[Surgical treatment of patients with severe fecal incontinence].

The objective of the study is improvement of clinical and functional results of surgical treatment of patients with severe fecal incontinence. 79 patients with complete fecal incontinence were included in the study. The technique of surgical intervention was choosed in depending on the localization of structural and functional disorders of the rectum closing apparatus. Complex treatment in pre-operative and post-operative periods was directed on the improvement of functional results. Long-term results (6-24 months) were traced in 63 patients after surgical treatment and complex post-operative rehabilitation. Good and satisfactory results were identified in 57 (90.5%) patients, unsatisfactory results - in 6 (9.5%) patients. Choice of surgical technique in depending on the localization of structural and functional disorders of the rectum closing apparatus and combination of surgical correction with complex functional rehabilitation allow to increase treatment efficiency. Also it improves closing function in the most patients.

[Results of graciloplasty at the patients with complete insufficiency of anal sphincter].

Graciloplasty was performed at 43 patients with III stage of anal sphincter insufficiency. Program of preoperative preparation including therapeutic physical training and electrostimulation of gracilis muscle permitted to improve muscle's functional activity on 19.1%. Functional postoperative rehabilitation permitted to prevent the degenerative processes on displaced muscle and to improve the function of fecal continence. The good results after graciloplasty with functional rehabilitation has been achieved at 80%, satisfactory results at 8.6% patients.

[Long-term results of excision of anal fissure in combination with lateral subcutaneous sphincterotomy].

One hundred and seventeen patients with anal fissure underwent fissure excision in combination with lateral subcutaneous sphincterotomy. The mean follow-up after treatment was 4.3 years. All the patients were questioned by the phone. Thirty-six ones who had some symptoms were examined at outpatient department. The examination included physical examination, anorectal manometry, endorectal ultrasonography, irrigoscopy, defecography. Recurrences of anal fissure were revealed in 12 (10.2%) patients. The cause of recurrence was incomplete sphincterotomy. Different grade of anal incontinence was revealed in 23 patients: 2 of them had soiling, 12 -- incontinence of the flatus, 8 -- incontinence of liquid faeces, 1 -- incontinence of solid faeces. In 4 patients the cause of anal incontinence was excessive sphincter section during sphincterotomy, in 16 -- perineal descent syndrome, in 3 -- advanced age. It is concluded that it is necessary to modify surgical technique and to examine patients more carefully before surgery including anorectal manometry.

[Potentialities of modern clinical X-ray radiology in the differential diagnosis of tumor and other obstructive diseases of the large bowel]. / Vozmozhnosti sovremennoi klinicheskoi rentgenologii v differentsial'noi diagnostike opukholevykh i drugikh obstruktivnykh zabolevanii tolstoi kishki.

The misdiagnosis rate in defining the cause of obstructive colonic disease is 8.2-24.4%. This is consistent with the fact that every 5 patients with colonic obstruction present difficulties in establishing the nature of a pathological process. The paper provides the results of analysis of clinical and X-ray symptoms in 350 patients with difficult differentially diagnosed cases of narrowing of the rectum and colon. Based on the analysis, the authors identified the basically important X-ray signs that might differentiate tumor stenoses from other obstructive diseases. They also defined the specific X-ray signs of such diseases as infiltrative cancer; extraintestinal cancer involved in the large bowel; inflammatory strictures in ulcerative colitis, diverticulosis, actinomycosis, tuberculosis, intestinal endometriosis, invagination, and other obstructive diseases. The developed differentiated diagnostic criteria could enhance the overall accuracy of X-ray study in this difficult group of patients from 72.7-80% to 93%.

[X-ray study in the examination of patients with perineal fistulas]. / Rentgenologicheskii metod v obsledovanii bol'n"kh so svishchami promezhnosti

The paper discusses whether X-ray study of patients with perineal fistulas is required and justified. The main reason is that there is a diversity of diseases which display the same signs as paraproctitis. Of 426 examinees, perineal fistulas were mainly caused by chronic paraproctitis in 85% and by other various diseases showing the similar symptoms in 15%. The basic studies of these patients included fistulography made in 300 patients with external fistulas and proctofistulography performed in 126 patients with incomplete internal fistulas. Comparing the data of X-ray study with those of clinical and morphological ones showed the sensitivity of the former to be 94.5%. Based on the results of their own observations, the authors defined indications for fistulography or proctofistulography. In addition to the analysis of the findings, they present the main points of differential X-ray diagnosis of different diseases manifested by perineal fistulas.

[The treatment of wounds of the anal canal and perineum]. / Lechenie ran anal'nogo kanala i promezhnosti.

Analysis of processes of wound healing in 215 patients after operations for hemorrhoids, anal fissures and rectal fistulas was carried out. Clinico-cytologic control of healing of postoperation wound has shown that ultra-violet irradiation of wound surface is most effective at early stages of wound healing due to its pronounced bactericidal and antiinflammatory action. Low frequency laser irradiation intensifies tissue reparative and hastens healing of wounds. The proposed method for treatment of wounds by successive use of ultra-violet and laser irradiation of wound surface combined with conventional ointment medications, improves the results of treatment and decreases the rate of purulent complications 2 times, promotes rapid healing of wounds.

[Surgical treatment of anal insufficiency]. / Khirurgiia analnoi nedostatochnosti.

Organic defects in the lateral walls of the rectal obturative apparatus involving no more than one fourth of its circumference are repaired by end-to-end or side-to-side sphincteroplasty. Sphincterolevatoroplasty is indicated in anterior or posterior defects and sphincterogluteoplasty with short or long grafts of the greatest gluteus muscles in larger defects. For cases in which the gluteal muscles cannot be used, an operation has been developed for repair of the defects with the medial part of the great adductor muscle. A damaged internal sphincter muscle of the anus is reconstructed by means of a muscular cuff formed from the wall of a pulled down rectum.

[Clinical course and treatment of traumatic rectal fistula]. / Klinika i lechenie travmaticheskikh svishchei priamoi kishki.

From experience in treatment of 104 patients with rectal fistulas of traumatic origin the authors distinguished the specific features of the clinical manifestations of the disease which must be taken into consideration in choosing the therapeutic tactics. In contrast to the management of common chronic paraproctitis, the treatment of traumatic rectal fistulas differs in principle, particularly when the internal opening of the fistula is in the wall of the rectal ampulla++. The authors determined the indications for various methods of treatment and techniques of operative interventions, including multistage surgical treatment with the creation of temporary colostomy.