Search for a command to run...
AIM: evaluating effectiveness and safety of the method of fistula repair using a lateral rectal flap in patients with anal fistulas involving more than 1/3 of the external sphincter (complex anal fistulas). PATIENTS AND METHODS : a single-centre, prospective, single-group study included 60 patients who underwent anal fistula repair using a lateral rectal flap (LRF). The check-up before and after the surgery was carried out using instrumental methods — transrectal ultrasound (TRUS) and sphincterometry. The majority of patients had an extrasphincteric fistula (41/60 (68.3%)), pararectal cavities were detected in 39/60 (65%) patients, including multiple cavities in 23/39 (38.3%). The late results were studied after 3–12 months. The median follow-up was 7 (4; 8) months. The primary endpoint was the rate of non-recurrence cases (treatment effectiveness), the secondary ones were the assessment of continence, pain syndrome, risk factors for unsatisfactory results (recurrence). RESULTS: the effectiveness of the LRF method was 48/60 (80%; 95% CI 67.7; 89.2) cases. Sphincterometry and Wexner’s incontinence scale showed no worsening of continence after surgical treatment (1 (0; 3) point before the surgery and 2 (0; 3) points after 3–6 months (p = 0.68)). The assessment of risk factors for unsatisfactory results of LRF application revealed such factors as excess body weight (body mass index ≥ 30.7 kg/m²) (body mass index ≥ 30.7 kg/m²) (odds ratio (OR) = 1.14 (95% coincidence interval (CI) 1.02; 1.29), p = 0.02); purulent intersphincteric leaks (OR = 5.50 (95% CI 1.14; 26.6), р = 0.03); purulent ischioanal leaks(OR = 16.8 (95% CI 3.20; 7.55), р = 0.0009) and purulent pelviorectal leaks(OR = 7.86 (95% CI 1.69; 36.6), р = 0.008), as well as multiple purulent cavities (OR = 4.40 (95% CI 1.14; 16.9), р = 0.03).At the same time, the LRF method allows to achieve recovery in 28/39 (71.8%) patients with solitary cavities, and in 15/23 (65.2%) cases of multiple cavities. CONCLUSION : the LRF method allows for the one-stage elimination of “complex” anal fistulas in 80% of cases, without worsening of anal continence. According to the Visual Analogue Scale, the median score did not exceed 3 for the entire follow-up period, what corresponds to a low level of pain; at the same time, the maximum intensity was noted on the 2–4 days after surgery, whereas by the 10 day almost all patients did not experience pain.