The study was conducted for the sake of reasoning of the expediency of
simultaneous minimally invasive treatment of combined pathology of hemorrhoids
and anal fissures and to study the effectiveness of complex surgical treatment of anal
fissures and hemorrhoids using transanal hemorrhoidal dearterialization (THD).
The urgency of the problem of treatment of the colorectal zone diseases is
determined by the fact that, according to many authors, the proportion of patients with
combined diseases of the rectum is 20-30%, and there is a tendency to increase.
Diagnosis and choice of treatment mode for combined diseases of the rectum are a
complex and not yet fully understood problem. The frequency of hemorrhoids and anal
fissures are, respectively, first and third place among proctological diseases. According
to various literature sources, 55-70% of patients have a combination of chronic
hemorrhoids with anal fissure [27, 28, 33, 35, 36, 96, 97].
In the surgical treatment of combined diseases of the rectum, the doctor always
has a question: to divide the surgery into two stages or to make a simultaneous surgical
correction of the combined pathology. In Ukraine, as in the post-Soviet countries,
traditional surgical interventions account for 83%, and minimally invasive techniques
- 17%. In the United States and the European Union, the share of the latter is 79-83%.
Therefore, today the development and implementation of less traumatic minimally
invasive methods of surgical treatment of this pathology is of particular practical
importance.
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The dissertation uses data from a retrospective comparative analysis of the results
of treatment of 177 patients with chronic hemorrhoids of various degrees and chronic
anal fissure. All patients were operated in the proctology department of Kyiv Regional
Hospital. The study included 83 men (46.9%) and 95 women (53.1%). Age from 19 to
70 years.
According to the character of the performed surgical interventions, patients were
divided into three groups:
• The first group includes 60 patients who underwent simultaneous surgery for
anal fissure and hemorrhoids according to the classical method for the period from 2010
to 2012. Men and women accounted for 25 (41.6%) and 35 (58.4%), respectively.
• The second group includes 60 patients who underwent surgery for anal fissure
without intervention for hemorrhoids in 2013. Men and women accounted for 24 (40%)
and 36 (60%), respectively.
• The third group included 57 patients who underwent surgery for anal fissure
and hemorrhoids according to the original method in 2013. Men and women accounted
for 21 (36.8%) and 36 (63.2%), respectively.
Examination of patients included determination of blood microcirculation and
the degree of tissue ischemia in the area of anal fissure by laser Doppler flowmetry
[144]. The study was performed in all patients of the second and third groups before
surgery, 3 weeks, 3 months and 1 year after surgery.
Patients of the first group underwent hemorrhoidectomy according to MilliganMorgan, removal of the anal fissure, posterior dosed sphincterotomy, anoplasty.
Patients of the second group underwent only anal fissure removal, posterior dosed
sphincterotomy, anoplasty. Patients of the third group were operated according to the
original method (Ukrainian patent for invention № 120318 dated 11.11.2019), which is
as follows. Anal fissure is excised within healthy tissues, the mucous membrane of the
anal canal is mobilized, dosed sphincterotomy and suturing of the mucosal defect is
performed; under the control of the Doppler sensor, stitching and ligation of the
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terminal branches of the a. rectalis superior is performed for 1, 3, 5, 7, 9 and 11 hours
of the conditional dial; if necessary, additional pexia of hemorrhoids is performed.
Thus, at the same time elimination of the anal mucous membrane defect is reached,
acquire sphincter spasm abolishment, improving of blood flow in the area of the
previous existence of the fissure and reducing of blood supply to the cavernous tissue
of hemorrhoids, with minimal trauma to the anal canal.
The quality of treatment of patients was assessed by the following criteria:
urinary retention in the early postoperative period, pain intensity, time of hospital stay
after surgery, frequency of postoperative wound suppuration, anal stenosis and
incontinence, recurrence of hemorrhoids and anal fissures.
