OPTICAL AND SUBMICROSCOPIC FEATURES OF PATHOLOGICAL CHANGES IN HEMORRHOIDS REMOVED BY VARIOUS INSTRUMENTS

Despite the rapid development of low-invasive technologies in the treatment of hemorrhoids, the operation offered by Milligan - Morgan and Ferguson remains nowadays the most radical intervention of hem-orrhoids of the 3d and 4th degree. In the accumulation of experience, hemorrhoectomy according to Milligan-Morgan and Ferguson 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. Hemorrhoectomy is an operation in which patient satisfaction is low, although it is a commonly performed operation in modern surgical practice. The main cause of dissatisfaction is pronounced postoperative pain, acute urinary retention, postoperative bleeding, suppuration of the wound and other complications. Much of the complication is related to the type of surgical instrument that removes the hemorrhoid complex. It is important to find a tool that allows you to effectively dissect fabrics with minimal damaging effects. In the conditions of the Surgical Department of the Central City Clinical Hospital (CCCH) in Ivano-Frankivsk for the period of 2012-2018, 180 patients with the 3d and 4th degree of hemorrhoids were operated successfully. All patients perform a three-quadrant hemorrhoectomy. Depending on the surgical treatment, all patients were divided into 3 groups. In the first group of patients (n = 62), a classic closed hemorrhoectomy was performed. In the second group of patients (n = 60), they performed the hemorrhoectomy by Milligan-Morgan using monopolar high-frequency current. In the third group of patients (n = 58), they performed the hemorrhoectomy by Milligan-Morgan using high-frequency soft tissue welding. In order to study the effect of metal scalpel, diathermocoagulation and bipolar coagulation on the tissue of the hemorrhoid complex in the studied patients, histological studies were performed. In the classic closed hemorrhoectomy according to Ferguson hemorrhagic-dystrophic processes are ob-served in the intestinal wall, disorganization of connec-tive tissue components is expressed. In the case of hemorrhoectomy by Milligan-Morgan, a monopolar electrocoagulation unit in the bowel wall is dominated by edema. In the case of hemorrhoectomyby Milligan-Morgan, a bipolar high-frequency electrocoagulator captures a thin layer of coagulation necrosis, preservation of the shell structure of the intestinal wall. There is slight swelling of the intercellular basic substance and the phenomenon of stasis in small vessels, mosaic islets of hemorrhagic impregnation. The use of bipolar high frequency coagulation is characterized by a controlled, sparing effect on the tis-sues, the area of lateral necrosis after bipolar coagulation is smaller than after the use of conventional diathermy. Dissection and coagulation using a bipolar high-frequency coagulator is characterized by a strictly local effect, the presence of "biological welding" of layers, the organ being dissected and reliable hemostasis. Electron microscopic examination confirms the optical data. Ac-cording to the results of the performed study, the follow-ing conclusions is drawn: the use of the bipolar current of the electrosurgical equipment during the operation of Milligan-Morgan has advantages over the classical meth-ods of its performance.