Epidemiology and treatment of surgical diseases of the rectum, anus and perineum

The goal of the study is to assess the scope and structure of the inpatient surgical care provided to patients with diseases of the rectum, anus and perineum in order to determine urgent proctologic states and optimal surgical care. Materials and Methods. In 2013, 768 patients with anorectal diseases were treated in the clinic. Surgical activity was 92.5 %: 788 patients (95.3 %) in 2014 and 767 patients (97.3 %) in 2015. Results. During three years, 996 patients with hemorrhoids were treated in the clinic. Patients underwent traditional hemorrhoidectomy according to Milligan-Morgan (791 people), apparatus hemorrhoidectomy according to Longo's method (85 people), desarterization combined with sclerotherapy of internal hemorrhoids (120 people). The most dangerous method in terms of early postoperative complications was the traditional hemorrhoidectomy; while the safest one was desarterization associated with sclerosis of internal hemorrhoids. Treatment of paraproctitis complication, Fournier gangrene, was conducted in cooperation with an urologist. There were no lethal outcomes. Average hospitalization period was 25.2±10.3 days. The structure of patients' wound microflora with suppurative epithelial coccygeal passage (ECP) was represented by Staphylococcus epidermiditis (51.5 %), Staph. Aureus (15.2 %), Staph. Saprophyticus (15.2 %), En-terobacter. Faecalis (6.1 %), Ent. Aerogenes (3.0 %), Escherichia coli (6.0 %), and Streptococcus pyogenes (3.0 %). More than 90 % of the isolated strains were susceptible to cefuroxime, ciprofloxacin and gentamicin. Conclusion. The increase in surgical activity is connected with quality improvement in inpatient and outpatient units. Most patients with anorectal disease suffer from hemorrhoids. Their proportion increased from 38.8 % in 2013 to 45.1 % in 2015. Treatment for putrefactive paraproctitis should be performed by coloproctologists. All patients with ECP should be administered intravenous ciprofloxacin.