This journal is
indexed in Scopus
Year 2014 Vol. 22 No 1
A.N. RAZIN, B.N. ZHUKOV, A.A. CHERNOV, S.E. KATORKIN
THE METHOD OF OPERATIVE TREATMENT OF PATIENTS WITH EXTRASPHINCTERIC PARARECTAL FISTULAS
SBEE HPE “Samara State Medical University”,
The Russian Federation
Objectives. To improve treatment results of patients with extrasphincteric pararectal fistulas by means of the operative method of plastic correction.
Methods. The results of the examination and operative treatment of 146 patients with extrasphincteric pararectal fistulas have been analyzed. Clinical and instrumental examination (sigmoidoscopy, test with vital dye, probing of the fistulous passage, sphincterometry, transrectal sonoraphy of the pararectal zone tissues and fistulography) has been performed. Ligature method was applied in 50 (34,2%) patients (the 1st group). Rectoplasty with lateral displacement of the mucous-submucosal rectal flap was performed in 50 (34,2%) cases (the 2nd group). The proposed method of plastic correction was done in 46 (31,5%) patients (the 3rd group). Assessment of the operative treatment results was carried out in the early (up to 3 months) and distant (up to 4 years) postoperative periods.
Results. In the early postoperative period hemorrhage was diagnosed in 2 (4,0%) cases in the 1st group, in 3 (6,0%) – in the 2nd group, in 5 (3,4%) – in the 3rdst group, in 3 (6,0%) – of the 2nd group, in 2 (4,3%) – of the 3rdst group, in 6 (12,0%) – of the 2nd group, in 3 (8,6%) – of the 3rdst group, in 1 (2,0%) – of the 2nd group and there wasn’t any – in the 3rd group.
Conclusions. Minor trauma, the lack of the anal sphincter functional insufficiency, a small number of relapses, reduction of the medical and social rehabilitation terms of patients are considered to be the advantages of the designed method of the operative correction of the extrasphincteric pararectal fistulas.
- Il'in VA, Vorobei AV, Khulup GIa, Shved IA. Rezul'taty khirurgicheskogo lecheniia vysokikh svishchei priamoi kishki [Results of surgical treatment of rectal fistulas in a high position]. Koloproktologiia. 2005;(2):8-15.
- Van Onkelen RS, Gosselink MP, Schouten WR. Treatment of anal fistulas with high intersphincteric extension. Dis Colon Rectum. 2013 Aug;56(8):987–91.
- Osnovy koloproktologii [Fundamentals of coloproctology]: ucheb. Posobie. red. Vorob'ev GI. 2-e izd. Moscow, RF; 2006. 432 p.
- Ratto C, Litta F, Parello A, Zaccone G, Donisi L, De Simone V. Fistulotomy with end-to-end primary sphincteroplasty for anal fistula: results from a prospective study. Dis Colon Rectum. 2013 Feb;56(2):226–33.
- Schwandner T, Roblick MH, Kierer W, Brom A, Padberg W, Hirschburger M. Surgical treatment of complex anal fistulas with the anal fistula plug: a prospective, multicenter study. Dis Colon Rectum. 2009 Sep;52(9):1578–83.
- Mitalas LE, van Onkelen RS, Monkhorst K, Zimmerman DD, Gosselink MP, Schouten WR. Identification of epithelialization in high transsphincteric fistulas. Tech Coloproctol. 2012 Apr;16(2):113–17.
- Wallin UG, Mellgren AF, Madoff RD, Goldberg SM. Does ligation of the intersphincteric fistula tract raise the bar in fistula surgery? Dis Colon Rectum. 2012 Nov;55(11):1173–78.
- Tan KK, Tan IJ, Lim FS, Koh DC, Tsang CB. The anatomy of failures following the ligation of intersphincteric tract technique for anal fistula: a review of 93 patients over 4 years. Dis Colon Rectum. 2011 Nov;54(11):1368–72.
- Tsunoda A, Sada H, Sugimoto T, Nagata H, Kano N. Anal function after ligation of the intersphincteric fistula tract. Dis Colon Rectum. 2013 Jul;56(7):898–902.
- Murav'ev AV, Maliugin VS, Zhuravel' RV, Lysenko OV. Sposob plasticheskoi operatsii pri ekstrasfinkternykh svishchakh priamoi kishki [The method of plastic surgery for extra-sphincter fistulas of the rectum]. Koloproktologiia. 2012;(3):11–14.
- Zhukov BN, Razin AN, Katorkin SE, Chernov AA. Optimizatsiia khirurgicheskogo lecheniia patsientov so slozhnymi formami khronicheskogo paraproktita [Optimization of surgical treatment of patients with complicated forms of chronic paraproctitis]. Vrach-aspirant. 2012; 52(3.4):517–20.
- Zhukov BN, Razin AN, Chernov AA, Razin NN, Katorkin SE. Sposob operativnogo lecheniia patsientov s ekstrasfinkternymi pararektal'nymi svishchami [The method of surgical treatment of patients with extra sphincter pararectal fistulas]: patent na izobretenie ¹ 2491024 RF / ¹ 2012107057/14; zaiav. 27.02.2012; opubl. 27.08.2013, Biull ¹ 24.
443079, Rossiiskaia Federatsiia, g. Samara, pr. Karla Marksa, d. 165 «b», Kliniki Samarskogo gosudarstvennogo meditsinskogo universiteta, kafedra i klinika gospital'noi khirurgii,
Katorkin Sergey Evgenievich
Razin A.Ò. A surgeon of coloproctology department, a post-graduate student of the chair of hospital surgery of SBEE HPE "Samara State Medical University."
Zhukov B.N. Honored Worker of Science, MD, professor, a head of the chair of hospital surgery of SBEE HPE "Samara State Medical University."
Chernov A.A. PhD, a head of coloproctology department of hospital surgery of SBEE HPE "Samara State Medical University."
Katorkin S.E. PhD, an assistant professor of the chair of hospital surgery SBEE HPE
"Samara State Medical University".