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AIM: to reveal fistula healing incidence after application of FiLaC™ technique and factors that can affect it. MATERIALS AND METHODS: when searching electronic medical databases for publications that evaluated the results of the FiLaC™ technique in the treatment of anal fistula, 6 studies were selected, corresponding to the search queries. The search was carried out taking into account the principles of systematic literature reviews and meta-analyses (PRISMA). The time interval for searching publications was between 2011 and October 2018. In the publications included in the analysis, the following parameters were evaluated: general characteristics of the study groups, technical aspects of the FiLaC™ technique, the site of the fistula in relation to the anal sphincter, the option of closing the internal fistula, the incidence of healing and recurrence of fistula, the duration of the follow-up period after surgery, re-operated cases of fistula recurrences. RESULTS: taking into account the data obtained in the analysis of the selected studies, the mean incidence of fistula healing was 64.5% (40.0-88.2)%. It was found that the only factors that can be used to assess their impact on the incidence of fistula healing were: the gender and the variant of the fistula site in relationship to the anal sphincter (transsphincteric/extrasphincteric). Statistical analysis and evaluation of the odds ratio revealed no effect on the treatment result of the above parameters. CONCLUSION: the analysis of the data showed that FiLaCis mainly indicated for the treatment of patients with extrasphincter and transsphincteric anal fistulas. The method can be recommended as a sphincter-sparing treatment in patients with initially weakened anal sphincter function and, consequently, with a high risk of anal sphincter insufficiency in the application of traditional techniques. Further evaluation of the treatment results in the treated period and their comparison with the results after other variants of coagulation of the fistula walls is required to obtain a clearer understanding of the effectiveness of the FiLAC technique.

AIM: to evaluate the efficacy of new «invaginative» method for rectovaginal fistulas. MATERIALS AND METHODS: thirty-seven females aged 37.3 (20-73) years with high rectovaginalfistulas (RVF) were included in the study. All patients underwent fistula surgery using novel «invaginative» method, which includes invagination of the fistula tract into the rectum, RVF origin included inflammatory bowel diseases in 7 (18.9%) patients, delivery injury - in 21 (56.7%), pelvic surgery - in 5 (13.5%), other causes - in 4 (10.8 %). Twenty (54.1 %) patients had two previous unsuccessful repairs on average. Diverting stoma formation as a first stage for RVF repair was performed in 4 (10.8%) patients. Meanfollow-up was 14,7± 6,6 months. RESULTS: «invaginative» method has been performed in all patients. Eight (21.6 %) of them produced recurrence after 2-6 weeks after surgery. No postoperative complications occurred. CONCLUSION: «invaginative» method is a safe and effective in treatment of high rectovaginal fistulas. It can be performed without diverting colostomy in most cases.

AIM: to evaluate changes of anorectal manometry parameters and clinical symptoms of fecal incontinence 3 months after fistulectomy with primary sphincteroplasty. MATERIALS AND METHODS: fifty-two patients (37 males) with complex anal fistulae of cryptoglandular origin underwent fistulectomy and primary sphincteroplasty. The fistulas were recurrent in 13 (25 %) cases, 8 (15,4 %) patients had preoperative fecal incontinence. Fecal incontinence Wexner score was 0,46 (0-8) before surgery. Anorectal manometry was performed before and 3 months after surgery. RESULTS: three months days after surgery mean and maximum resting anal pressure were not significantly low compared with the baseline. In patients with initially normal data before the surgery (n=22), resting anal pressure was significantly lower (before surgery M=56,1 ± 7,6 [46,1-69,0], after surgery 45,5 ± 8,8 [38,0-63,0], p=0,006, Wilcoxon test). There were no significant changes in squeezing anal pressure. Resting anal pressure has become below the normal after surgery in 13 (59.1 %) patients. Clinical symptoms of fecal incontinence was detected in 10 patients postoperatively (gas incontinence and soiling). Fecal incontinence Wexner score was 1,64 (0-11) after surgery (p=0,007). CONCLUSION: fistulectomy with primary sphincteroplasty leads to change of resting anal pressure basically in patients with initially normal pressure and mainly - in patients with anterior fistulas. Fecal incontinence symptoms after with surgery produced 26,3 % patients. These data confirm the need of individual approach when choosing the method of surgical treatment of analfistulae.

AIM: to estimate efficacy of local use of fluocortolone pivalate combined with lidocaine for postoperative pain after excisional hemorrhoidectomy.PATIENTS AND METHODS: two-hundred patients were included in retrospective study. All patients underwent excisional hemorrhoidectomy. Patients were divided in two groups, each group included 100 patients comparable in demographics, hemorrhoids stage. Traditional postoperative systemic pain relief was used in both groups and included NSAIDs and opioid receptor antagonists. The main group included patients with postoperative additional local use of fluocortolone pivalate in combination with lidocaine in operative theatre, every day after during postoperative control examination and after each defecation up to 7 days after surgery. The pain intensity was estimated using visual analog scale (VAS).RESULTS: on the 1st day after surgery pain was less intensive in the main group (1.57 vs 3.24; p<0,05), as well as on the 3d day (0,91 vs 2.48; p<0,05) and on 7th day (0.63 vs 1.12; p<0,05).CONCLUSION: local use of fluocortolone pivalate combined with lidocaine reduces postoperative pain twice.