OPTIMAL APPROACHES TO MODERN MODIFI-CATIONS OF MILLIGAN-MORGAN OPERATION IN COMPLICATED HEMORRHOID TREATMENT

Despite the rapid development of low-invasive technologies in the treatment of hemorrhoids, the operation offered by E.Milligan and G.Morgan remains nowadays the most radical intervention of hemorrhoids of the 3d and 4th degree. In the accumulation of experience, hemorrhoidectomy according to Milligan-Morgan had undergone a number of changes. Technical progress and the latest medical equipment contributed to the wide development of various modifications of this surgical intervention, which prompted us to study the peculiarities of the use of electrocoagulation equipment during the Milligan-Morgan operation. In the conditions of the Surgical Department of the Central City Clinical Hospital (CCCH) in Ivano-Frankivsk for the period of 2016-2018, 326 patients with the 3d and 4th degree of hemorrhoids were operated successfully. The results of the severity of postoperative pain, the duration of in-patient treatment and the period of rehabilitation were studied in four groups, where hemorrhoidectomy accord-ing to the Milligan-Morgan method was performed using the electrocoagulation set developed by the ER-BEACC450 company or the high-frequency electrocoag-ulator EC-300M1, and using prolonged epidural anesthe-sia during the first day after the operation. Based on the obtained data, statistically ordered tables of pain levels during different time after surgical intervention in each patient group were constructed, an analysis of the correlation of pain sensations to the duration of inpatient treatment and the period of complete rehabilitation of patients was performed. In all patients, peak pain levels are observed 12 hours after surgery. According to the results of our study (2012-2014), when we did not use high-frequency currents for hemorrhoidectomy, the pain level at that time was 9.0 points in the 10-point system of pain assessment. In the same study, it was found that when using the ERBE ACC450 for hemorrhoidectomy, the pain level was 5.0 points, and with the use of the high-frequency coagulator EC-300M1 it was 5.3 points. During the first day in control groups of patients who used prolonged epidural anesthesia, the pain level was at the level of 1.5-2.3 points, which is 56.6-71.6% less than in the other two groups. The use of high-frequency currents allowed us to reduce the length of patient's stay in the hospital by 2.3 days. The use of prolonged epidural anesthesia significantly affected the patient's pain during the first day after the operation and contributed to a reduction in the intensity of pain during the next two days. Monitoring of patients on 14 and 28 days showed that wound healing in 5-7 days longer in patients who used the device M1 300 EC for hemorrhoidectomy. According to the results of the performed study, the following conclusions is drawn: the use of the mono and bipolar current of the electrosurgical equipment during the operation of Milligan-Morgan has advantages over the classical methods of its performance. There is no significant difference in the level of pain sensation and the length of patients' stay in the hospital with the use of the electrocoagulation apparatus, but full epithelization of postoperative wounds occurs more quickly in patients, who were applied a mono-polar electrode. Use of the prolonged epidural anesthesia during the first 24 hours allowed us to significantly improve the psychological comfort of patients and gave us the possibility to completely refuse the application of injection anesthetics.