Current trend in surgical treatment of hemorrhoid-closed hemoroidectomy without sutures. Our clinical experience
DOI:
https://doi.org/10.11603/2414-4533.2021.4.12718Keywords:
proctology, hemorrhoids, closed hemorrhoidectomy without sutures, complications of hemorrhoidectomy, electric tissue weldingAbstract
The aim of the work: to improve the results of surgical treatment of hemorrhoids using various electrosurgical equipment.
Materials and Methods. The treatment of 81 patients with hemorrhoids grade 2–4 for the period from 2016–2021 was analyzed. They were treated on the basis of the Department of Surgery No. 3, O. Bohomolets National Medical University. Hemorrhoidectomy using electrosurgical equipment (ALAN Elsy360M+, Patonmed EKVZ-300, Liga Sure) was conducted.
Results and Discussion. Structure of patients by sex: among them there were 45 (55.6 %) women and 36 (44.4 %) men. The mean age of patients was 37.2 years. 27 (33.3 %) patients had a hemorrhoid grade 2, 48 (59.3 %) – grade 3, in 6 (7.4 %) – grade 4. All surgeries were performed in the operating room, under spinal or general anesthesia. No patient required any additional intraoperative hemostasis. The average duration of surgery was 17.4 minutes (ranging from 12 to 31 minutes). The length of stay in the hospital was 2–3 days, and the period of outpatient treatment – 12–21 days. The patients' ability to work was restored after 10–12 days. Only 5 (6.17 %) of the all patients reported recurrent discomfort and itching in the rectum 4 weeks after surgery. The severity of the pain syndrome, assessed on a visual analog scale, averaged 3.7 points, which corresponds to slight pain or tolerable pain when moving. The most pronounced pain in patients was observed on day 3–4 of the postoperative period, which is probably due to the rejection of coagulation necrosis from wound surfaces during this period. In 5 (6.17 %) patients in the postoperative period reflex urinary retention was noted. Long-term results in the period from 12 to 18 months were observed in 44 (54.3 %) patients. Complete recovery and restoration of quality of life occurred in 42 (95.45 %) patients. The reasons for unsatisfactory quality of life assessments in the other 2 (4.55 %) patients were chronic constipation and were not directly related to surgery. We did not report a recurrence of the disease during this observation period in any patient. Narrowing of the anal canal was detected in 2 (4.5 %) patients. Clinical symptoms and stenosis were completely eliminated by finger devulsion in combination with drug treatment. Thus, hemorrhoidectomy performed with electrosurgical equipment is a safe, effective and modern surgical procedure that requires virtually no use of suture material. The application of the technique significantly reduces surgical blood loss, reduces the time of the operation, reduces its cost.
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