The quality of life of patients after combined surgical operations for combined diseases of the excretory canal and rectum
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16688Keywords:
combined pathology of the excretory canal and rectum, high-frequency electrosurgery and radio-wave surgery devices, combined surgical operations, quality of life of patientsAbstract
The aim of the work: to assess the quality of life of patients at different timepoints of the postoperative period after performing combined surgical interventions for combined anorectal diseases using high-frequency electrosurgery devices “ERBE ICC 200”, “EFA”, “KLS Martin”, radio-wave surgery “Surgitron” and a metal surgical scalpel according to modern scales for assessing the quality of life.
Materials and Methods. The results of surgical treatment of 120 patients from four study groups (30 patients from each) with combined pathology of the anorectal canal and rectum, operated on using high-frequency electrosurgery devices “ERBE ICC 200”, “EFA”, “KLS Martin” and radio wave surgery device “Surgitron”, as well as 30 patients from the control group with combined anorectal pathology, operated on using a metal surgical scalpel, were analyzed. The pain syndrome of patients in the control and study groups was assessed on the 1st, 3rd, 5th and 7th days using a visual analog scale (VAS), the local status of the operated area of patients was assessed 1, 3, 6, 12, 24 months after combined operations, the functional state of the sphincter apparatus of the rectum was assessed (Wexner scale) and functional defecation disorders in the long-term postoperative period (6 months – 2 years), and the psychological and medical and social rehabilitation of patients in the long-term postoperative period (6 months – 2 years) was also assessed.
Results. Using of high-frequency surgical devices “ERBE ICC 200”, “EFA” and “KLS Martin” for combined operations in patients with combined pathology of the excretory canal and rectum, as well as the radio wave surgical device “Surgitron”, 1 month after the operations was accompanied in 90–96.6 % of cases by complete healing of postoperative wounds without signs of scar stricture, the occurrence of the weakest or weak pain syndrome on the VAS scale on the first day of the postoperative period, in the long term after the operation (6 months – 2 years) in 93.3–100 % of cases by normal continence of the excretory canal and normal defecation, as well as in 96.6–100 % of cases by a high level of psycho-social adaptation. Using of a metal surgical scalpel for combined operations in patients of the control group with combined pathology of the excretory canal and rectum 1 month after the operations was accompanied in only 70 % of cases by complete healing of postoperative without signs of scar stricture with the presence of a significantly greater number of complications, which amounted to 30 % in the form of various types of fistulas of the excretory canal (23.4 %) and its scar strictures (6.6 %), the occurrence of moderate pain syndrome on the VAS scale on the first day of the postoperative period, in the long term after the operation (6 months – 2 years) only in 73.3 % of cases by normal continence of the excretory canal with the presence of varying degrees of its incontinence and functional disorders of defecation in 26.7 % of cases, as well as only in 73.3 % of cases by a high level of psycho-social adaptation with the presence of various levels of social disorders and maladjustments.
Conclusions. Using of high-frequency surgical devices "ERBE ICC 200", "EFA" and "KLS Martin", as well as the radio-wave surgical device "Surgitron" for combined operations in patients with combined pathology of the excretory canal and rectum was accompanied in 90–100 % of cases by complete healing of postoperative wounds without signs of scar stricture, normal excretory continence and normal defecation with the absolute absence of any disorders, as well as in 96.6–100 % of cases by a high level of psychosocial adaptation with complete satisfaction with the results of the operation. Using of a metal surgical scalpel for combined operations in patients from the control group with combined pathology of the excretory canal and rectum was accompanied in 70–93.3 % of cases by complete healing of postoperative wounds without signs of scar stricture with the presence of a significantly higher number of complications, which amounted to 6.6–30 %, only in 73.3 % of cases by normal excretory continence and the absence of any defecation disorders with the presence of various degrees of excretory incontinence and functional defecation disorders in 26.7 % of cases, as well as only in 73.3 % of cases by a high level of psychosocial adaptation with the presence of various degrees of social disorders and maladaptations in 26.7 % of cases, negatively affecting the quality of life of patients and the timing of their medical and social rehabilitation.
