Shudrak A. Differential approach for chose of surgical treatment method for chronic hemorrhoids

Dissertation is devoted to improvement of surgical treatment results in patients with chronic hemorrhoids by scientific justification, design and implementation of new surgical treatment methods, differential approach for chose of treatment method depending of the disease stage. 1030 were treated for chronic hemorrhoids of I-IV stages by means of modern well known and newly designed methods with comparative analyze in dynamics of 2-year follow-up. The reasons of unsatisfactory results were found for procedures, directed to the vascular factor of the chronic hemorrhoids pathogenesis, like infrared fotocoagulation, latex banding, THD. New operative procedures without known disadvantages were introduced for all stages of chronic hemorrhoids. Universal pathogentic classification of operative procedures was developed, for assisting in systematization of all existing treatment methods for chronic hemorrhoids. Treatment algorithm for chronic hemorrhoids was developed, this algorithm includes ranking of priority for operative procedur es in all stages of disease based on evaluation of negative results risk in long term perspective. Implementation of procedures, caring high ranking priority (including newly developed), due to developed algorithm, provides 94,0 % of good results in long term period for I stage of chronic hemorrhoids, up to 96,5 % for I stage of chronic hemorrhoids and 99,0 % for III-IV stages of chronic hemorrhoids. When opportunities for performing of high priority procedures do not exist, middle priority procedures are recommended. They provide good resultsin 80,4 % stage I stage of chronic hemorrhoids, 68,6 % stage II of chronic hemorrhoids and in 81,9 % stage III-IV of chronic hemorrhoids. Performing of high priority procedures in all stages of chronic hemorrhoids with implementation of developed by us methods provided better results (97,2 % in 249 patients), compared to traditional methods, that also have high priority (92,9 % in 155 patients), р = 0,042.