Freeze-dried collagen implant for the surgical treatment of trans-sphincteric anal fistula
Journal Title: Хірургія України - Year 2018, Vol 0, Issue 3
Abstract
The aim — to improve the surgical treatment results of transsphincteric anal fistulas with freezedried collagen implant. Materials and methods. 88 patients with transsphincteric fistulas of rectum were operated in the of Surgery and Proctology Department from 2012 to 2017. Patients were aged 25 to 65 years old, average age constituted 54.3 ± 2.1 years. Men — 54 (61.3 %), women — 32 (38.7 %). A transanal ultrasound study with complex substance and a circular image sensor (5 — 7.5 MHz) was performed in all patients. 32 patients (36.4 %) had front, 26 (29.5 %) — lateral and 30 (34.1 %) — posterior fistulas, according to the study. Patients were divided into 2 groups depending on the method of surgical treatment. First group comprised 44 patients who were treated with the freezedried allogeneic collagen implant by original technic and a comparison group of 44 patients who used traditional surgical treatment methods of rectal fistulas (the fistula excision in the lumen of the gut — in 28 (63.6 %) observations, Seton Placement (ligation) — in 16 (36.4 %)). The effectiveness of operations was assessed by comparing the immediate and longterm results. Results and discussion. 2 patients (4.5 %) in the first group appeared to have wound abscess, 4 (9.1 %) — serous inflammation of operative wound. Anal incontinence was hardly in evidence. The wound healed on 10.0 ± 1.1 day. In the comparison group, local complications were observed in the early postoperative period in the form of wound suppuration in 9 (20.4 %) patients, partial incontinence of gases in 10 (22.7 %), anal incontinence of the first degree in 8 (18.9 %) %), persistent anal incontinence — in 6 (13.6 %). The wound healed on average 24.0 ± 2.1 days. Longterm results of treatment (1 to 24 months) were examined by observation and questioning of 42 patients in the main group and 41 — in comparison groups. Relapse of the disease in the main group occurred in 2 (4.7 %) patients, in the comparison group — in 7 (17.1 %). In the comparison group, stable anal incontinence was also observed in 6 (14.6 %) and partial incontinence in 8 (19.5 %). Conclusions. Surgical treatment of transsphincteric fistulas with freezedried collagen implant provides ensures reliable closure of the internal fistula opening and helps reduce the relapse rate to 4.7 compared to 17.1 % using traditional techniques.
Authors and Affiliations
Ya. P. Feleshtinsky, Ye. Ye. Born, M. O. Yosipenko
Keywords
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- EP ID EP416303
- DOI 10.30978/SU2018-3-84
- Views 121
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