The thesis presents theoretical generalizations and a new solution to the problem of diagnosis and treatment of patients with chronic hemorrhoids of grade III-IV Goligher, which includes substantiation of the role of functional disorders of defecation, connective tissue dysplasia and blood supply to the cavernous bodies of the rectum, quality of life in the rectum, quality of life. The results of which allowed to improve and supplement the methods of surgical treatment. Aim of the study: to improve the efficiency of surgical treatment of patients with chronic hemorrhoids of grade III-IV Goligher by developing optimal diagnostic criteria and surgical tactics with consideration of functional features of the rectum. We conducted a clinical examination and treatment of 140 patients with chronic hemorrhoids of grade III-IV Goligher. Among the examined patients, men were 58 (41.4±4.20 %), women – 82 (58.6±4.20 %). Most patients were young (52.1±4.20 %). Middle-aged individuals were 25.0±3.70 %, elderly 22.9±3.50 %. All patients underwent a finger examination of the rectum. The tone of the external and internal sphincter was sufficient in 69.3±3.90 % and 62.9±4.08 %, respectively (p<0.001). The elongation and elasticity of the external sphincter was retained in most patients (p<0.001) – 72.1±3.79 % and 76.4±3.59 %. Rarely, on examination in patients with chronic hemorrhoids, pain was observed – 8.6±2.37 %. A sufficient degree of volitional reduction was observed in the majority of patients – 92.9±2.18 % (p<0.001). Evaluation of anorectal dysfunction in patients with chronic hemorrhoids of grade III-IV Goligher was performed according to the Rome IV criteria. In patients with chronic hemorrhoids of grade III Goligher significantly less likely to experience such manifestations of anorectal dysfunction as fecal incontinence (OR 0.33, 95 %, CI 0.14-0.76, p=0.01), uncertain functional anorectal pain (OR 0.24, 95 %, CI 0.09-0.60, p=0.003), proctalgia fugax (OR 0.18, 95 %, CI 0.06-0.56, p=0.003) and functional defecation disorders (OR 0.26, 95 %, CI 0.11-0.60, p=0.002). Levator ani syndrome encountered the same frequency and was not significantly different in patients with different severity of hemorrhoids. Two or more forms were also more commonly diagnosed with grade IV hemorrhoids by Goligher – OR 9.05, 95 %, CI 3.70-22.15, p=0.001. When using the review methodology recommended by ACG Clinical Guideline, as a result of the analysis of the functioning of the muscle elements that provide an adequate mechanism of defecation in patients with grade III and IV Goligher, we identified five variants of functional disorders of defecation: physiological response – 51 patient (36.4±4.07 %); sphincter dyspnea – 9 patients (6.4±2.07 %); puborectal loop spasm – 6 patients (4.3±1.71 %); dyspinergic defecation – 39 patients (27.9±3.79 %); inadequate propulsion – 35 patients (25.0±3.66 %). In the statistical distribution of patients with chronic hemorrhoids, depending on age and the presence of sphincter and puborectal muscle dysfunction, we found that various disorders of defecation were more likely to be observed in young and adulthood. It was found that 83 patients (59.3±4.15 %) had mild non-specific connective tissue dysplasia and 57 (40.7±4.2 %) had mild. Among patients with mild form, 64 had chronic hemorrhoids grade III and 19 – IV (OR 6.74, 95%, CI 3.18-14.29, p<0.001; χ2=25.04). Among patients with the average form of nonspecific connective tissue dysplasia were 40 and 17, respectively (OR 2.19, 95%, CI 1.07-4.46, p<0.05; χ2 = 3.99). In all patients with chronic hemorrhoids, it was found that the level of oxyprolin in the urine was significantly (p<0.05) elevated to 52.66±11.78 mg/day. There was a relationship between elevated oxyproline levels and the presence of hemorrhoids. In patients with stage III, this indicator was 44.71±7.35 mg/day, which was significantly (p<0.05) different from the rate of patients with stage IV – 60.61±9.86 mg/day. In the control group, the minimum level of oxyprolin in the urine was 11.5 mg/day, the maximum is 31.8 mg/day (median 18.2), whereas in patients with grade III hemorrhoids, the minimum was 24.3 mg/day, and the maximum was 65.2 mg/day (median 45.9). In patients with grade IV, the median was 55.23 mg/day, with a minimum of 40.5 and a maximum of 78.2. At the same time, no significant difference was noted in the analysis of the number of patients in the different groups in which intra- and postoperative complications were noted. Within 6 months, we managed to analyze the postoperative condition in 113 patients (80.7 %). The incidence of long-term complications after Milligan-Morgan surgery was significantly higher (p<0.05) than after laser open hemorrhoidectomy and laser open hemorrhoidectomy supplemented with laser transcutaneous submucosal mucopexia. Branch – medicine.
