The treatment results of rectal fistulas in Crohn's disease - VAAFT

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Danilov Mikhail, Atroshchenko Andrew, Pozdnyakov Stepan, Ruchkina Evgeniya and Khatkov Igor

Moscow Clinical Scientific Center, Russia

: J Liver Disease Transplant

Abstract

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Treatment of fistulas of the rectum in Crohn's disease is a difficult task for both gastroenterologists and surgeons. Medicamental treatment of this pathology is recommended as the first line of therapy, and surgical treatment serves to control severe septic complications. The frequency of relapse in the surgical treatment of rectal fistula with the use of various methods can reach up to 55% and 70% if there is also Crohn's disease. Surgical interventions with the plastic component and the excision of the fistula show good results, but they practically do not make sense in case of Crohn's disease. Mini-invasive interventions video-assisted anal fistula treatment (VAAFT) is becoming increasingly popular, in the treatment of rectal fistulas in Crohn's disease, in particular. Our clinic performed 12 procedures using video-endoscopic technologies (VAAFT) in patients with Crohn's disease, the comparison group included patients who underwent ligation of the fistula in the intersphincteric space (LIFT)-18. In the first stage, setons were put into all the patients, followed by operation in the period from one to three months. Patients of both groups did not differ in age and sex (p=34), as well as in fistula types: Trans-sphincteric- VAAFT=8, LIFT=14, extra-sphincteric- VAAFT=4, LIFT=6 (p=45). The groups did not significantly differ in the duration of the surgical intervention: VAAFT-28±5.2 min, LIFT-26±5.8 min (р=.12), pain syndrome in the postoperative period (VAS scale) (p=.07), postoperative bed-day (4±1.2 and 4±1.4, p=.24). All patients in VAAFTgroup underwent the first stage of fistuloscopy, then the fistula was cleared from fibrin overlap, fistula ablation was performed in the direction from the inner to the external opening, the internal opening was excised and sutured. According to the preoperative examination (transanal US, MRI), there was an ischio-rectal lag associated with the fistula in two patients in the VAAFT group and one in the LIFT group, and surgical intervention was supplemented by sanitation and drainage through the external fistula opening. The median follow-up of the total sample of patients was 12.6 months. In two patients of the LIFT group (10%) and the 1st group VAAFT (8.3%), the relapse of the disease was detected at different times: 6, 7 and 3 months, respectively (p=.18), the setons were put into the patients once again; medicamentous therapy was continued (preparations of 5-ASA, hormones, and biological therapy). Video-endoscopic treatment of rectum fistulas (VAAFT) in Crohn's disease is quite new and promising surgical technique that demonstrates satisfactory results in both early postoperative and distant period. The small-traumatic nature of the technique makes it possible to perform it in multiple and recurrent fistula of the rectum.

Biography

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