COMPARATIVE ANALYSIS OF RESULTS OF SURGICAL TREATMENT FOR CHRONIC PARAPROCTITIS, HIGH ANAL FISTULAS DEPENDING ON THE METHOD USED

Abstract

More than 30% of patients with chronic paraproctitis are found out to present complex forms of this pathology. They are often complicated with the external sphincter incontinence due to the deformation of the anal canal and cicatricial changes in the anal constrictors. The deficiency of the anal sphincter is observed in 4.9-33% of patients, and recurrent operations on the rectum are often accompanied by the development of elements of neurogenic and motor incontinence resulted from the massive sphincter trauma. Objective. To conduct a comparative analysis of the results of surgical treatment for chronic paraproctitis between standard method of surgical treatment and a method we proposed. Objects and methods. 58 patients with extrasphincteric anal fistulas of varying degrees of severity operated on by applying two methods were involved into this study: the group 1 included 32 patients who were operated on by using the Seton method; the second group consisted of 26 patients who were operated on by using the new method with applying “Tachocomb” preparation. Results. Early postoperative complications were noted in 37.5% of patients in the first clinical group, and 15.4% in the second group. In six months of follow-up period, the pressure values in the internal sphincter at rest in the second group exceeded those in the patients operated on by using the standard technique. 6 patients (18.8%) operated by using the standard method the recurrence of fistula was observed in 6 months following the operation; 11 (34.4%) patients demonstrated satisfactory results, and 15 (46.8%) were found to have good functional results. In the second clinical group, 16 patients (61.5%) were found to have good results; 8 people (30.7%) had satisfactory results and only 1 patient (5.9%) had fistula recurrence. The results of treatment were evaluated in 3, 6, 12 and 18 months following the operations, and the minimum terms of patients’ monitoring were more than one year. Conclusions. Thus, the good and satisfactory long-term results of treatment for high rectal fistulas in patients of the second clinical grpup operated on by applying the newly developed method with «Tachocomb» allow us to recommend the method to widely implement into the clinical practice for patients with extra- and trans-sphincteric fistulas of the 3rd - 4th degrees of severity.