MODERN ASPECTS OF SURGICAL TREATMENT OF ACUTE AND CHRONIC PARAPROCTITIS

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Abstract

Results of surgical treatment of patients with acute and chronic paraproctitis. These results suggest that the choice of the optimal amount and method of surgical intervention in acute paraproctitis and rectal fistula is crucial in preventing relapses and complications, and ensuring a favorable outcome in the long term. A differentiated approach to the choice of surgical intervention in patients with acute and chronic paraproctitis improves both immediate and long-term outcomes of patients in this category

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Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

12-16

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

ABSTRACT

Results of surgical treatment of patients with acute and chronic paraproctitis. These results suggest that the choice
of the optimal amount and method of surgical intervention in acute paraproctitis and rectal fistula is crucial in
preventing relapses and complications, and ensuring a favorable outcome in the long term. A differentiated approach
to the choice of surgical intervention in patients with acute and chronic paraproctitis improves both immediate and
long-term outcomes of patients in this category

KEYWORDS

Acute abscess, rectal fistula, surgery.

INTRODUCTION

Paraproctitis is one of the most frequent diseases in
proctological practice. Diagnostic and treatment issues

of this disease are constantly discussed in the Russian
and foreign press, however, they are still not

Research Article


MODERN ASPECTS OF SURGICAL TREATMENT OF ACUTE AND
CHRONIC PARAPROCTITIS

Submission Date:

February 27, 2022,

Accepted Date:

March 17, 2022,

Published Date:

March 29, 2022 |

Crossref doi:

https://doi.org/10.37547/TAJMSPR/Volume04Issue03-03


Rustamov Murodulla Isоmiddinovich

Candidate of Medical Sciences, Assistant of the Department of General Surgery, Samarkand State Medical
Institute, Samarkand, Uzbekistan

Saydullaev Zayniddin Yaxshiboevich

Candidate of Medical Sciences, Assistant of the Department of General Surgery, Samarkand State Medical
Institute Samarkand, Uzbekistan

Rustamov Inoyatulla Muradullaevich

Assistant of the Department of General Surgery, Samarkand State Medical Institute, Samarkand,
Uzbekistan

Journal

Website:

https://theamericanjou
rnals.com/index.php/ta
jmspr

Copyright:

Original

content from this work
may be used under the
terms of the creative
commons

attributes

4.0 licence.


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13

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

12-16

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

completely solved and often become a subject of
discussions. According to data of leading clinics in our
country and abroad patients with acute paraproctitis
make up 0,5-4% among patients with general surgical
pathology and 20-40% in the structure of proctologic
diseases. Patients with chronic paraproctitis comprise
0.5-4% of all surgical inpatients and 30-35% of patients
with rectal diseases [1,5,8,9,13,24].

The lack of familiarity of surgeons with this pathology
leads to a large number of unsatisfactory outcomes.
Many patients with acute paraproctitis do not always
receive timely and qualified care, undergo prolonged
treatment, and are out of active employment for a long
time[2,3,6,10,11]. As a result of long-term purulent
process in perianal region a cicatricial deformity of
perineum with anal sphincter insufficiency develops
that often leads to permanent disability of patients
[4,7,12,23]. To date, the percentage of unsatisfactory
treatment results is still quite high. In 13-20% of patients
operated on for acute paraproctitis, there are
pyoinflammatory complications in the wound, in 4-10%
of patients the disease relapses or develops into a
chronic course, in 6-8% of patients there is anal
sphincter deficiency and in 17-36% of operated patients
there is discomfort in the anus [14,15,17,20,25].

According to most researchers, after surgical
treatment of rectal fistulas, suppuration of the
postoperative wound occurs in 10-13% of patients,
recurrence of the disease in 1.5-10.2% of operated
patients and anal sphincter failure in 1.5-27.9% of
patients [16,18,19,21,22]. After surgical intervention for
intra- and transsphincter fistulas, anal discomfort
occurred in 1.8-22.4% of patients [1,8,10,19,24].

The prevalence and frequency of this pathology,
especially in persons of working age, unsatisfactory
immediate and long-term outcomes of the disease
motivate researchers to search for new, most modern

approaches aimed at improving the results of
paraproctitis treatment.

PURPOSE OF THE STUDY

To develop a set of diagnostic, tactical and therapeutic
measures aimed at improving the treatment outcome
of acute and chronic paraproctitis.

MATERIALS AND METHODS

866 patients with acute and chronic paraproctitis were
treated in the proctology department of SamMI Clinic
No.1 2016- 2022.We carried out retrospective analysis
of treatment of 866 patients (men 601 (69.3%); women
265 (30.7%)). Age:20-40 years old - 314 (36,2%), 40-60
years old - 301 (34,7%), 60 and more - 35 (4,0%).

The operation for acute paraproctitis was carried out in
650 patients. Localization of purulent processes in
pararectal cage: acute subcutaneous paraproctitis -327
(50,3%); acute submucosal paraproctitis - 76 (11,6%);
acute ischiorectal paraproctitis - 204 (31,3%); acute
palviorectal paraproctitis - 29 (4,6%); acute retrorectal
paraproctitis - 3 (0,4%); anaerobic paraproctitis - 11
(1,8%). Diabetes mellitus was observed in 21 (3.2%)
patients.

