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Khirurgii

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Year 2015 Vol. 23 No 4

GENERAL & SPECIAL SURGERY

M.Y. GAIN, S.V. SHAKHRAI, Y.M. GAIN

HEMORRHOIDAL LASER COAGULATION AND MUCOPEXY IN THE SURGERY OF GRADE II AND III CHRONIC HEMORRHOIDS: A RANDOMIZED TRIAL

SEE "Belarusian Medical Academy of Post-Graduate Education"
The Republic of Belarus

Objectives. To evaluate the efficiency of hemorrhoidal laser coagulation and mucopexy in complex treatment of grade II and III chronic hemorrhoids by J. Goligher classification (1975).
Methods. The patients were divided into two groups according to the surgical intervention. In the 1st (main) (n=45) group the minimally invasive surgery – subcutaneous-submucous hemorrhoidal laser coagulation and mucopexy with proximal suture artery ligation were performed. In 34 patients (75,6%) the procedure was performed under local anesthesia, in 11 patients (24,4%) – under spinal anesthesia. In the control group (n=45) the closed Ferguson’s hemorrhoidectomy was carried out under spinal anesthesia. A comparative analysis of the results from a single-center, prospective, randomized, controlled study has been conducted.
Results. In comparability the final clinical effect and radicalism with the hemorrhoidal laser coagulation of the designed technique has surpassed the closed hemorrhoidectomy in the indices of the local edema duration (median terms of its disappearance in compared groups are 1 and 4,5 days, p=0,0000594, z=−4,01521 Mann-Whitney U Test), of pain syndrome intensity in 89,1% of patients after hemorrhoidectomy the observed pain relief associated with 1-2% promedolum injections, this was not necessary in the main group), the qualitative and quantitative characteristics of the postoperative complications (frequency of early complications lack in compared groups made up 43 (95,6%) and 29 (64,4%), p=0,0018, long-term complications – 43 (95,6%) and 31 (68,9%), p=0,0017, Chi-square), and also according to other indices have been established.
Conclusion. The designed method of subcutaneous-submucous laser coagulation with wavelength of 1,56 mn in combined with desertification hemorrhoids through suture ligation and mucopexy proven to be less invasive procedure used for treatment of grade II and III chronic hemorrhoids compared with closed hemorrhoidectomy.

Keywords: laser procedure, Ferguson’s hemorrhoidectomy, coagulation, mucopexy, hemorrhoids, postoperative complications, randomized, controlled trial
p. 429-435 of the original issue
References
  1. Vorob'ev GI, Blagodarnyi LA, Shelygin IuA. Gemorroi [Hemorrhoids]: ruk dlia vrachei. 2-e izd, pererab dop. Moscow, RF: Litterra, 2010. 200 p.
  2. Datsenko BM. Datsenko AB. Gemorroi [Hemorrhoids]. Khar'kov, Ukraina: Novoe Slovo. 2011. 144 p.
  3. Rivkin VL, Kapuller LL, Belousova E A. Koloproktologiia [Coloproctology]: ruk dlia vrachei. Moscow, RF: GEOTAR-Media, 2011. 368 p
  4. Liandres IG/red. Lazery v klinicheskoi khirurgii [Lasers in clinical surgery]. Minsk, RB: 1997. 228 p.
  5. Iaitskii HA, Vasil'ev SV, Sednev AV. Ispol'zovanie poluprovodnikovogo lazera v khirurgicheskom lechenii khronicheskogo gemorroia [The use of a semiconductor laser in the surgical treatment of hemorrhoids]. Regionar Krovoobrashchenie i Mikrotsirkuliatsiia. 2002;(2):17-21.
  6. Geinits AV, Elisova TG. Lazery v khirurgicheskom lechenii gemorroia [Lasers in surgical treatment of hemorrhoids]. Lazernaia Meditsina. 2009;(2):31-35.
  7. Chia YW, Darzi A, Speakman CT, Hill AD, Jameson JS, Henry MM. CO2 laser haemorrhoidectomy-does it alter anorectal function or decrease pain compared to conventional haemorrhoidectomy? Int J Colorectal Dis. 1995;10(1):22-24.
  8. Plapler H, de Faria Netto AJ, da Silva Pedro MS. 350 ambulatory hemorrhoidectomies using a scanner coupled to a CO2 laser. J Clin Laser Med Surg. 2000 Oct;18(5):259-62.
  9. Leff EI. Hemorrhoidectomy-laser vs. nonlaser: outpatient surgical experience. Dis Colon Rectum. 1992 Aug;35(8):743-46.
  10. Wang D, Zhong KL, Chen JL, Wang XX, Pan K, Xia LG, Chen XC, Yang XD. Effect of diode laser coagulation treatment on grade III internal hemorrhoids. [Article in Chinese] Zhonghua Wei Chang Wai Ke Za Zhi. 2005 Jul;8(4):325-47.
  11. Plapler H, Hage R, Duarte J, Lopes N, Masson I, Cazarini C, Fukuda T. A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work? Photomed Laser Surg. 2009 Oct;27(5):819-23. doi: 10.1089/pho.2008.2368.
  12. Giamundo P, Cecchetti W, Esercizio L, Fantino G, Geraci M, Lombezzi R, Pittaluga M, Tibaldi L, Torre G, Valente M. Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc. 2011 May;25(5):1369-75. doi: 10.1007/s00464-010-1370-x.
  13. Jongen J, Kahlke V. Randomized trial of the hemorrhoid laser procedure vs rubber band ligation: 6-month follow-up. Dis Colon Rectum. 2012 Apr;55(4):e45; author reply e45. doi: 10.1097/DCR.0b013e318246ad4a.
  14. Jahanshahi A, Mashhadizadeh E, Sarmast MH. Diode laser for treatment of symptomatic hemorrhoid: a short term clinical result of a mini invasive treatment, and one year follow up. Pol Przegl Chir. 2012 Jul;84(7):329-32. doi: 10.2478/v10035-012-0055-7.
Address for correspondence:
220013, Republic of Belarus,
Minsk, ul. P. Brovki, d. 3, korp. 3,
GUO "Belorusskaya meditsinskaya akademiya
poslediplomnogo obrazovaniya",
kafedra neotlozhnoy khirurgii,
tel. mob.: 375 44 557-88-15,
e-mail: mishahain@tut.by,
Gain Mihail Yurevich
Information about the authors:
Gain M.Y. PhD, an assistant of the emergency surgery chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Shakhrai S.V. PhD, an associate professor of the emergency surgery chair of SEE "Belarusian Medical Academy of Post-graduate Education".
Gain Y.M. MD, professor, Vice-rector on scientific work of SEE "Belarusian Medical Academy of Post-graduate Education".
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