The main reasons for the development of complications of 'open' surgeries for severe acute pancreatitis are the destruction of the wall of the main pancreatic duct, parapancreatitis, the intervention of a hollow organ or a vessel of trunk in a purulent lesion. As a rule, mentioned changes appear due to the long-team course of severe acute pancreatitis.

Flavonoids are herbal medicines and widely used for chronic venous diseases and hemorrhoids. Flavonoid diosmin in both micronized and non-micronized form is a part of various drugs. According to literature data, flavonoids are able to reduce venous stasis, suppress local inflammation, improve venous tone and lymphatic outflow. It should be noted that biological models of in vivo trials have certain limitations while available data of different researches are contradictory. However, flavonoids were recommended for hemorrhoids in view of meta-analysis of 14 trials comparing flavonoids (diosmin, micronized purified flavonoid fraction and rutosides) with placebo in 1514 patients with hemorrhoids and Cochrane review of 24 randomized controlled trials (2,334 participants). These drugs should be administered as a part of complex therapy. At the same time, there is no conclusive evidence to prefer only one of these medicines. There are also no data confirming the benefits of daily dosage of 3000 mg per day of micronized fraction of flavonoids compared with 1800 mg of purified diosmin per day for treatment of acute hemorrhoids.

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Surgical treatment of the anal fissure is associated with unreasonably high risks of delayed development of fecal incontinence to gas or liquid stool. Standardized sphincter-preserving therapy, based on the pharmacological reduction of increased internal anal sphincter tone (chemical sphincterotomy) allows to improve significantly the results of the non-surgical approach of treating one of the most common pathology in proctological practice. Our work presents a retrospective analysis of the treatment of 295 patients with anal fissure treated with diltiazem ointment, nifedipine ointment, nitroglycerin ointment and botulinum toxin A. Significant improvement or disappearance of complaints was noted in 84% of patients. The use of botulinum toxin A was successfull in 10 out of 11 patients without the need of surgical intervention. High efficiency (91% of patients) of the sphincter-preserving approach with a significant decrease in the need for aggressive surgical manipulation allows to decrease sphincterotomy rate and reduces the risk of delayed fecal incontinence.