Makarov N.V., Starosek V.N., Kirillov A.V.

SI “Crimea State Medical University named after S. I. Georgievsky”

Chair of Surgery (Postgraduate Education Division)

(Department head – professor V.N. Starosek)

Simferopol

Level of inflammatory mediators in case of paraproctitis surgical treatment

The diseases of sigmoid and rectum constitute the majority of all gastrointestinal diseases, especially of those, which require surgical treatment. Sigmoid and rectum cancer, hemorrhoids, paraproctitis and anal fissure are the most common rectum diseases nowadays. About 85-90 % of them may be treated only surgically, among them we should mention paraproctitis, because it may lead to serious complications.

Paraproctitis is a purulent inflammation of the cellular tissues surrounding the rectum caused by bacterial microflora of rectum which invades surrounding tissues. It is a severe disease because it forms acute pain, high temperature and may lead to abscess or even necrosis of pararectal cellular tissues. In some cases it may also burst to fistula form. Paraproctitis may be acute as well as chronic. Acute paraproctitis is more painful for patient, but its chronic form is difficult to treat.

The most common treatment of paraproctitis is surgical treatment and the operation is usually performed by a ligature method (Hippocrates method), which consists in cutting of fistula tissues with a ligature. This method is simple, but has quite long restoration period (about 20 days, and in some cases even longer, than a month) and brings a lot of discomfort to patient in postoperative period.

There is also a modern method of treatment called «translocational proctoplasty», which consists in internal fistula foramen plastics with the muco-muscular patch from anal canal normal tissues. Traumatism of this type of surgical invasion is low and the restoration period is 2-3 times shorter then such period in case of ligature method surgery.

The advantages of translocational proctoplasty may be proved by comparison of inflammatory mediators’ level in different stages of treatment. All the inflammatory mediators shows the activity of inflammatory processes in human organism, but we choose C-reactive protein (CRP), a special acute-phase protein as very effective and reliable index of inflammation process, which says us about regeneration processes in patient’s organism.

The analyses of CRP level in patients were performed in pre-operative period, in postoperative period on the third, seventh and fourteenth day (fourteenth day analyzes were performed only in first group of patients). The 2 groups of 10 patients were formed, first group consisted of patients who were treated by ligature method, and the second group was consisted of those patients who were treated by translocational proctoplasty method. Table below show us average level of CRP (analyzes data is shown in nmol/liter).

Table 1. Level of CRP in case of paraproctitis surgical treatment.

Index	C-reactive protein average level
Day of analyze	pre-operative period	third day	seventh day	fourteenth day
First group	45,65±1,25	127,5±4	47,2±1,25
Second group	45,85±1,25	171,5±1,2	115±1,25	46,5±1

As we can see in case of translocational proctoplasty method the lever or CRP is about 25-30% lower in early postoperative period than in case of ligature method using. On seventh day the level of CRP becomes almost as same as in preoperative period in case of translocational proctoplasty, in case of ligature method treatment such an index is shown only on fourteenth day of postoperative treatment. This may say about higher efficiency of surgery method and easy postoperative time for patient.

Conclusions:

1. C-reactive protein level is a very stable index of inflammatory processes in human organism.

2. Translocational proctoplasty has more complications for patient than surgery by ligature method.

3. Period of CRP level normalization in case of translocational proctoplasty is twice shorter in comparison with ligature method.

4. Translocational proctoplasty is simplest and most effective method of acute and chronic paraproctitis surgical treatment.

Literature:

1. Gastrointestinal and Colorectal Anesthesia, Bellamy M., Kumar C.M.

USA: Informa, 432 p.

2. A great single-source reference encompassing all aspects of colorectal surgery, Sands D.R., Sands L.R. USA: Informa, 2009, 189 p.