Born E. Comprehensive surgical treatment of chronic paraproctitis. (Еxperimental and clinical study)

The dissertation is devoted to the actual problem of improving the efficiency of treatment of patients with chronic paraproctitis by improving diagnostics, substantiation, development and implementation of a method of complex surgical treatment using a freeze-dried collagen implant. Survey and surgical treatment of 196 patients with chronic paraproctitis, including recurrent chronic paraproctitis, was observed in 47 (23.9 %) patients. It was found that the cause of relapses of chronic paraproctitis during classical operations is the non-irradiated internal opening of the fistula and its branches, which was confirmed in 96.8 % of patients with combined (transabdominal, transrectal) ultrasound examination. The experiment proved that the use of a freeze-dried collagen implant to close the rectal defect in animals provides uniform germination of the gut wall with the connective tissue by creating its own collagen and the stability of the implant to the bacterial collagenase, which confirms the possibility of its use in clinical practice. The proposed method of complex surgical treatment of patients with chronic paraproctitis with incision of the inner aperture in extrasphinic fistulas, dissection of the internal opening of the transfectional fistula and the closure of these sites by lyophilized collagen implant provides germination of the connective tissue of the fortified area of the rectum and eliminates the substrate for recurrent rectal fistula to 4.1 % against 14.2 %, respectively. It has been proved that the use of the developed method of complex surgical treatment of patients with chronic paraproctitis compared with classical methods shows a higher efficiency of the developed method, which allowed to reliably (p<0,05) reduce in the early postoperative period by 6 times the number of complications from the postoperative wound (infection of the wound 4 % versus 23.8 % in the control group), anal incontinence decreased from 22.4 % in the control group until it was completely absent in the main group, reduce the duration of full postoperative rehabilitation (from 8.1±1 week en 3±1 week) and reduce the likelihood of rectal fistula recurrence from 14.2 % to 4.1 %.