In the provision of specialized proctological care, anal fistulas are confidently among the top three most common, occurring in 20—40% of cases. Complex forms of chronic paraproctitis account for 30—45% of all cases of chronic paraproctitis. Surgical treatment and rehabilitation of patients with chronic paraproctitis, especially those with trans- and extrasphincteric fistulas, are particularly challenging. The use of physiotherapy programs in the early postoperative period is an important part of the comprehensive treatment of patients with complex anal fistulas. One of the effectiveness criteria is an assessment of changes in pain dynamics, based on visual analog scale (VAS) data, the use of analgesics in the early postoperative period, and the SF-36 quality of life scale.
OBJECTIVE
To evaluate the effectiveness of physiotherapy postoperative rehabilitation programs in pain management during the surgical treatment of complex anal fistulas based on visual analog scale (VAS) data, the use of medicinal analgesics in the early postoperative period, and the SF-36 quality of life scale.
MATERIAL AND METHODS
The study included 111 patients with complex trans- and extrasphincteric rectal fistulas of grades III—IV complexity who underwent excision of the fistula tract and reconstruction of the internal fistula opening with a full-thickness rectal flap. Patients were divided into two groups: the study group (n=56) underwent a comprehensive physiotherapy rehabilitation program in the early postoperative period (from day 2 after surgery); the control group (n=55) did not. The groups were comparable in terms of gender, age, severity and duration of the disease, and the extent of surgical treatment.
RESULTS
The most pronounced analgesic effect was obtained in patients of the main group, where a comprehensive physiotherapeutic rehabilitation program was used, as evidenced by a reliable decrease in pain syndrome from 5.8±0.8 points on the 1st day to 3.5±0.2 points on the 2nd day (p<0.01) and to 2.4±0.5 points on the 3rd day (p<0.001), after a course of physiotherapeutic treatment, the positive dynamics were even more significant and the severity of pain syndrome was 1± 0.6 points (p<0.001), and in the long-term period at all observation periods (after 2, 6 and 12 months), pain syndrome did not occur in any patient (p<0.001). Significantly less significant results were obtained in patients of the control group, where on the 1st day the intensity of the pain syndrome was 6.1±0.2 points, on the 2nd and 3rd days there was a slight increase in the severity of pain — up to 6.7±0.3 points and 6.5±0.3 points, respectively, 2 weeks after the operation there was a slight decrease — up to 5.8±0.1 points, after 2, 6 and 12 months the intensity of the pain syndrome was still 4.5±0.6 points (p<0.02), 2±0.3 and 1±0.4 points, respectively. An analysis of medications prescribed for pain relief, their frequency, and duration of use, based on physician prescriptions, revealed that nonsteroidal anti-inflammatory drugs (NSAIDs) were most frequently used (78% of cases), centrally acting analgesics (21%), and opioid analgesics (1%). Analysis of the obtained data revealed that the quality of life of patients who underwent fistula excision surgery with reconstruction of the internal fistula opening using a full-thickness rectal flap depends on the use of a physiotherapy rehabilitation program (by 16.7% compared to the control group), due to more severe pain and the need for additional analgesics.
CONCLUSION
The use of a physiotherapy rehabilitation program after surgical treatment of transsphincteric and extrasphincteric rectal fistulas reduced postoperative pain in patients in the study group by 1.9 times compared to the control group, minimized the use of medicinal analgesics in the early postoperative period, and improved quality of life by 16.7% compared to standard treatment.
