COMPARATIVE CHARACTERISTICS OF DIFFERENT METHODS OF TREATMENT OF CHRONIC COMPLICATED HEMORRHOIDS
Authors: Makukha A. V. , Kashtalyan M. A. , Shapovalov V. Yu. , Enin R. V. 
Published: October 2021

Abstract. Introduction. In recent years, a method of surgical treatment of hemorrhoids by the method of ligation of hemorrhoidal arteries under Doppler control (THD technique), as well as with additional rectoanal reconstruction (HAL-RAR) has been developed and widely used.

The aim of the study. The aim of our study was to compare methods of treatment of chronic complicated hemorrhoids stage II-III: classical Milligan-Morgan surgery, staple mucopexy according to Longo, as well as a combined technique: Doppler desarterization by HAL-RAR with additional removal of the external anodermal component.

Materials and methods. In the clinic of coloproctology of Military medical: Clinical Center of the Southern Region of Odessa performed an analysis of three groups of patients for the period from 2011 to 2021, who underwent hemorrhoidectomy for complicated forms of hemorrhoids (bleeding, nodular prolapse, mucosal prolapse, anal fissure). All patients suffered from chronic complications of stage II or III hemorrhoids, with one or more of the above complications. Selected cases are divided into three groups: Group I (control) operations on Milligan-Morgan — 240 patients, including -64 women and 176 men; Distribution by age from 18 to 75 years; Group II staple hemorrhoidopexy for Longo — 276 patients, including 89 women and 115 men. Distribution by age from 18 to 72 years; Combined interventions using the wireless Doppler surgical complex Wi-3 HAL-RAR and additional removal of excess anoderm (from January 2019 to May 2021) operated on 53 patients, including 31 (58%) men and 22 (42%) women . Distribution by age from 28 to 62 years.

Results and discussion. According to our data: bed day ranged from 1 to 8 days, mostly it was lower in group III — 1.3 (± 0.4) bed per day compared to 3.1 (± 0.8) in group II and 4.8 (± 1,7) in group III resorptive fever was not observed; the highest pain syndrome for VASH (average 7 points) in the group of patients of group I — compared with patients from group II (average 4 points) and patients of group III (average 2 points); the highest number of early postoperative complications was found in the group of patients operated on Milligan- Morgan: 1) acute urinary retention was observed in 43 cases (18%) of group I, compared with 38 cases (14%) of group II. The lowest number of cases of urinary retention was observed in group III — 2 cases (4%) (p <0.05). 2) postoperative bleeding from the wound was significantly more common in group I — 9 cases (3.75%), compared with group II — 6 cases (2.5%). No postoperative bleeding was observed in group III. 3) resorptive fever was most common in group I — 43 cases (18%) compared with group II - 33 cases (12%). Resorptive fever did not occur in group III (p<0.05).

In all patients using the combined intervention HAL-RAR + excision of the external component of the anoderm, the pain was acquired by taking nonspecific anti-inflammatory drugs without the use of narcotic analgesics. No complications were observed. All patients noted no reduction in quality of life in the postoperative period.

Conclusions. 1. Surgical treatment of hemorrhoids by the combined method of HAL-RAR + excision of the external component is a simple and effective method that in the postoperative period reduces the patient’s stay in the hospital, relatively lower in pain and the frequency of early postoperative complications. 2. HAL-RAR technology with excision of the outer component of the anoderm can be the operation of choice in the surgical treatment of chronic complicated hemorrhoids stage II-III.