Fistula-in-ano is one of the most common perineal inflammatory diseases [1]. Many techniques have been developed for the treatment of complex anorectal fistulas. The most difficult cases require a special approach. Biological substances are used for minimally invasive treatment of anorectal fistulas [2]. Insertion of autological fibrin substance into the fistula tract is one of the types of such procedures [3].

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Background. Reliable data on the efficacy and safety of fistulectomy with primary sphincter repair for the treatment of high transsphincteric anal fistulas are deficient.The aim. To compare the efficacy and safety of fistulectomy with advancement muco-muscular flap (F) and fistulectomy with primary sphincter reconstruction (SR) for the treatment of high anorectal fistulas.Methods. A cohort of 92 consecutive patients with transsphincteric anal fistula involving 1/3 to 2/3 of the sphincteric complex were included in prospective randomized study. The primary endpoint was the recurrence rate. The duration of surgery, blood loss, pain intensity, postoperative complications, the duration of wound healing, incontinence, quality of life were registered.Results. Forty-six patients were randomized in each group. A statistically significant difference was obtained for operative time (Group “F” – 45 (20–160) min, Group “SR” – 33 (10–55) min). The blood loss was 3 (1–20) and 2 (1–10) ml in Groups “F” and “SR”, respectively (p = 0.482). The return to work in Groups “SR” and “F” occurred after 7 (2–14) and 8 (4–20) days, respectively (p = 0.005). The pain syndrome was significantly greater in Group “F” (p < 0.05) on days 1 and 7. Recurrence rate was in 23.9 % (11 cases) in Group “F” and in 6.5 % (3 cases) in Group “SR” (p = 0.042). Incontinence was in 7 (15.2 %) people in Group “F”, in 10 patients (21.7 %) – in Group “SR” (p = 0.591). There was no statistically significant difference in postoperative complications.Conclusion. Findings can expand the indications for the treatment of high transsphincteric anorectal fistulas involving from 1/3 to 2/3 of the sphincter complex without statistically significant risk for functional results.

Introduction. Nowadays there are no sufficient evidence based data for a scientifically approach to the treatment of hemorrhoids during pregnancy and after childbirth, as well as current data of the prevalence of hemorrhoidal thrombosis (HT) and possible risk factors. Material and methods. The study included pregnant women and puerperas who were actively diagnosed with chronic hemorrhoids (CH) and HT. The physical examination was performed four times: at the woman’s initial visit to the obstetrician-gynecologist, at 24 weeks of pregnancy, at 36 weeks of pregnancy, in the postpartum period (within 7 days after delivery). Patients suffering from HT were asked to answer a questionnaire to determine possible risk factors. Results. A study was conducted on a population of 668 women. 104 women was diagnosed with CH in the postpartum period, and 81 - during pregnancy. The median VAS score with HT was 7. Second delivery, age over 30 years old, lack of physical activity during pregnancy and vaginal delivery are possible risk factors for the development of HT. Conclusions. In the presence of a high risk of HT during pregnancy and in the postpartum period, preventive examinations by a coloproctologist are an important aspect of patient management.

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