[Comparison of Doppler-assisted dearterialization with mucopexy and hemorrhoidectomy].

AIM: To compare two methods of hemorrhoid treatment. MATERIAL AND METHODS: This prospective study included 240 patients with hemorrhoids stage III-IVA. Stages III and IVA were diagnosed in 156 (65%) and 84 (35%) patients respectively. Randomization was performed using envelopes method in one to one distribution. In group 1 (n=120) Doppler-assisted dearterialization of internal hemorrhoids with mucopexy was performed (DDM), in group 2 (n=120) - hemorrhoidectomy using harmonic scalpel (HE). RESULTS: Duration of surgery was 17.9±6.1 and 34.5±10.1 minutes in DDM and HE groups respectively (p<0.01). Postoperative pain severity was higher in group 2 (4.8 compared with 2.5 scores of the first group (p<0.01). Narcotic analgesics were used less often in DDM group (1.3 doses compared with 6.1 doses in HE group (p<0.01). Disability period was 14.4±5.2 and 30.3±5.4 days in both groups respectively (p<0.01). Immediate postoperative complications occurred in 9 (7.5%) and 19 (15.8%) patients of DDM and HE groups respectively. Recurrent prolapse of internal hemorrhoids was diagnosed in 2 (1.7%) patients of the 1st group in terms of up to 45 days. CONCLUSION: DDM is reliable minimally invasive method of hemorrhoids stage III-IVA treatment and has similar efficacy with HE. DDM reduces postoperative pain severity, hospital stay and disability period.

[Results of ligature of distal branches of the upper rectal artery in chronic hemorrhoid with the assistance of Doppler ultrasonography]. / Rezul'taty ligirovaniia distal'nykh vetvei verkhnei priamokishechnoi arterii pod kontrolem ul'trazvukovoi doplerometrii pri khronocheskom gemorroe.

In October 2000 to February 2002 Doppler ultrasonography assisted suturing and ligation of hemorrhoidal arteries were performed in 102 patients with chronic hemorrhoids (57 men, 45 women, mean age 44 +/- 4.3 years). The mean duration of the disease was 10 +/- 4.6 years. Elimination of scarlet blood and hemorrhoidal prolapse without concomitant proctologic diseases were indications for surgery. Sixty-nine patients were followed up for more than 12 months, the follow-up lasted on the average 12 +/- 4 months. There were no clinical symptoms in 57 (82.6%) on the 69 patients. Combined ligation of arterial branches and nodes with latex rings was performed in 7 patients with stages III-IV hemorrhoids. Sclerotherapy was performed in 2 patients with stage III with occasional elimination of blood on defecation. Hemorrhoidectomy was performed in 3 (2.9%) patients with stage IV hemorrhoid due to ineffective ligation. Suturing and ligation of distal branches of the upper rectal artery decrease the inflow of arterial blood to hemorrhoidal nodes without venous outflow disorders. Fixation of hemorrhoidal nodes to the muscular wall eliminates the symptoms of hemorrhoidal prolapse. These factors lead to elimination of hemorrhoidal symptoms in 82.6% of the patients operated on.

[The treatment of wounds of the anal canal and perineum]. / Lechenie ran anal'nogo kanala i promezhnosti.

Analysis of processes of wound healing in 215 patients after operations for hemorrhoids, anal fissures and rectal fistulas was carried out. Clinico-cytologic control of healing of postoperation wound has shown that ultra-violet irradiation of wound surface is most effective at early stages of wound healing due to its pronounced bactericidal and antiinflammatory action. Low frequency laser irradiation intensifies tissue reparative and hastens healing of wounds. The proposed method for treatment of wounds by successive use of ultra-violet and laser irradiation of wound surface combined with conventional ointment medications, improves the results of treatment and decreases the rate of purulent complications 2 times, promotes rapid healing of wounds.