The first colproctrectomy with the formation of a pelvic intestinal reservoir was performed in 1970. Since then, the technique has been thoroughly tested and currently it is the gold standard in the surgical treatment of ulcerative colitis and familial adenomatous polyposis. This operation allows to improve the quality of patients’ life, reducing the need to form a permanent ileostomy, improving the psychomotional, social and physical rehabilitation of patients. However, this intervention is associated with a high risk of postoperative complications. Impairment of the the pelvic reservoir functioning, as well as the addition of infection, are terrible complications that significantly worsen the patient’s quality of life. Surgeons performing this type of surgery have to face a number of intraoperative and postoperative complications that require repeated interventions. The aim of the study is to improve the results of treatment of patients with the small bowel reservoir. A review and analysis of the literature is performed in this issue. Successful results of performing colproctectomy with the formation of a pelvic enteric reservoir depend on careful preoperative planning, experience of the surgeon, prevention of intra‑ and postoperative complications.
Rectal fistula – one of the most common coloproctological diseases. Annually, thousands of patients with anal fistula have had treated around the world. Treatment of this disease is an actual problem in coloproctology nowadays due to the high frequency of recurrence and anal incontinency. The chronic persistent perianal suppuration and multiple surgical interventions the main predictor of emergence of the anal incontinence, which could be achieve almost 50 %, according the literature data. The risk of emergence the anal incontinence is particularly high in the treatment of complex fistulas. Therefore, the problem of complex rectal fistulas treating remains an actual task in the clinical practice of a coloproctologist.
Background. Video-assisted anal fistula treatment (VAAFT) is a new minimally invasive sphincter-sparing technology.Objective: to describe technical characteristics of VAAFT and evaluate short-term outcomes.Materials and methods. We used a specialized surgical video system (VAAFT®; Karl Storz) for the treatment of complex high rectal fistulas. This technology allows a surgeon to use a special fistuloscope to perform visual examination of the fistula, find its internal opening, and detect secondary fistula passages and inflows. In addition to visual inspection, it is possible to simultaneously conduct a cytological brush through the working channel of the endoscope in order to clear the fistula from detritus and desquamate lining mucosa, and then perform fistula ablation using a monopolar electrode. The internal opening of the fistula can be either closed by a flap or sutured using a linear stapling device or closed using an endoscopic clip with additional sealing of the suture line with biological glue.Results. Between September 2017 and August 2019, a total of 112 patients underwent VAAFT® surgeries. Ninety-three patients (83 %) were followed up for 6 months postoperatively. We observed no significant complications during the follow-up period. The majority of study participants (85 %) did not experience severe pain (>2–4 points on a visual-analog scale) in the early postoperative period. Primary healing was achieved in 98 patients (87.5 %) within 2–3 months. Eighty-nine individuals (79.5 %) were followed up for more than 1 year. Rectal fistula healing within 1 year after VAAFT® surgery was observed in 82 % of patients.Conclusions. The main advantage of the VAAFT® technique is the combination of the diagnostic stage for fistula visualization and identification of the internal opening with the possibility of simultaneous surgical treatment.
В статье на основании обобщения данных литературы проанализированы методологические аспекты предоперационного планирования и технические хирургические приемы для предупреждения интра-и послеоперационных осложнений при выполнении колпроктэктомии с формированием тазового тонкокишечного резервуара. Знание данных особенностей позволяет уменьшить количество осложнений и улучшить функциональные результаты хирургического лечения.
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