SURGICAL TREATMENT OF PATIENTS WITH CHRONIC HEMORRHOIDS
Symmary. About 300 surgical treatments for hemorrhoids are known now. The most common method in the world remains the Milligan-Morgan operation and its numerous modifications. These surgical interventions are essential in the choice of surgical treatment for chronic hemorrhoids. However, both open and closed hemorrhoidectomy have their disadvantages.
Purpose. To study the effectiveness of various surgical treatments for patients with chronic hemorrhoids using a laser coagulator.
Materials and methods. We conducted a clinical examination and treatment of 140 patients with chronic grade III-IV hemorrhoids by Goligher. All patients were presentably divided into three groups. The first group included 60 patients who had classic open hemorrhoidectomy - the Milligan-Morgan operation. The second group included 40 patients in whom had surgical treatment with a laser coagulator - laser open hemorrhoidectomy. The third group consisted of 40 patients who underwent laser open hemorrhoidectomy, supplemented with laser transcutaneous submucosal mucopexia.
Results and discussion. Analyzing the indicators of pain in different groups of patients at different postoperative period, we found that on the first postoperative day the classic Milligan-Morgan surgery, the was most uncomfortable procedure (the first group of patients). Among the patients in the second and third groups there were no people who rated pain above 7 points. In the first group, the median period of first defecation was in 5.0 days. As for in patients of the second group, the first defecation was observed in terms of the 3-5 days with a median of 4.0 days. A similar indicator was observed in patients of the third group. Patients in the second and third groups did not indicate severe pain during the first act of defecation. The anal hematoma was found only in patients of the first group (p<0.01). Anal infiltration occurred in 12.5±5.23 % in the third group (p<0.01). Infections of wounds were not found in any group.
Conclusion. Laser open hemorrhoidectomy is an effective method of surgical treatment of patients with chronic hemorrhoids. However, like the classic open hemorrhoidectomy Milligan-Morgan, it allows to eliminate only pathological substrate (cavernous bodies). To prevent recurrence of the disease, it should be supplemented with laser transcutaneous submucosal mucopexia. Analysis of cases of early postoperative complications showed that the classic Milligan-Morgan hemorrhoidectomy, compared with intraoperative laser coagulation, had a significantly higher frequency (p<0.001).
2. Василюк С.М., Сідорук С.С. Аноректальна дисфункція і хронічний геморой. Клінічна хірургія. Том 85, № 6.2 (червень) 2018: 114-116.
3. Fox A, Tietze PH, Ramakrishnan K Anorectal conditions: hemorrhoids. FP Essent. 2014 Apr;419:11-9.
4. Садовий І.Я. Профілактика розвитку стриктури анального каналу при гемороїдектомії // Архів клінічної медицини. № 2 (20) – 2014 с. 110-111.
5. Василюк С.М., Сідорук С.С. Гендерні особливості клінічного перебігу хронічного геморою III-IV ступеня. Art of medicine. 4(8) жовтень-грудень, 2018: 21-4.
6. Moult HP, Aubert M, De Parades V. Classical treatment of hemorrhoids. J Visc Surg. 2015 Apr;152(2 Suppl):S3-9.
7. Мадаминов А.М., Малькави М.М., Айсаев А.Ю., Люхуров Р.Н. Результаты хирургического лечения хронического геморроя III–IV стадии, осложненного кровотечением. Вестник КРСУ. 2016. Том 16. № 11: 46-49.
8. Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg. 2016 Jun;40(6):1509-19.
9. Бродовський С. П., Іфтодій А. Г., Козловська І. М. Оптимізація хірургічного лікування хронічного геморою III-IV стадії. Клінічна хірургія. - 2017. - 2. – 10-12.