DOI: https://doi.org/10.22263/2312-4156.2025.5.43
E.V. Denisenko1, Yu.M. Gain2, V.L. Denisenko1,3, S.V. Shakhray2, M.Yu. Gain2
A new technique of a minimally invasive treatment of rectal fistulas
1Vitebsk Regional Clinical Specialized Center, Vitebsk, Republic of Belarus
2Belarusian State Medical University, Minsk, Republic of Belarus
3Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2025;24(5):43-55.
Abstract.
What this paper adds. The authors were the first to propose a minimally invasive method for the treatment of high rectal fistulas, including the combination of three minimally invasive techniques: laser thermoobliteration of the fistula tract, the introduction of fibrin glue into its lumen and into the peri-fistula tissues - a plasma preparation enriched with platelets and leukocytes.
Objectives. To effective minimally invasive method for treating high rectal fistulas.
Material and methods. A single-center prospective randomized controlled cohort study was conducted to evaluate the treatment results of 118 patients with rectal fistulas. Patients were divided into 3 groups. In the 1st (main) group, the operation included laser thermal obliteration of the fistula tract, introduction of fibrin glue into its lumen and a preparation of plasma enriched with platelets and leukocytes into the peri-fistula tissues (the operation using a combined technique developed by the authors). In the 2nd group, excision of the fistula was performed using the ligature method of treatment. In the 3rd group, isolated treatment of the fistula tract with a laser was used as treatment.
Results. In the course of a comparative analysis of all groups, it was found that the duration of inpatient treatment was statistically significantly shorter in the groups using minimally invasive technologies (Mann–Whitney U test, Z=-7.42, p<0.0001). The shortest wound healing period was observed in the 1st (main) group (Mann–Whitney U test, Z=-8.7, p<0.0001; Z=6.09, p=0.002), while the duration (Mann–Whitney U test, Z=-9.324, p<0.0001) and intensity of postoperative pain syndrome (Mann–Whitney U test, Z=-8.999, p<0.0001) were statistically less pronounced in groups 1 and 3 of patients. The function of anal retention 1 year after the intervention suffered less in patients of groups 1 and 3 (Mann–Whitney U test, Z=7,385, p<0.0001). The recurrence rate was comparable between 1 and 2 (Mann–Whitney U test, Z=1,601; p=0.109) and was significantly higher in group 3 compared with group 2 (Mann–Whitney U test, Z=-2.031; p=0.042), while higher indicators of the quality of life of patients throughout the entire follow-up period were noted in groups 1 and 3.
Conclusions. The effective minimally invasive treatment method of high transsphincteric and extrasphincteric fistulas of the rectum was developed.
Keywords: fistulas of the rectum, high fistulas, laser thermal obliteration of the fistula, fibrin glue, platelet- and leukocyte-rich plasma (L-PRP).
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Submitted 01.08.2025
Accepted 21.10.2025
Information about authors:
Eduard V. Denisenko – surgeon of the surgical department, Vitebsk Regional Clinical Specialized Center, https://orcid.org/0009-0002-4265-9885, e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра.;
Yu.M. Gain – surgeon, Doctor of Medical Sciences, Professor of the Chair of Emergency Surgery, Belarusian State Medical University;
V.L. Denisenko – Chief Physician of Vitebsk Regional Clinical Specialized Center; Doctor of Medical Sciences, Professor of the Chair of General Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
S.V. Shakhray – surgeon, Doctor of Medical Sciences, Professor, Professor of the Chair of Emergency Surgery, Belarusian State Medical University;
M.Yu. Gain – surgeon, Candidate of Medical Sciences, Associate Professor of the Chair of Emergency Surgery, Belarusian State Medical University.
