Summary. An analysis of clinical guidelines and literary articles on the treatment of patients with chronic hemorrhoids was carried out. Clinical recommendations do not differ in different countries regarding the approaches in terms of choosing options for conservative or operative therapy and methods of surgical treatment. Changing the diet, which allows you to eliminate constipation, normalize intestinal motility and obtain soft and voluminous stools, is an important stage of treatment. Pharmacological therapy has a low evidence base. Studies on the effectiveness of flavonoids for the treatment of chronic hemorrhoids are very heterogeneous, which does not allow for unequivocal conclusions. Rubber band ligation is the most effective procedure for the rapid elimination of chronic hemorrhoid symptoms, but it cannot effectively eliminate hemorrhoidal prolapse. Injection sclerotherapy has severe specific complications, which is why it is predicted to decrease in frequency for the treatment of chronic hemorrhoids. The only surgical approaches that experts recommend are open and closed hemorrhoidectomy. Stapler hemorrhoidopexy has a high frequency of specific complications, so it is necessary to approach its choice for the treatment of chronic hemorrhoids with caution. Doppler-guided hemorrhoid artery ligation is a physiological method of treatment, but it has a very high cost and is not economically viable. Conclusions. In patients with chronic hemorrhoids Goligher-1, Goligher-2, and in some cases - Goligher-3, “office procedures” can be chosen, but the patient should be informed about questionable results in the remote period. The operation of choice for patients with chronic Goligher-3 and Goligher-4 hemorrhoids remains open hemorrhoidectomy, the current modifications of which mainly include various technological approaches to cutting out nodes. Techniques in which a slightly different principle was proposed can be used as an alternative approach due to worse results when observing in distant terms.
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).
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