References
1. Wald A, Bharucha AE, Limketkai B, Malcolm A, Remes-Troche JM, Whitehead WE, Zutshi M. ACG Clinical Guidelines: Management of Benign Anorectal Disorders. Am J Gastroenterol. 2021 Oct. 1; 116(10):1987-2008. DOI: 10.14309/ajg.0000 000000001507. PMID: 34618700. DOI: https://doi.org/10.14309/ajg.0000000000001507
2. Zutshi M. Anorectal disease: Contemporary management. Springer Cham, Heidelberg, New York, London: Springer International Publishing Switzerland. 2016; 314. DOI: https://doi.org/10.1007/978-3-319-23147-1
3. Medina-Gallardo A, Curbelo-Peña Y, De Castro X, Roura-Poch P, Roca-Closa J, De Caralt-Mestres E. Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients. Int J Surg Case Rep. 2017; 30:73-5. DOI: 10.1016/j.ijscr.2016.11.018. Epub 2016 Nov. 15. PMID: 27960130. DOI: https://doi.org/10.1016/j.ijscr.2016.11.018
4. Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg. 2016 Jun.; 40(6):1509-19. DOI: 10.1007/s00268-016-3419-z. PMID: 26813541. DOI: https://doi.org/10.1007/s00268-016-3419-z
5. Balciscueta Z, Balciscueta I, Uribe N. Post-hemorrhoidectomy pain: can surgeons reduce it? A systematic review and network meta-analysis of randomized trials. Int J Colorectal Dis. 2021 Dec.; 36(12):2553-66. DOI: 10.1007/s00384-021-04013-6. DOI: https://doi.org/10.1007/s00384-021-04013-6
6. Haksal MC, Çiftci A, Tiryaki Ç, Yazıcıoğlu MB, Özyıldız M, Yıldız SY. Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids. Turk J Surg. 2017 Dec. 1; 33(4):233-36. DOI: 10.5152/turkjsurg.2017.3493. eCollection 2017. PMID: 29260125.
7. Ng KS, Holzgang M, Young C. Still a Case of "No Pain, No Gain"? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020. Ann Coloproctol. 2020 Jun.; 36(3):133-47. DOI: 10.3393/ac.2020.05.04. DOI: https://doi.org/10.3393/ac.2020.05.04
8. Picchio M, Greco E, Di Filippo A, Marino G, Stipa F, Spaziani E. Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review. Indian J Surg. 2015 Dec.; 77(Suppl 3):1301-07. DOI: 10.1007/s12262-014-1087-5. DOI: https://doi.org/10.1007/s12262-014-1087-5
9. Abcarian H, Cintron J, Nelson R. Complications of anorectal surgery: Prevention and management. Cham: Springer International Publishing. 2017; 329. DOI: https://doi.org/10.1007/978-3-319-48406-8
10. Birchley D. Randomized clinical trial of the effects on anal function of Milligan-Morgan versus Ferguson haemorrhoidectomy. Br J Surg. 2007 Jan.; 94(1):122; author reply 122. DOI: 10.1002/bjs.5745. PMID: 17205489. DOI: https://doi.org/10.1002/bjs.5745
11. Simillis C, Thoukididou SN, Slesser AAP, Rasheed S, Tan E, Tekkis PP. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg. 2015 Dec.; 102(13):1603-18. DOI: 10.1002/bjs.9913. DOI: https://doi.org/10.1002/bjs.9913
12. Bara BK, Mohanty SK, Behera SN, Sahoo AK, Swain SK. Fissurectomy Versus Lateral Internal Sphincterotomy in the Treatment of Chronic Anal Fissure: A Randomized Control Trial. Cureus. 2021 Sep. 28; 13(9):e18363. DOI: 10.7759/cureus.18363. DOI: https://doi.org/10.7759/cureus.18363
