Comprehensive assessment of hemorrhoidectomy with lateral ultrasonic dissection in the “cut” mode

Abstract

The effectiveness of the original technique of hemorrhoidectomy with lateral ultrasonic dissection in the “cutting” mode was analyzed from a clinical standpoint and studied according to pathomorphological changes in tissues during its use. A comparative assessment of the immediate results of treatment as well as pathomorphological changes in the tissue of removed hemorrhoids in two groups of patients was performed. The main group included 30 patients in whom the original hemorrhoidectomy technique with lateral ultrasound dissection in the “cutting” mode was used. The control group consisted of 30 patients who underwent Milligan – Morgan hemorrhoidectomy using electrocoagulation. No significant difference was found between these groups in terms of the age and sex structure of patients, as well as the main clinical characteristics of the disease. In a comparative analysis of the immediate treatment results, the intensity of the pain syndrome and the incidence of postoperative complications were lower in the main group than in the control group. In the assessment of pathomorphological changes, the depth of coagulation necrosis and the severity of necrobiotic changes in the underlying layer after hemorrhoidectomy with lateral ultrasonic dissection in the “cutting” mode were significantly less than those after Milligan – Morgan surgery using electrocoagulation. A significant difference was also revealed in the timing of tissue regeneration. The formation of active granulations in the postoperative wound area in the main group was noted on postoperative days 14–16, while this process developed no earlier than on postoperative day 20 in the control group. As a result, complete epithelialization of wounds after hemorrhoidectomy with lateral ultrasound dissection in the “cutting” mode occurred much earlier, i.e., postoperative days 26–30. A similar process after the Milligan – Morgan hemorrhoidectomy using monopolar coagulation was completed only on postoperative days 36–38. Thus, the use of the original technique of lateral ultrasound dissection provides a more sparing effect on tissues, which is the key to a favorable course of the postoperative period and rapid rehabilitation of patients.

Keywords

hemorrhoids / hemorrhoidectomy / lateral ultrasound dissection in the cutting mode / electrocoagulation / Milligan – Morgan operation

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RIGHTS & PERMISSIONS

Sazonov A.A., Maistrenko N.A., Romashchenko P.N., Makarov I.A.