Background and Aim of Study: Rectal fistulae make 20% of all proctologic pathology. Despite numerous methods of surgical treatment of rectal fistulae, percentage of recurrence does not tend to decrease. Complicacy of surgical correction consists in balance between radical surgery with total resection of fistulae and minimal damage of anal sphincter. Development and implementation of novel mini-invasive methods of surgical treatment remains actual in surgery. The aim of the study: to compare and analyze results of treatment of transsphincter rectal fistulae using standard methods and using biowelding. Materials and Methods: We carried out retro-and prospective research of surgical treatment of 57 patients with transsphincter rectal fistulae. All patients were treated in surgical development during September 2018 to November 2019. All patients were divided into two groups. First group included 30 patients, treated with standard methods (resection of fistula with sphincterectomy and incision of rectal fistula with sphincteroplasty). Other group included 27 patients, who were treated with biowelding. Results: According to data, satisfactory result of treatment in first group was observed in 66.7% of cases; in second group success was in 96.3%. Usage of biowelding for removal of intrasphincter part of fistula allowed both decreasing of surgery duration and preventing damage of sphincter apparatus. Conclusions: Excision of rectal fistulae using biowelding can be effective for treatment of such patients. Usage of this method allowed avoiding damage of sphincter apparatus, shortening time of wound healing and number of hospital stay, decreasing expression of pain syndrome in postoperative period.

Background. The search for and development of new minimally invasive methods for the surgical treatment of anal fistulas is a relevant area of surgery. Such methods combine less traumatization and preservation of the sphincter's complex. Employment of such methods for surgical treatment of anal fistulas reduced the time of stay of patients in the hospital and improved their quality of life. Subjects and methods. A retro-and prospective study involved 58 patients with uncomplicated transsphincteric anal fistulas. All patients were treated in the hospital from January 2014 to April 2019. The patients were divided into two groups: the first group included 32 patients who were operated on according to the standard procedure using fistulotomy and Seton procedure; the second group consisted of 26 patients who were operated on using the modified LIFT method. Results. Most of these patients (72.4%) were men at the age of 42.53 6.79. The median of BMI was 25.7 kg/m2. There wasn't mortality after operations. The median follow-up was 21 (6-48) weeks. In the first group there were 3 cases (9.3%) of anal sphincter insufficiency and 7 cases of recurrent fistulas (21.9%) at different times after surgery. In the second group there were no anal sphincter failure following administration of the modified method LIFT, but there were 15.4% of recurrent anal fistulas. Conclusion. The proposed modified method of ligation of intersphincteric fistula tract is an effective method for the treatment of anal fistulas. The results obtained suggest that the developed method can be used to treat other types of anal fistulas.

многие методы хирургического лечения анальных свищей являются недостаточно эффективными, так как многие из них негативно влияют на качество жизни оперированных пациентов в связи с развитием частичного или полного нарушения произвольного удержания содержимого толстой кишки, мочи и сопровождаются значительным процентом рецидивов свищей, требующих выполнения повторных операций. существует целый ряд публикаций и рекомендаций по лечению свищей прямой кишки, но многие из них являются противоречивыми, что делает принятие практических решений при лечении чрезвычайно сложным. В попытке достичь трех основных целей лечения (закрытия фистулы, сохранения функции сфинктера и минимизации времени заживления) за последние десятилетия были предложены различные минимально инвазивные методы сохранения сфинктера: перемещение эндоректального лоскута, использование фибринового клея и различных герметизирующих «тампонов», введение в свищевой ход стволовых клеток, полученных из жировой ткани, перевязка межсфинктерного свищевого тракта, видеоассистированное лечение и другие методы. Несмотря на столь большой арсенал предложенных минимально инвазивных технологий в лечении анальных свищей, остается много неясных вопросов о том, как адаптировать имеющиеся хирургические варианты к более сложным клиническим случаям.

Abstract. Introduction. Preoperative determination of the functional state of the sphincter apparatus of the rectum is an important part of the treatment of patients. Assessment and analysis of the functional viability of the anal sphincter are necessary for the choice of tactics for surgical correction of rectal fistulas. This approach makes it possible to assess the effectiveness of a specific surgical method and determine the degree of sphincter insufficiency in the postoperative period. The aim of the study: to assess the normative values of neurophysiologicsl parameters of the sphincter apparatus of the rectum and pelvic floor muscles by using the method of electrosphincteromyography. Materials and methods. The study included 93 patients who were treated in the surgical department of the Kharkiv Regional Hospital for rectal fistulas. Indicators of the contractile function of the sphincter apparatus were determined by the method of interference electrosphincteromyography in the preoperative period. The comparison group consisted of 28 volunteers who did not have rectal diseases associated with impaired intestinal retention function (0 points on the Wexner incontinence scale). Results. The standard values of the bioelectrical activity of the sphincter apparatus were obtained by examining a group of volunteers by the method of interference electrosphincteromyography. The analysis of the results obtained demonstrates a slight decrease in the initial indicators of the bioelectric activity of the sphincter complex in the postoperative period. Conclusions. Minimally invasive methods of surgical treatment of rectal fistulas are preferred, because during the study, patients showed a decrease in the initial parameters of the contractile viability of the anal sphincter.

Abstract. Aim. Modern surgical approaches to the treatment of anal fistulas involve operations that least damage the sphincter complex of the rectum. The essence of the operation is a complete excision of the anal fistula, which is often accompanied by a significant number of recurrences depending on the chosen method of operation. Failure is likely the result of inflammation that persists after surgery, and cytokines play an important role in these processes. The aim of the study: evaluate local production and determine the role of IL-6 and TNFα in the formation of rectal fistulas. Materials and methods. The tissue of the fistula tract was obtained in 90 patients of both sexes with transsphincteric fistula of cryptoglandular origin in the period from September 2018 to February 2020, who underwent surgery (fistulotomy, modified technique LIFT, use of biowelding technique of the fistula tract). Results. The frequency of IL-6 producing cells was highest (32.0±4,0) specimens in the field of view not only in inflammatory infiltrate, but also in granulation tissue and immature connective tissue of the fistula tract. The lowest rates of IL-6 producing cells were (23.0±3,0) specimens in the field of view. The frequency of TNFα receptor-producing cells ranged from (17.0±1,0) specimens in the field of view to (24.0±3,0) specimens in the field of view. Conclusions. A large number of IL-6 and TNFα-producing cells has been identified not only in inflammatory infiltration but also in granulation and immatureconnective tissue, indicating the active role of these cytokines in the formation of rectal fistulas.

Summary. The search for the optimal method of surgical treatment of fistulas of the rectum is an important issue of modern surgery. The main complications after operations are the recurrence of the disease and anal incontinence. The reasons for such complications are not only the incorrect choice of the surgical technique, but also technical errors in their implementation. The proposed methods of surgical interventions are characterized by a combination of radical excision of the fistula tract and minimal impact on the anal sphincter. Objective. To analyze the results of surgical treatment of rectal fistulas using minimally invasive technologies and to determine the prospects of their use. Materials and methods. The study consisted retro- and prospective analysis of surgical treatment of patients with various types of rectal fistulae. The advantages of using minimally invasive methods (the modified method LIFT and excision anal fistulas with biowelding) were revealed. Results. The use of the proposed methods demonstrated high efficiency and reduced rates of postoperative complications. Conclusions. The effectiveness of the techniques consists in the minimal damaging effect on the muscle structures of the anal complex. This reduces the risk of insufficiency of the anal sphincter in the postoperative period. The use of minimally invasive techniques reduce the duration of surgery, the number of hospital days, and the overall wound healing time.