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sbornikkonferenczii19iyunya2023

The purpose of the study: 
To improve the results of surgical treatment of 
patients with epithelial coccygeal passage by developing and implementing an 
effective surgical method, including measures to prevent recurrence of the disease. 
Materials and methods
: The results of surgical treatment of 41 patients with 
epithelial coccygeal fistula (further ECF), were treated at the clinic of the University 
Hospital of the Non-Commercial Joint-Stock Company "Semey Medical 
University" (further UH NCJSC "SMU") for the period from 2019 to 2022 were 
analyzed. The ratio of men was 34 (82,9%), women - 7 (17,1%). The age of the 
patients varied from 19 to 51 years. The average age of patients is 37,2 ± 1,2 years. 
Among them, 14 (34,1%) patients with relapses of the disease after previous surgical 
treatment (6 patients with multiple relapses).In the study group: in 10 (24,4%) 
patients with severe inflammation in the ECF, open wound conduct was applied; in 
11 (26,8) patients with uncomplicated flow of the pathological process, excision of 
the ECF was performed with suturing of the wound longitudinally tightly by Donati 
sutures; in 20 (48,8%) patients with multiple fistula passages and a widespread 
lesion, radical excision of the ECF with sacrococcygeal region plastic surgery with 
displaced non-free skin flaps in the developed in the UH NCJSC "SMU". The choice 
of the method of surgery depended on the prevalence of the inflammatory process, 
the duration of the disease, the presence of a history of relapses. 


197 
Results: 
The analysis of the results showed the possibility of improving the 
effectiveness of the treatment of ECF through an individual approach to determining 
the indications and choosing the method of surgery. In the group with plastic surgery 
of the sacrococcygeal region with displaced non-free skin flaps, postoperative 
complications and relapses were not observed in the developed clinic of the UH 
NCJSC "SMU". In the group of patients with open wound management, 3 relapses 
were registered, which came through 2-5 months after surgery through pronounced 
infiltrative-inflammatory reactions and scarring changes during wound healing by 
secondary tension. When performing radical operations with suturing the edges of 
the wound to the bottom (at the sutures Donati), 2 recurrences were revealed due to 
pronounced tension of the edges of the wound, their eruption at the bottom of the 
wound and the formation of residual cavities in the early postoperative period. The 
terms of inpatient treatment in these three groups ranged from 8 to 13 days, on 
average, 9,5 ±2,3 bed days. 
Conclusions: 
The technique of surgery for ECF should be justified 
individually, depending on the severity and prevalence of the inflammatory process. 
The most promising in terms of improving the long-term results of treatment of ECF 
(including recurrent fistulas) are radical operations with the possibility of 
simultaneous closure of the surgical wound with non-free skin flaps. 


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