CHOICE OF DRAINAGE LIGATURE IN THE TREATMENT OF COMPLEX FORMS OF ACUTE PARAPROCTITIS

Anal abscess is the most popular case in urgent coloproctology. The problem ofanal fistula formation remains open. Primary fistulotomy for anal abscess reduces the incidence offistulas, however, this method of treatment affects the muscle fibers of the obturator apparatus ofthe rectum and lead to anal incontinence. The role of a loose set-on in the treatment of fistulas iswidely known and well-studied, which cannot be said about the use of this method in the treatmentof anal abscess.Aim of the study. To research the effectiveness of a loose seton in a two-stage treatmentwith paraproctitis.Materials and methods. This retrospective study included 60 patients with acuteischiorectal abscess. The patients were divided into 2 groups, 30 persons each. At the first stage oftreatment, patients of group A underwent incision and drainage of the abscess, patients from groupB, incision and drainage of the abscess was supplemented with a drainage ligature passing throughthe affected crypt. At the second stage, 22 patients from group A and 30 patients from group Bunderwent a combined LIFT operation with laser destruction of the fistulous tract. Before thesecond stage of treatment, patients of both groups underwent transrectal ultrasound in order toexclude the presence of leaks and cavities. The function of anal sphincter was assessed usingsphincterometry and a Wexner scale questionnaire before and after the second stage of treatment.Results. The average follow-up period for the patients after the second stage of treatmentwas 18.3 months. in group A and 16 months in group B. The recurrence in group A were registeredin 5 out of 22 people (22.7%), in the group of patients with a loose set-on – in 3 out of 30 persons(10%). Dysfunctions of anal sphincter after the first and second stages of surgical treatment werenot registered in any of the groups.Conclusions. The use of loose set-on in two-stage treatment of paraproctitis allows toconfidently control draining of abscess, form a consolidated fistulous tract without spurs and leaks,prepare the patient for the second stage of surgical treatment and reduce the recurrence rate afterminimally invasive treatment of rectal fistulas without loss of anal sphincter function.