Five years of experience in using the laser coagulation method in the treatment of trans- and extrasphincter fistulas of the rectum

Abstract

THE AIM OF the STUDY was to study the results of surgical treatment of patients with trans- and extrasphincter fistulas of the rectum using laser coagulation, depending on the method of closure of the internal fistula opening.PATIENTS AND METHODS: within the framework of scientific research conducted at the NMIC of Coloproctology named after A.N. During a 5-year period, 121 patients underwent surgical interventions using laser coagulation of the fistula passage in combination with 3 different options for closing the internal fistula opening.43 patients were included in the group of laser coagulation of the fistula course in combination with its ligation in the intersphincter space (LT+PSMP), 47 – in the group of laser coagulation of the fistula with plasty of the internal fistula opening with a mucomuscular flap (LT+SML), 31 - in the group of laser thermocoagulation of the fistula course with suturing of the internal fistula opening with separate seams (LT+UVC). The average age of patients is 42 (20-70) years. Men - 82, women -39. The average follow-up period was 19 (3-52) months. In the perioperative period (before surgery, 1 and 2 months after the intervention), patients underwent ultrasound monitoring to assess the healing process of fistulas and early detection of relapses of the disease. To assess the effect of operations on the functional state of the rectal occlusion apparatus before the intervention and 3 months after the operation, patients underwent sphincterometry.RESULTS: in the LT+PSMP group, fistula healing was noted in 33/43 (76.7%) patients, in the LT+SML group - in 33/47 (70.2%) patients, in the LT+UVS group – in 17/31 (54.8%) patients (p=0.129). The only established factor that demonstrated a statistically significant effect on the frequency of positive results in the LT+PSMP group was the diameter of the internal fistula opening. Thus, with a fistula hole diameter of more than 3 mm, a positive result was achieved in 24 (54.5%) of 44 patients, and with a hole diameter of less than3.0 mm, the fistula course healed in 58 (75.3%) of 77 cases (p=0.025).The average length of a bed day (Iu) was 3.5. Complications during surgery and the immediate postoperative period were recorded in only 3 (2.5%) cases.CONCLUSION: Over the five-year period of application, the laser coagulation method has proven itself as a sphincter-sparing intervention that can compete with traditional methods of treating rectal fistulas in a selected group of patients. Regardless of the method of closing the internal fistula opening, the technique has demonstrated a high level of safety. The best rates of healing were recorded when laser coagulation was combined with ligation of the fistula in the intersphincter space (76.7%), however, the search for the most reliable way to isolate the fistula from the lumen of the rectum should be continued.