MODERN MINIMALLY INVASIVE METHODS OF SURGICAL TREATMENT OF HEMORRHOIDS
DOI:
https://doi.org/10.11603/2414-4533.2025.4.15745Keywords:
laser vaporization, transanal hemorrhoidal dearterialization (THD), mucopexy, hemorrhoids, postoperative complications, painAbstract
The aim of the work: to compare the effectiveness of subdermal submucosal laser vaporization of hemorrhoidal nodes with transanal hemorrhoidal dearterialization (THD) supplemented with mucopexy in patients with grade II hemorrhoids.
Materials and Methods. The outcomes of treatment of 50 patients with grade II hemorrhoids were analyzed. Subdermal submucosal laser vaporization was performed in 25 patients (main group). In 25 control patients, transanal hemorrhoidal dearterialization (THD) with mucopexy was carried out. The groups were comparable in age and sex. All operations were performed under general anesthesia in a day-surgery setting. Postoperative pain, complications and quality of life were compared between the groups.
Results. The mean duration of laser vaporization was 25 minutes, and of THD with mucopexy 35 minutes. Patients in both groups stayed in the postoperative ward for two hours and then continued rehabilitation at home. Follow-up examinations were performed on postoperative days 10 and 30 and at 1 year. Pain was assessed using a 0–2-point scale. On the first postoperative day, the mean pain score was 1.1 points in the main group and 1.2 points in the control group; on day 10 it was 0.15 and 0.17 points, respectively. No patient in the main group developed postoperative hemorrhoidal thrombosis or rectal bleeding, whereas two patients in the control group developed thrombosis, which was managed conservatively. By day 30, all patients in both groups had complete healing of the wounds and a reduction of hemorrhoidal cushions to normal size. At the 1-year examination, anoscopy in two patients of the main group showed enlargement of one hemorrhoidal cushion, which was successfully treated by outpatient ligation; repeated examination 1 month later demonstrated recovery with normalization of hemorrhoidal vein size. In the control group, at the 1-year follow-up, hemorrhoidal cushions were of normal size, and no rectal pain or episodes of bleeding were observed after the intervention.
Conclusions. The results of subdermal submucosal laser vaporization for grade II hemorrhoids are comparable to those of THD with mucopexy. Both methods rapidly restore patients’ working capacity and improve their quality of life.
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