Relevance. Paraproctitis is one of the most common proctologic diseases and accounts for 20-40% of all diseases of the rectum. In patients of working age, from 6.0% to 22% of cases occur. Until now, the treatment of this disease is a matter of debate. Despite the successes achieved in the treatment of this pathology, the results of treatment are not always satisfactory. The high incidence of complications and relapses of the disease, long periods of treatment and disability testify to the complexity and unsolvedness of many issues of this pathology. Purpose of the study. To analyze the results of surgical treatment of patients with acute and chronic paraproctitis. Material and methods of investigation. We conducted a retrospective analysis of the treatment of 54 patients treated in the proctology department of the SamSMI clinic. Localization of abscess in pararectal tissue: Acute subcutaneous paraproctitis - 27; Acute submucosal paraproctitis - 1; Acute ischiorectal paraproctitis - 20; Acute pelviorectal paraproctitis - 3; Acute retrectectal paraproctitis - 1; Anaerobic paraproctitis - 1; Diabetes mellitus was observed in 4 patients. Diagnosis of acute paraproctitis was based on the history, clinical picture, the results of an objective examination of patients. In the preoperative period, examination, palpation of the perianal area, finger examination of the rectum, laboratory, radiological, ultrasound, bacteriological examination of patients was carried out. Operative interventions were performed under sacral or spinal anesthesia. With subcutaneous and submucosal forms of paraproctitis, the abscess was opened into the rectum lumen by Gabriel - 28 patients. With ischiorectal and pelviorectal forms of paraproctitis, a two-stage surgical tactic was used. In the acute stage of the disease, an autopsy, sanitation and drainage of the abscess was performed. Necrectomy with a wide opening of purulent fouling was used in patients with anaerobic forms of paraproctitis, which were distinguished by a purulent necrotic lesion of pararectal tissue and a severe clinical course. In the postoperative period, intensive antibacterial and infusion therapy was carried out. Antibiotics were applied taking into account the sensitivity of microflora. With the formation of pararectal fistulas, a radical operation was performed - excision of the purulent course with the elimination of the internal fistula opening. There were performed operations for fistula of the rectum - 23, intrasfincture fistula - 7, transsfincter - 12, extrasphinctus - 3. With intrasfincter fistulas, the following operations were performed: excision of the fistula into the lumen of the gut with suturing the bottom of the wound. Suppuration of wounds, relapses, and lack of anal pomace was not. With transsphincter fistulas used excision fistula with suturing part of the external sphincter and ligature method. Suppuration of the wound was noted in 1 patient, relapses in 1, and failure of anal pulp in 1. In extrasfine fistulas, excision of fistula and ligature method was performed, excision of the fistula with displacement of the mucosal flap. There was a festering wound in 1 patient, relapses - 1. The average duration of inpatient treatment was 7 days. The total duration of temporary incapacity for work is 22 days. Conclusions. Thus, a differentiated approach to the choice of surgical intervention, optimization of preoperative preparation and postoperative treatment of patients with acute paraproctitis allows to improve both immediate and long-term outcomes of treatment of patients of this category, to shorten the terms of treatment and temporary disability, the number of complications and relapses.