13. Acar T, Acar N, Güngör F, Kamer E, Güngör H, Candan MS, et al. Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option? Asian J Surg. 2019 May; 42(5):628-33. DOI: 10.1016/j.asjsur.2018.10.001. DOI: https://doi.org/10.1016/j.asjsur.2018.10.001
14. Boland PA, Kelly ME, Donlon NE, Bolger JC, Larkin JO, Mehigan BJ, McCormick PH. Management options for chronic anal fissure: a systematic review of randomised controlled trials. Int J Colorectal Dis. 2020 Oct.; 35(10):1807-15. DOI: 10.1007/s00384-020-03699-4. DOI: https://doi.org/10.1007/s00384-020-03699-4
15. De Robles MS, Young CJ. Real world outcomes of lateral internal sphincterotomy vs botulinum toxin for the management of chronic anal fissures. Asian J Surg. 2022 Jan.; 45(1):184-88. DOI: 10.1016/j.asjsur.2021.04.027. Epub 2021 May 6. DOI: https://doi.org/10.1016/j.asjsur.2021.04.027
16. Garg P, Garg M, Menon GR. Long-term continence disturbance after internal anal sphincterotomy for chronic anal fissure: a systematic review and meta-analysis. Colorectal Dis. 2013 Mar.; 15(3):e104-17. DOI: 10.1111/codi.12108. DOI: https://doi.org/10.1111/codi.12108
17. Patel YS, Chavda J, Parikh J, Naik N. Study of operated patients of lateral of internal anal sphincterotomy for chronic anal fissure. J Clin Diagn Res. 2013 Dec.; 7(12):2863-65. DOI: 10.7860/JCDR/2013/7656.3698. DOI: https://doi.org/10.7860/JCDR/2013/7656.3698
18. Jordan J, Roig JV, Garcia-Armengol J, García-Granero E, Solana A, Lledó S. Risk factors for recurrence and incontinence after anal fistula surgery. Colorectal Dis. 2010 Mar.; 12(3):254-60. DOI: 10.1111/j.1463-1318.2009.01806.x DOI: https://doi.org/10.1111/j.1463-1318.2009.01806.x
19. Wexner SD, Bleier J. Current surgical strategies to treat fecal incontinence. Expert Rev Gastroenterol Hepatol. 2015; 9(12):1577-89. DOI: 10.1586/17474124.2015.1093417. Epub 2015 Sep. 28.
20. Mitalas LE, Dwarkasing RS, Verhaaren R, Zimmerman DD, Schouten WR. Is the outcome of transanal advancement flap repair affected by the complexity of high transsphincteric fistulas. Dis Colon Rectum. 2011 Jul.; 54(7):857-62. DOI: 10.1007/DCR.0b013e31820eee2e. DOI: https://doi.org/10.1007/DCR.0b013e31820eee2e
21. Vergara-Fernandez O, Espino-Urbana LA. Ligation of intersphincteric fistula tract: what is the evidence in a review? World J Gastroenterol. 2013 Oct. 28; 19(40):6805-13. DOI: 10.3748/wjg.v19.i40.6805. DOI: https://doi.org/10.3748/wjg.v19.i40.6805
22. Herold A, Lehur PA, Matzel KE, Ronan O`Connell P. Coloproctology. Berlin, Heidelberg: Springer-Verlag. 2017; 465. DOI: https://doi.org/10.1007/978-3-662-53210-2
23. Soltani A, Kaizer AM. Endorectal advancement flap for cryptoglandular or Crohn’s fistula-in-ano. Dis Colon Rectum. 2010 Apr.; 53(4):486-95. DOI: 10.1007/DCR.0b013e3181ce8b01. DOI: https://doi.org/10.1007/DCR.0b013e3181ce8b01
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