NEW MODIFICATION OF DOWNWARD TRANSPOSITION OF MUCOUS COAT IN THE SURGICAL TREATMENT OF PARARECTAL AND RECTOVAGINAL FISTULAS

B.A.AGAYEV, SH.A.NOVRUZOVA, R.M.MAMMADOV, K.R.SЕYIDOVA

Azerbaijan Medical University, Baku, AZERBAIJAN

Pararectal and rectovaginal fistulas constitute 15-20,8% of proctologic diseases. Occurrence of various complications, and some times of complications causing disability of a patients (anal spjhyncter insufficiency, recurrences) in 5-35% of cases after surgical operations of such fistulas which can be treated only by surgical means, shows outstanding problems in this sphere of proctology and gynaecology. The main reason of recurrences of the downward transposition of the rectal mucosa preferred in the surgical correction of such fistulas, is the backward retraction and necrosis of a part of mucous coat. To prevent such complications, we offer a new modification. The essence of the offered method to carry out arched transverse resection 1,5-2 cm higher the proximal end by mobilization of the mucous coat at a shorter distance in order to increase mobility of the part of separated mucous coat. Another difference of our modification from Jade-Robble classic method is lack of longitudinal resections on the sides, which allows better maintenance of blood supply of mobilized part of the mucous coat from sides to down and due to middle-rectal arteries.

The method was applied in 5 patients, such complications as postoperative retraction, necrosis of a part mucous coat were encountered. RRS performed 3 months after the operation determined fine healing of injuries of arched resection on the colonic wall with 0,4-0,5 cm width, without narrowing.

Thus, the offered new method increases the opportunity to mobilize a part of the mucous coat at a shorter distance, and maintain sufficient vascularization, to avoid such complications as retraction and necrosis of a part of mucous coat in post operative period and to easily close the rectal orifice of ekstra and transsphyncter pararectal and rectovaginal fistulas, and as a result to prevent recurrence of fistulas.

Date: 2014-12-28; view: 759