SURGICAL TREATMENT OF EXTRASFINECTORAL LIPS WITH USE OF ALOGENIC COLLAGEN IMPLANT
About the author:
Feleshtinsky Ya. P., Born Ye. Ye., Smyshchuk V. V., Prepodobny V. V., Yosypenko M. O.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The aim of the workis to improve the results of surgical treatment of extrasphincter fistulas. Object and methods. In the clinic of the Department of surgery and proctology for the period from 2012 to 2017, 53 patients with extrasphincter fistulas were operated. The age of the patients ranged from 25 to 60 years. The average age is 52.3 ± 2.1 years. Males 31 (58.4%), women – 22 (41.5%). 25 (47.1%) patients were diagnosed with extrasphincter fistulas of the 1st degree of difficulty, 15 (28.3%) of the 2nd, 7 (13.2%) of the 3rd and 6 (11.3%) 4th degree of complexity. Depending on the technique of surgical treatment, the patients were divided into 2 groups. The first group consisted of 27 patients, which performed our developed surgical treatment using a biological allogenic collagen implant. The second group consisted of 26 patients who performed the classic methods of excision of the fistulas of the rectum. Fistulotomy was performed in 9 (34.6%) patients, Fistulectomy (excision of the fistula in the gut lumen) in 7 (26.9%) and Seton Placement (ligating overlay) at 10 (38.4%) patients.Research results and their discussion. In the first group of patients, suppuration of the wound occurred in 1 (3.7%) patients, in 3 (11.1%) serous inflammation of the postoperative wound, which was eliminated by drainage and the appointment of anti-inflammatory therapy (diclofenac 3.0 1 times/m), anal incontinence in patients was not marked. The wound healed for 10 ± 1.2 days. In the second group of patients in the early postoperative period there were local complications in the form of suppurative wounds in 7 (26.9%) patients, partial incontinence of gases appeared in 6 (23.0%) patients, anal incontinence of the 1st degree was noted at 6 (23.0%), stable anal incontinence arose in 4 (15.3%), the wound was healed for 24 ± 2.3 days. Long-term results of treatment, which were studied from 1 to 24 months, by surveys and questionnaires of 21 patients in the first group and 22 patients in the second group. Relapse in the first group occurred in 1 (3.7%) of the patient in the second group occurred in 4 (15.4%) patients. In addition, in the second group, stable anal incontinence was observed in 3 (13.6%) and partial incontinence gases in 4 (18.1%) patients. Conclusions. The proposed technique reduced the number of relapses in patients with extrasphincter fistulas after surgical treatment by 11.7% compared with the classical ones. Local use of a lyophilized allogeneic collagen implant promotes accelerated formation of own collagen in the patient’s tissues, which leads to a rapid closure of the defect.
extrasphincter fistulas, collagen implant, transanal ultrasound examination
- Lurin IA, Tsema EV. Sravnitelnaya otsenka otdalennyih rezultatov lecheniya bolnyih s ekstrasfinkternyimi svischami pryamoy kishki s ispolzovaniem sovremennyih, hirurgicheskih metodik. Ukr. med. zhurn. 2006;4:76-8. [in Russiаn].
- Feleshtinskiy YaP, Born EE, vinahidniki; Nathionalna medithna akademiya pisliadiplomnoyi osviti imeni PL. Shupika, patentovlasnik. Sposib kompleksnogo hirurgichnogo likuvannya hronichnogo paraproktitu z vikoristannyam kolagenovoyi plivki. Patent Ukrayini № 109214. 2016 Ser 10. [in Ukrainian].
- Filips RKS, Vorobyov GP, redactor. Kolorektaliaya hirurgiya. M: GEOTAR-Media; 2009. 258 s. [in Russiаn].
- Chernov AA, Zhukov BN, Isaev VR. Optimizatsiya hirurgicheskogo lecheniya bolnyih so slozhnyimi ekstra i chrezsfinkternyimi pararektalnyimi svischami. Kazan. med. zhurn. 2007;6:604-5. [in Russiаn].
- Shelyigin YuA, redactor. Klinicheskie rekomendatsii. Koloproktologiya. M: GEOTAR-Media; 2015. 528 s. [in Russiаn].
- Arroyo A, Pérez-Legaz J, Moya Arroyo PA. Fistulotomy and sphincter reconstruction in the treatment of complex fistulain-ano: long-term clinical and manometric results. Ann. Surg. 2012 Jan 12;255:935-9.
- Göttgens KW, Janssen PT, Heemskerk J, van Dielen FM, Konsten JL, Lettinga T, et al. Long-term outcome of low perianal fistulas treated by fistulotomy: a multicenter study. Int J Colorectal Dis. 2015 Dec 16;30:213-19.
- Han JG, Yi BQ, Wang ZJ. Ligation of the intersphincteric fistula tract plus a bioprosthetic anal fistula plug (LIFT-Plug): a new technique for fistula-in-ano. Colorectal Dis. 2012 Mar 20;15:582-6.
- Jordán J, Roig JV, García-Armengol J, García-Granero E, Solana A, Lledó S. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis. 2010 Dec 6;12:254-60.
- Köckerling F, Alam NN, Narang SK, Daniels IR, Smart NJ. Treatment of Fistula-In-Ano with Fistula Plug a Review Under Special Consideration of the Technique. Front Surg. 2015 Jan 20;16:2-55.
- Köckerling F, Rosen von T, Jacob D. Modified plug repair with limited sphincter sparing fistulectomy in the treatment of complex anal fistulas. Front Surg. 2014 Jan 11;1:17.
- Raslan SM, Aladwani M, Alsanea N. Evaluation of the cutting seton as a method of treatment for perianal fistula. Ann Saudi Med. 2016 Aug 15;36:210-5.
- Tan KK, Lee PJ. Early experience of reinforcing the ligation of the intersphincteric fistula tract procedure with a bioprosthetic graft (BioLIFT) for anal fistula. ANZ J Surg. 2013 Nov 10;84:280-3.
- Visscher AP, Schuur D, Roos R, Van der Mijnsbrugge GJ, Meijerink WJ, Felt-Bersma RJ. Long-term follow-up after surgery for simple and complex cryptoglandular fistulas: fecal incontinence and impact on quality of life. Dis Colon Rectum. 2015 Sept 21;58:533-9.
Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 201-204 pages, index UDK 616.352-007.253-031.21-089.85-089.844