METHOD FOR SURGICAL TREATMENT OF COMPLEX RECTAL FISTULAS Russian patent published in 2025 - IPC A61B17/00 A61B1/31 A61B6/02 A61K8/22 A61K49/00 A61K33/40 A61P43/00 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to colorectal surgery. After installation of a beak-shaped anoscope with diameter of 23 mm with a transverse cutout on 1/2 of a circle, a fistulous passage is stained with a solution of methylene blue at ratio of 1:1 with 3% solution of hydrogen peroxide; an internal fistulous opening is determined. Then, in a peripheral vein, Indocyanine Green is introduced in dose of 0.25 mg/kg, an intraoperative ICG-angiography is performed, number and location of distal branches of rectal arteries and borders of formation of full-thickness flap are determined so that in patients with 3 distal branches of rectal arteries the full-thickness flap is 1/3 of rectal circumference and in the centre of flap there is one vessel. And in patients with 4 and 5 branches of rectal arteries full-thickness flap was also 1/3 of rectal circumference with location of two adjacent vessels along flap periphery. Then, an ellipsoid incision is used to incise an external opening of the fistulous passage to an intra-sphincter portion of the fistulous passage, followed by suturing of the internal fistulous opening with the use of Vicryl 3/0 suture material. Formation of a full-thickness flap is started with an incision in the perianal region and a medial side using an acute preparation and bipolar coagulation with visualization and preservation of the internal anal sphincter. Distal portion of the flap is formed by performing a perianal incision with further bringing down the full-thickness flap and fixing it with the use of Vicryl 2/0 suture material.

EFFECT: method is highly effective, with a low risk of damaging the obturator, allows minimizing the risk of infection of peri-rectal fat in the minimum period of postoperative wound healing.

1 cl, 2 ex