Abstract
Aim. Evaluation of the effectiveness and identification of the benefits of a video-assisted fistula treatment method using fistuloscopy, in comparison with traditional methods of surgical treatment of complex forms of chronic paraproctitis, trans- and extrasphincteric, relapsing rectal fistulas. Patients and methods. A complex analysis of the results of surgical treatment was carried out in 228 patients with chronic paraproctitis, transphincteric, ectrasphincteric, including recurrent rectal fistulas, divided into three groups (main and two control), depending on the surgical methods of chronic paraproctitis used. Results. The result of surgical treatment of pararectal fistulas in the three study groups was compared. The effectiveness of treatment was assessed by the results of immediate and long-term postoperative period. It has been established that the use of a video-assisted fistula treatment method using fistuloscopy excludes the presence of an extensive postoperative wound in the perianal region, which significantly reduces the likelihood of its secondary infection, and the sphincter trauma, and in fact virtually eliminates its insufficiency. The use of video-assisted method of treatment of fistulas made it possible to reduce the number of postoperative complications. Conclusion. The final results (92.7% of favorable outcomes) allow us to recommend a video-assisted treatment for fistulas for wide practical implementation.
Highlights
Anorectal fistula is one of the most common diseases in coloproctology
Rectal fistulas in the structure of coloproctological diseases range from 15% to 30% [1, 2]
The results of treatment showed that the use of a video-assisted method using fistuloscopy, in addition to the treatment stage, has an important diagnostic value that influenced intraoperative tactics
Summary
Anorectal fistula is one of the most common diseases in coloproctology. According to the literature, rectal fistulas in the structure of coloproctological diseases range from 15% to 30% [1, 2]. The presence of high transsfincter and extrasfincter fistulas of the rectum, complicated by the formation of infiltrative changes and purulent cavities in the pararectal spaces, is accompanied by a continuous course and frequent exacerbations of the inflammatory process [8] Often this causes the occurrence and development of severe local changes that cause significant deformation of the anal canal and perineum, scar transformation of the anorectal locking apparatus muscles, resulting in insufficiency of the rectal locking apparatus, primarily the external sphincter. Unsuccessful outcomes of surgical treatment when attempting radical excision of fistulas are accompanied by significant trauma to the components of the external and internal sphincters after their intraoperative damage and replacement with scar tissue after wound healing This is fraught (in addition to dysfunction of the pelvic elements) with the development of various degrees of fecal incontinence and flatus. According to modern authors [6, 7, 9], in patients with high transsfincter and extrasfincter fistulas of the rectum, the risk of anal incontinence up to 83% [1,2,3]
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