Aim.To generalize and present current data on the development of approaches to hemorrhoidectomy, as well as to analyse the function of the rectal closing apparatus after surgery.Key findings.The haemorrhoid disease is one of the most common human diseases and the most common reason for visiting a coloproctologist. In Russia, the prevalence of haemorrhoids amounts to 130–145 people per 1,000 adult population, with its proportion in the structure of colon diseases varying from 34 to 41 %. Minimally invasive methods for treating such conditions have been shown to be effective in patients with 1–3 stage haemorrhoids. However, these methods have shown little value at stage 4 hemorrhoids, largely because they fail to affect all parts of the disease pathogenesis. Thus, hemorrhoidectomy remains to be the “gold standard” for stage 4 hemorrhoids treatment, which is aimed at eliminating the three main vascular collectors. Hemorrhoidectomy is accompanied by the risk of stricture and postoperative anal sphincter failure. In this regard, it is necessary to assess the functional state of the rectal closing apparatus after hemorrhoidectomy. Improving hemorrhoidectomy, for example, by the use of an ultrasonic scalpel, allows the hemorrhoidectomy to be performed without additional sewing of vessels and coagulation, and the injury of the anal sphincter to be minimized.Conclusion. The possibility of injuring the anal sphincter is a serious problem in anal surgery. Anal sphincter incontinence is a serious illness that exacerbates the patients’ social life. Unfortunately, the issue of anal sphincter incontinence after hemorrhoidectomy is under-investigated, resulting in few rehabilitation programs.
AIM: to improve the results of treatment in hemorrhoid Grade IV.PATIENTS AND METHODS: the prospective randomized study included 101 patients with combined hemorrhoids Grade IV were divided in two groups. Both groups were homogenous in age and gender. All patients underwent open hemorrhoidectomy with monopolar coagulation. Low-temperature argon plasma application was implemented in postoperative period as an additional option in the main group at 2, 4, 6, 8, 14, 21, 30 days after surgery. Visual Analogue Scale (VAS, 0 to 10 points) was used to assess pain intensity. Bacteriological and cytological tests performed at 2, 8, 14, 21, 30 days and then every 7 days until the wounds were completely healed. The area of the postoperative wound and the rate of healing were calculated using a planimetric method. Quality of life was assessed before surgery, and on days 8 and 30 using the SF-36 questionnaire.RESULTS: on the 30th day after surgery, cytology confirmed wound healing occurred in 38 (76.0%) patients of the main group and in 18(36.0%) patients in the control group, p = 0.0001. VAS score at day 8 after surgery was 3 (3; 4) and 4 (3; 5) points in main and control group, respectively, p = 0.00003. Quality of life measuring showed significant difference in the physical component between groups: 48 (44; 53) vs 42 (38; 48) points in the main and control group, respectively (p < 0.05). On the 30th day after the procedure, the physical component of the quality of life was 48 (44; 53) points in the patients of the main group, 42 (38; 48) — in the control group, p = 0.005. There was found significant difference in wound microbial content between groups: 104 vs 107 CFU on the 30th day after the surgery.CONCLUSION: the low-temperature argon plasma accelerates wound healing, as well as reduces the pain intensity. A significant antimicrobial effect was detected.
AIM: to improve the results of treatment in hemorrhoid Grade IV.PATIENTS AND METHODS: the prospective randomized study included 101 patients with combined hemorrhoids Grade IV were divided in two groups. Both groups were homogenous in age and gender. All patients underwent open hemorrhoidectomy with monopolar coagulation. Low-temperature argon plasma application was implemented in postoperative period as an additional option in the main group at 2, 4, 6, 8, 14, 21, 30 days after surgery. Visual Analogue Scale (VAS, 0 to 10 points) was used to assess pain intensity. Bacteriological and cytological tests performed at 2, 8, 14, 21, 30 days and then every 7 days until the wounds were completely healed. The area of the postoperative wound and the rate of healing were calculated using a planimetric method. Quality of life was assessed before surgery, and on days 8 and 30 using the SF-36 questionnaire.RESULTS: on the 30th day after surgery, cytology confirmed wound healing occurred in 38 (76.0%) patients of the main group and in 18(36.0%) patients in the control group, p = 0.0001. VAS score at day 8 after surgery was 3 (3; 4) and 4 (3; 5) points in main and control group, respectively, p = 0.00003. Quality of life measuring showed significant difference in the physical component between groups: 48 (44; 53) vs 42 (38; 48) points in the main and control group, respectively (p < 0.05). On the 30th day after the procedure, the physical component of the quality of life was 48 (44; 53) points in the patients of the main group, 42 (38; 48) — in the control group, p = 0.005. There was found significant difference in wound microbial content between groups: 104 vs 107 CFU on the 30th day after the surgery.CONCLUSION: the low-temperature argon plasma accelerates wound healing, as well as reduces the pain intensity. A significant antimicrobial effect was detected.
We propose a new surgical approach to the treatment of familial colorectal adenomatous polyposis implying preservation of a portion of the rectum with removed mucosa. For reconstruction of the rectum, allotransplantation of the mixed culture of fetal allogenic somatic cells of the intestinal epithelium and mesenchymal cells of various origin is used. The mechanisms of mucosa reparation were studied in 34 patients. Endoscopic, morphological, and immunohistochemical studies showed that cell transplantation considerably accelerated reparation of the mucosa in mucosectomized rectum. The proposed treatment of familial colorectal adenomatous polyposis allows delaying the development of rectal polyps and cancer for many years.
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