Article 8221

Title of the article

The results of efficacy evaluation of colostomy and devices for sealing the rectum in patients with anaerobic paraproctitis 

Authors

Konstantin I. Sergatskiy, Doctor of medical sciences, associate professor, associate professor of the sub-department of surgery, Medical Institute, Penza State University (40 Krasnaya street, Penza, Russia), E-mail: sergatsky@bk.ru
Valeriy I. Nikol'skiy, Doctor of medical sciences, professor, professor of the sub-department of surgery, Medical Institute, Penza State University (40 Krasnaya street, Penza, Russia), E-mail: pmisurg@gmail.com
Ekaterina V. Titova, Candidate of medical sciences, associate professor of the sub-department of surgery, Medical Institute, Penza State University (40 Krasnaya street, Penza, Russia), E-mail: pmisurg@gmail.com
Vladislav E. Kiselev, Resident of the sub-department of surgery, Medical Institute, Penza State University (40 Krasnaya street, Penza, Russia), E-mail: pmisurg@gmail.com
Yaroslav E. Feoktistov, Candidate of medical sciences, associate professor of the sub-department of surgery, Medical Institute, Penza State University (40 Krasnaya street, Penza, Russia), E-mail: pmisurg@gmail.com
Aleksandr V. Gerasimov, Candidate of medical sciences, associate professor of the sub-department of surgery, Medical Institute, Penza State University (40 Krasnaya street, Penza, Russia), E-mail: pmisurg@gmail.com 

Index UDK

616-089:616-08 

DOI

10.21685/2072-3032-2021-2-8 

Abstract

Background. An important factor in creating conditions for the healing of perineal wounds after opening and surgical debridement of the focus of infection in patients with acute paraproctitis is the fight against contamination with the contents of the rectum. There are 2 options for solve the problem − the removal of a protective colostomy and the use of special devices for sealing the rectum and controlled removal of feces. However, there is no assessment of the effectiveness of these techniques in patients with acute anaerobic paraproctitis. The purpose of this research is to develop a set of measures to prevent the contamination of extensive perineal wounds with fecal masses in patients with acute anaerobic paraproctitis.
Materials and methods. We studied 71 cases of acute anaerobic paraproctitis during the study period. In 3 patients (4.2%), pronounced destruction of the rectal wall above the level of the dentate line was revealed, which served as an indication for the imposition of a protective double-barreled sigmostomy. To prevent contamination of the wound surface of the perineum with the contents of the colon in 11 (15.5%) patients with acute anaerobic paraproctitis, a device was used that provided the removal of feces.
Results. The calculation and comparison of the density of microbial colonization of the postoperative wound, the leukocyte index of intoxication, the level of C-reactive protein and some clinical parameters in patients, depending on the method used to prevent contamination of the wound surface with the contents of the colon, was carried out.
Conclusions. In patients with acute anaerobic paraproctitis, in the presence of extensive wound surfaces, for the prevention of contamination of postoperative wounds, the method of choice is the use of special devices for controlled removal of feces. Protective colostomy can be used in exceptional cases − with total destruction of all walls of the rectum above the level of the dentate line and in the absence of the technical possibility of using special devices for controlled fecal removal. 

Key words

acute paraproctitis, anaerobic infection, protective colostomy 

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References

1. Prokhorov A.V. A modern view of Fournier’s gangrene. Tikhookeanskiy medi-tsinskiy zhurnal = Pacific Medical Journal. 2017;1:5–9. (In Russ.)
2. Sakhautdinov V.G., Timerbulatov M.V., Timerbulatov Sh.V. Anaerobic paraproctitis. Meditsinskiy vestnik Bashkortostana = Medical bulletin of Bashkortostan. 2016;11(2):91–95. (In Russ.)
3. Marino F., Manca G. Use of Flexi-Seal to manage early colostomy complications. Int Wound J. 2017;14(2):439. doi:10.1111/iwj.12627
4. Ozkan O.F., Koksal N., Altinli E., Celik A., Uzun M.A., Cıkman O., Akbas A., Ergun E., Kiraz H.A., Karaayvaz M. Fournier's gangrene current approaches. Int Wound J. 2016;13(5):713–716. doi:10.1111/iwj.12357
5. Oguz A., Gümüş M., Turkoglu A., Bozdağ Z., Ülger B. V., Agaçayak E., Böyük A. Four-nier's Gangrene: A Summary of 10 Years of Clinical Experience. Int Surg. 2015;100(5):934–341. doi:10.9738/INTSURG-D-15-00036.1
6. Yamauchi Y., Yoshida S., Ishida R., Nishikimi T., Yamada H., Yokoi K., Kobayashi H. Usefulness of fecal incontinence catheter (Flexi-Seal®) for postoperative management of evacuation in Fournier'sgangrene: two case reports. Nihon Hinyokika Gakkai Zasshi. 2016;107(1):59–62. doi:10.5980/jpnjurol.107.59
7. Yetışır F., Şarer A.E., Acar H.Z. Management of necrotizing fasciitis and fecal peritonitis following ostomy Necrosis and detachment by using NPT and Flexi-Seal. Case Rep Surg. 2015;2015:231450. doi:10.1155/2015/231450
8. Jones S., Towers V., Welsby S., Wishin J., Bowler P. Clostridium difficile Containment properties of a fecal management system: an in vitro investigation. Ostomy Wound Management. 2011;57(10):38–49.
9. Padmanabhan A., Stern M., Wishin J., Mangino M., Richey K., DeSane M. Clinical evaluationof a flexible fecal incontinence management system. Am J Crit Care. 2007;16(4):384–393.
10. Whiteley I., Sinclair G. Faecal management systems for disabling incontinenceorwounds. Br J Nurs. 2014;23(16):881–885. doi: 10.12968/bjon.2014.23.16.881
11. Ersoz F., Sari S., Arikan S., Altiok M., Bektas H., Adas G., Poyraz B., Ozcan O. Factors affecting mortality in Fournier's gangrene: experience with fifty-two patients. Singapore Med J. 2012;53(8):537–540.

 

Дата создания: 24.08.2021 14:56
Дата обновления: 27.08.2021 12:39