Novosti
Khirurgii

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Year 2016 Vol. 24 No 2

GENERAL & SPECIAL SURGERY

М.Y. GAIN, S.V. SHAKHRAI, Y.M. GAIN

PUNCTURE VACUUM TROMBUS EXTRACTION WITH LASER COAGULATION OF HEMORRHOID NODE IN TREATMENT OF ACUTE EXTERNAL HEMORRHOID THROMBOSIS: A RANDOMIZED TRIAL

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

Objectives. To estimate the efficacy of puncture vacuum thrombus extraction with laser coagulation of hemorrhoid node in complex treatment of patients with acute thrombosed external hemorrhoids (grade I, 2).
Methods. Depending on surgical intervention the patients were divided into five groups. Minimally-invasive procedure – puncture vacuum thrombus extraction with laser coagulation of cavernous capsule node being an office-based surgery (1 day) had been performed in two main groups (A and B; 30 patients per each).
The incision thrombus extraction procedure was performed in patients of group C (n=24), excision thrombus extraction – in patients of group D (n=27). The patients of group E (n=30) received only conservative treatment. The comparative analysis of the results of treatment had been carried out as a result of the prospective randomized trial.
Results. The least invasive technique of thrombus removal has been established to be an aspiration-puncture method. It allows the quick cupping of pain syndrome and inflammation in comparison with conservative treatment (The Mann-Whitney U Test has been used for the comparative analysis of anal discomfort (p=1,4•10-11, z = −6,6456). Simple incision thrombus extraction without destruction of hemorrhoidal tissue is not considered to be a radical procedure: recurrence disease rate reached 37,5% (p=0,007 Mann-Whitney U-Test). Hemorrhage from an intervention zone after incision thrombus extraction (group C) were noted (p=0,0006 Mann-Whitney U-Test) in 33,3%. The excision thrombus extraction (group D) is the radical procedure preventing recurrence development. However, this type of operation was accompanied by a higher rate of bleeding incidents in the incisional period (22,2%; p=0,0063 Mann-Whitney U-Test).
Conclusion. The combination of active surgical tactics (the developed method of puncture thrombus extraction with coagulation of hemorrhoid node by laser radiation (1,56 microns) under tumescent local anesthesia) permits to prerent a recurrence, to reduce the number of possible complications, to decrease a pain syndrome that can result to a considerable reduction of terms of therapy.

Keywords: laser coagulation, diode, thrombus extraction, hemorrhoids, risk of hemorrhage, randomized, controlled trial
p. 138-145 of the original issue
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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 Mikhail 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 (Science) of SEE "Belarusian Medical Academy of Post-graduate Education".
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