric fistulas most often occur proximal to the rectum and are usually the result of a procedure or acute paraproctitis and lead to irreversible destruction of the sphincter, perianal tissues, the emergence of chronic paraproctitis [1]. The most widely expressed protease in inflamed tissues is matrix metalloproteinase 9 (MMP-9), or gelatinase B, which is synthesized by various cells, such as epithelial, dendritic, T-cells, fibroblasts, keratinocytes, osteoblasts, macrophages. It is responsible for the degradation of denatured collagen (gelatin) and basement collagen. MMP-9 is involved in inflammatory processes and has both pro- and anti-inflammatory activities
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