23
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
23-28
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
completely solved and often become a subject of
discussions. According to data of leading clinics in our
Research Article
A SET OF DIAGNOSTIC, TACTICAL AND THERAPEUTIC MEASURES TO
IMPROVE THE TREATMENT OF ACUTE AND CHRONIC
PARAPROCTITIS
Submission Date:
February 27, 2022,
Accepted Date:
March 17, 2022,
Published Date:
March 29, 2022|
Crossrefdoi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue03-05
RustamovMurodullaIsomiddinovich
PhD Assistant of the Department of General Surgery, Samarkand State Medical Institute, Republic of
Uzbekistan, Samarkand, Uzbekistan
RustamovInoyatullaMuradullaevich
PhD Assistant of the Department of General Surgery, Samarkand State Medical Institute, Republic of
Uzbekistan, Samarkand, Uzbekistan
Journal
Website:
ericanjournals.com/ind
ex.php/tajmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
24
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
23-28
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)(2021:
5.
64
)(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
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 the total number of surgical inpatients and
30-35% of patients with rectal diseases. 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. As a result of the long-term chronic course
of the purulent process in the perianal area, a
cicatricial deformity of the perineum with anal
sphincter insufficiency develops, often leading to
persistent disability of the patients . The percentage
of unsatisfactory treatment results is still rather 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 failure and in
17-36% of operated patients there is discomfort in the
anus.
According to most studies, 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. After surgical
intervention for intra- and transsphincter fistulas, anal
discomfort occurred in 1.8-22.4% of patients.
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
outcomes
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 during 2016-2022. We retrospectively
analyzed the treatment of 866 patients (601 men
(69.3%); 265 women (30.7%)). By age: 20-40 years old -
314 (36.2%), 40-60 years old - 301 (34.7%), 60 and over -
35 (4.0%).
650 patients were operated for acute paraproctitis.
Localization of pus in pararectal tissue: acute
subcutaneous paraproctitis - 327 (50,3%); acute
submucosalparaproctitis
-
76
(11,6%);
acute
ischiorectalparaproctitis
-
204
(31,3%);
acute
pilviorectalparaproctitis
-
29
(4,6%);
acute
retrorectalparaproctitis
-
3
(0,4%);
anaerobic
paraproctitis - 11 (1,8%). Diabetes mellitus was
observed in 21 (3,2%) patients.
Diagnostics of acute paraproctitis was based on the
anamnesis, clinical picture, results of objective
examination of patients. In preoperative period we
carried out 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.
25
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
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2689-1026)
VOLUME
04
I
SSUE
03
Pages:
23-28
SJIF
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FACTOR
(2020:
5.
286
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5.
64
)(2022:
6.
319
)
OCLC
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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.
Extrasphincteric fistulas are classified according to
their degree of complexity. In the first degree of
extra-sphincteric fistula complexity, the internal
orifice is narrow with no scarring around it, 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, the
examination of the patient should be supplemented
by fistulography and determination of the sphincter
function of the anus. 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 a mucosa or muco-muscular flap of the
distal rectus to eliminate the internal fistula opening .
The greatest problem is the treatment of
extrasphincteric fistulas, with recurrences of 6-10%. In
the preoperative period, laboratory, radiological,
endoscopic and bacteriological examinations were
performed.
DISCUSSION OF THE RESULTS OF THE STUDY
The choice of the optimal volume and method of
surgical intervention in acute paraproctitis is decisive
in terms of preventing relapses and complications and
ensuring a favorable result in the long-term period.
Surgical interventions were performed under epidural
or spinal anesthesia.
With subcutaneous and submucosal forms of
paraproctitis, an abscess was opened into the lumen
of the rectum according to Gabriel - 285 patients
(43.8%).
In ischiorectal and pelviorectal forms of paraproctitis,
a two-stage surgical approach was used. In the acute
stage of the disease, an abscess was opened,
sanitized and drained.
Necrectomy with a wide opening of purulent streaks
was used in patients with anaerobic forms of
paraproctitis, which were characterized by extensive
purulent-necrotic lesions of pararectal tissue and
severe clinical course.
In the postoperative period, intensive antibacterial,
infusion therapy was carried out. Antibiotics were
used taking into account the sensitivity of the
microflora.
In the formation of pararectal fistulas, a radical
operation was performed - excision of the purulent
passage with the elimination of the internal opening
of the fistula. After opening an abscess of the
pararectal tissue without eliminating the internal
opening of the paraproctitis, a recurrence of the
26
Volume 04 Issue 03-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
03
Pages:
23-28
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)(2021:
5.
64
)(2022:
6.
319
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
disease or fistulas of the rectum occurred in 70-100%
of cases.
When choosing an operative intervention, the
following was taken into account: the ratio of the
fistula and the internal opening to the sphincter; the
presence of a cicatricial process along the fistula; the
presence of infiltrates and purulent streaks in the
pararectal tissue.
Operations were performed for rectal fistulas - 216,
intrasphincteric fistulas - 64 (30.5%), transsphincteric -
96 (44.5%), extrasphincteric - 56 (25.0%).
With intrasphincteric fistulas, operations were
performed: excision of the fistula into the intestinal
lumen with suturing the bottom of the wound. There
was no suppuration of wounds, relapses, insufficiency
of anal sphincter.
For transsphincteric fistulas, excision of the fistula
with suturing of a part of the external sphincter and
the ligature method were used. Wound suppuration
was noted in 3 patients (3.1%), relapses - in 8 (8.3%),
anal sphincter insufficiency - in 2 (2.0%).
In case of extrasphincteric fistulas, excision of the
fistula and the ligature method, excision of the fistula
with displacement of the mucous flap were
performed. There was suppuration of the wound in 2
patients (3.5%), relapses - 3 (5.3%), anal sphincter
insufficiency - 1 (1.7%). The average duration of
inpatient treatment was 8 bed-days. The total
duration of temporary disability is 23 days.
CONCLUSIONS
Thus, a differentiated approach to the choice of the
method of surgical intervention, optimization of
preoperative
preparation
and
postoperative
treatment of patients with acute paraproctitis can
improve both the immediate and long-term results of
treatment of patients in this category, reduce the
duration of treatment and temporary disability, the
number of complications and relapses.
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