The diagnosis of acute paraproctitis was based on the
anamnesis, clinical picture, and objective examination
of patients. Preoperative period included examination,
palpation of perianal area, finger examination of
rectum, laboratory, X-ray, ultrasound, bacteriological
examination of patients.

Treatment of patients with acute paraproctitis
presents a complex and difficult task which includes
radical sanation of purulent focus, liquidation of
distant consequences of the pathological process,
prevention of recurrence of the disease.


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14

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

12-16

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

Rectal fistula is an inflammatory process in anal crypt,
intersphincter space and pararectal tissue with
formation of fistulous passage. Patients with this
pathology account for about 216 (25%) of all
proctologic patients (1, 2).

Extrasphincteric fistulas are classified according to
their degree of complexity. In the first degree of extra-
sphincteric fistula complexity, the internal orifice is
narrow without scarring around it, there are no
pustules or infiltrates in the tissue, and the course is
fairly straight. In grade 2, there is scarring around the
internal orifice, but no inflammatory changes in the
tissue. In third-degree extra-sphincteric fistulas, there
is a narrow inner orifice without scarring around it, but
there is purulent inflammation in the tissue. In the
fourth degree, they have a wide internal orifice
surrounded by scarring, with inflammatory infiltrates
or purulent cavities in the cellular spaces.

In

transfincter

and

extrasphincter

fistulas,

fistulography and assessment of anal sphincter
function must complement the examination.

The most common types of operations for rectal
fistulas are excision of the fistula into the rectal
lumen;excision of the fistula into the rectal lumen
(Gabriel operation);excision of the fistula into the
rectal lumen with opening and drainage of the
leak;excision of the fistula into the rectal lumen with
sphincter suturing;excision of the fistula with
ligature;excision of the fistula with relocation of
mucosa or muco-muscular flap of the distal rectus to
liquidate the internal fistula opening [3].

The greatest problem is the treatment of
extrasphincteric fistulas, with recurrences of 6-10%.

In the preoperative period, laboratory, radiological,
endoscopic and bacteriological examination was

performed. The choice of the optimal volume and
method of surgical intervention for acute paraproctitis
is crucial in preventing recurrences and complications
and ensuring a favourable outcome in the long term.

Surgical interventions were carried out under peridural
or spinal anesthesia.

At subcutaneous and submucosal forms of
paraproctitis an abscess was opened in the lumen of
rectum according to Gabriel method in 285 patients
(43,8%). At ischiorectal and pelviorectal forms of
paraproctitis two-stage surgical tactics was used. At
the acute stage of the disease a dissection, sanation
and drainage of the abscess was carried out.

Necrectomy with a wide opening of purulent
abscesses was applied in patients with anaerobic forms
of paraproctitis characterized by extensive purulent-
necrotic affection of pararectal cellular tissue and a
severe clinical course.

In the postoperative period intensive antibacterial,
infusion therapy was carried out. Antibiotics were used
according to the sensitivity of the microflora.

When pararectal fistulas were formed, a radical
operation was performed - excision of the purulent
passage with elimination of the internal orifice of the
fistula. After opening of the pararectal fistula without
liquidation of the internal opening of the paraproctitis,
the recurrence of the disease or rectal fistula occurred
in 70-100% of cases.

At a choice of operative intervention it was taken into
account: relation of fistulous passage and internal
orifice to sphincter; presence of cicatricial process
along fistula; presence of infiltrates and purulent
sinkholes in pararectal cellulose.


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15

Volume 04 Issue 03-2022


The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN

2689-1026)

VOLUME

04

I

SSUE

03

Pages:

12-16

SJIF

I

MPACT

FACTOR

(2020:

5.

286

)

(2021:

5.

64

)

(2022:

6.

319

)

OCLC

1121105510

METADATA

IF

7.569















































Publisher:

The USA Journals

For rectal fistulas 216 operations were done,
intrasphincteric fistulas - 64 (30,5%), transphincteric -
96 (44,5%), extrasphincteric - 56 (25,0%).

In intrasphincteric fistulas the following operations
were performed: excision of the fistula into the
intestinal lumen with suturing of the wound bed. There
were no suppuration of wounds, recurrences, or
insufficiency of the anal bridge. Transsphincter fistulas
were treated by excision of the fistula with suturing of
part of the external sphincter and ligature method.
Inflammation of the wound occurred in 3 patients
(3.1%), recurrence in 8 (8.3%) and anal fistula failure in 2
(2.0%).

In extrasphincter fistulas we performed excision of
fistula and ligature method, excision of fistula with
relocation of mucosal flap. There was wound
suppuration in 2 patients (3.5%), recurrences in 3 (5.3%),
insufficiency of anal bridge in 1 (1.7%). The average
duration of inpatient treatment was 8 bed-days. The
total duration of temporary incapacity for work was 23
days.

CONCLUSIONS

the differentiated approach to the choice of operative
intervention, optimization of preoperative preparation
and postoperative treatment of patients with acute
paraproctitis makes it possible to improve both the
nearest and distant treatment results of patients of
this category, to reduce terms of treatment and
temporary disability, the number of complications and
recurrences.

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04

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