Epidural-sacral anesthesia in radical surgical treatment of acute paraproctitis

The epidural-sacral anesthesia was used in 242 patients operated upon for different forms of acute paraproctitis. No complications resulting from the anesthesia were noted. The incidence of failures in performing epidural-sacral anesthesia was 3.6%. The epidural-sacral anesthesia has advantages over other kinds of anesthesia, is safe and not technically difficult and practically has no contraindications.     

The primary postponed radical surgical treatment of acute suppurative paraproctitis]

The method of primarily postponed radical surgical treatment of acute purulent paraproctitis consists in puncture of the abscess, introduction of a double-channel drain, and continuous drop irrigation of the cavity for 1-2 days with antiseptic solutions and active aspiration for preoperative management. When the inflammatory process abates, fistulochromography is conducted and a radical operation is carried out on the same day with excision of the inner opening of rectal fistula. The method makes it possible to combine two operations in one stage which are undertaken in one third of patients in routine surgical treatment of acute paraproctitis. The described method shortens the period of treatment to 14-15 days and improves the immediate and long-term results. Eight patients were operated on with a good outcome.     

Surgical treatment of acute paraproctitis

The authors made operations on 113 patients with various forms of acute periproctitis by their original method. One of its main elements was to open the intermuscular space of the rectum by dissection of the internal sphincter and part of the circular muscular layer. The proposed method of treatment of acute periproctitis is thought by the authors to be radical since the operation was not followed by recidivations which shortened staying of the patients at the hospital.     

Clinical course and surgical treatment of complex forms of recurrent acute paraproctitis]

Clinical course and results of surgical treatment of 94 patients with complex forms of recurrent acute paraproctitis were analysed. Radical surgical intervention was conducted in 68 patients, of whom in 35--using the pararectal abscess opening with cryptectomy, in 17--with translocation of a distal rectum mucosa, in 16--with a ligature conduction through internal aperture of fistula. One-nine year follow-up of 89 patients is available. After radical intervention the recurrence and postoperative complications had occurred in 19%, after nonradical one--in all the patients.     

Surgical treatment of acute paraproctitis]

Based on the experience with surgical therapy of 1178 patients with acute paraproctitis, a detailed statistic and morphological analysis of the disease is given. The authors have proved the possibility of a one-moment radical operation practically for all forms of acute paraproctitis. The suggested methods are grounded on incision of a pararectal abscess in the intestinal lumen onto the involved Morgan cript. If partial or even complete incision of the anal compressor proves to be necessary during the operation, the authors would apply its suturing or non-tamponade method of the postoperative management.     

Amoxiklav in the treatment of acute paraproctitis

In 38 patients with an acute paraproctitis a new generation antibiotic Amoxiclave, owing broad spectrum of activity, was applied. While observing the wound clearance and healing process, together with clinical parameters, the results of bacteriological investigation were controlled. High efficacy of the preparation was observed as well as expediency of its application in the purulent wound surgery, for an acute paraproctitis in particular.     

Complex treatment of patients with acute paraproctitis

Results of the treatment of 3253 patients with acute paraproctitis are analysed. The treatment must be complex, with a radical operative intervention as a decisive measure directed to a radical dissection of the abscess and liquidation of the internal opening of the abscess in the rectum. Positive results were obtained in 88,3% of the patients.     

Treatment of acute paraproctitis by latex ligature method

A new procedure of operation in acute paraproctitis with transsphincteral purulent canal is proposed. The method is based on deferral transection of sphincter's portion by latex ligature, which ensure minimal diastasis of muscular ends and prevents the development of anal sphincter insufficiency. 35 patients with different forms of transsphincteral purulent canal were operated by this technique. There were other recurrences or anal sphincter insufficiency.     

The treatment of acute paraproctitis in an emergency proctology department]

An experience with treatment of 3160 patients with acute paraproctitis under conditions of a specialized department is presented. Rational curative methods allow to achieve healing of 2280 patients (72.2%) with small amount of complications (22 cases). The duration of treatment was shortened to 11.2 days. No recurrences were noted.     

A method of surgical treatment of acute ischio-rectal and pelvio-rectal paraproctitis with a transsphincter and extrasphincter position of the primary pus meatus

A one-moment radical method of surgical treatment was used in treatment of 36 patients with ischio-rectal and pelvio-rectal forms of acute paraproctitis. The method of surgical treatment of acute paraproctitis considerably shortened the period of hospital treatment, promoted the formation of a soft scar, excluded the development of the anal sphincter incompetence, and reduced the percentage of recurrent diseases.