СИМУЛЬТАННОЕ ОПЕРАТИВНОЕ ЛЕЧЕНИЕ ГЕМОРРОЯ И АНАЛЬНОЙ ТРЕЩИНЫ

Abstract

Simultaneous method of surgical treatment of hemorrhoids and anal fissure, which allows to simultaneously reduce blood supply to the cavernous tissue of hemorrhoids and improve blood flow in the area of pre-existing fissure by eliminating the defect of the anal mucosa and sphincter spasm with minimal trauma, is described.

The aim – to improve the results of treatment of patients with chronic hemorrhoids combined with chronic anal fissure by combined performance of transanal hemorrhoidal dearterialization with excision of the fissure.

Material and Methods. A retrospective comparative analysis of 177 patients with anal fissure and hemorrhoids was performed. Patients were divided into three groups: I – 60 patients who underwent hemorrhoidectomy by Milligan – Morgan and anal fissure removal, II – 60 patients who removed anal fissure without intervention for hemorrhoids, III – 57 patients who underwent surgery according to the original method. To assess the intensity of blood flow in the area of the anal fissure, laser Doppler flowmetry was performed. The results were evaluated according to the following criteria: pain intensity, early urinary retention, suppuration of the wound, recurrence, incontinence, hospital stay.

Results. With the help of laser Doppler flowmetry in the pre- and postoperative period, it has been proven that simultaneous surgical treatment of hemorrhoids and anal fissure by the proposed method helps to improve blood flow in the anal canal. At the same time it is possible to improve the results of treatment according to all evaluation criteria.

Conclusions. Simultaneous surgical treatment of patients who have a combination of hemorrhoids with anal fissure with proposed method can improve treatment outcomes. This method does not impair the intensity of blood flow to the anal canal. Thus, the proposed method is both minimally invasive and radical and can be recommended for implementation in surgical practice.