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Khirurgii

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Year 2018 Vol. 26 No 2

REVIEWS

S.E. KATORKIN, A.V. ZHURAVLEV, A.A. CHERNOV, V.N. KRASNOVA

MODERN SPHINCTER SAVING METHODS OF TREATMENT OF TRANSPHINCTERIC AND EXTRASPHINCTERIC PERIANAL FISTULAS

Samara State Medical University, Samara,
The Russian Federation

The review presents the world experience, reflecting advances in the treatment of patients with extrasphincteric and high transphincteric perianal fistulas. There is no single approach in the treatment of patients with this form of chronic paraproctitis, there are no clear indications for the application of any method of surgical treatment. The priority tasks facing coloproctologists are to reduce the traumatic nature of the operation, to prevent complications, to preserve the anatomical integrity and functional capacity of the rectum apparatus. Currently, preference is given to low-traumatic methods of surgical treatment, denoted by the term «sphincter saving techniques» and aimed at secure closure of the internal fistula opening, excision of the peripheral part of the fistulous tract, detection and elimination of purulent leakages in the pararectal tissue. These include video-assisted anal fistula treatment (VAAFT), obstruction of the fistula by biological sealant tampons (AFP) and two-component fibrin glue (FGA), intersection of the fistula in submucosal (SLOFT) and intersphincter (LIFT) spaces. There are indications for each of the methods; each of them has both advantages and some disadvantages. At present, the most interesting is LIFT, the operation which attracts with its simplicity, high efficiency and safety of surgical techniques in relation to the rectum blockage apparatus. According to the literature, its effectiveness exceeds 75% with full preservation of the anal holding function. The performed analysis allows comparing different methods of treatment of pararectal fistulas and to determine the further direction of their improvement and scientific studies.

Keywords: chronic paraproctitis, perianal fistula, LIFT technique, function of the rectum sphincter, postoperative complications, recurrence of the disease
p. 204-214 of the original issue
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Address for correspondence:
443079, The Russian Federation,
Samara, K. Marx Ave., 165B,
Clinic of Samara State Medical University,
Department and Clinic of Hospital Surgery,
Tel. office: 8 10 846 276 -77-89,
e-mail: katorkinse@mail.ru,
Katorkin Sergey E.
Information about the authors:
Katorkin Sergey E., PhD, Associate Professor, Head of the Department and Clinic of Hospital Surgery, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7473-6692
Zhuravlev Andrej V., PhD, Head of the Coloproctological Unit of the Hospital Surgery Clinic, Associate Professor of the Hospital Surgery Department, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-0353-840x
Chernov Andrey A., PhD, Surgeon of the Coloproctological Unit of the Hospital Surgery Clinic, Assistant of the Hospital Surgery Department, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0002-7622-6095
Krasnova Veronika N., Surgeon of the Coloproctological Unit of the Hospital Surgery Clinic, Samara State Medical University, Samara, Russian Federation.
https://orcid.org/0000-0001-7788-0665
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