COMPLEX TREATMENT OF PATIENTS WITH CHRONIC HEMORRHOIDS AND ACUTE ANO-RECTAL INFLAMMATORY PROCESSES

Hemorrhoids, acute paraproctitis, anal fissure are one of the most common diseases affecting persons of working age. The combination of such diseases occurs in 20-25% of patients. In the case of combined pathology of the anal canal and rectum, the following diseases combination is most often diagnosed: hemorrhoids and anal fissures (51.8 - 58.4% of observations), hemorrhoids and acute paraproctitis (19 - 81%). During surgical treatment of patients with acute inflammatory diseases of the anorectal area, little attention is paid to concomitant chronic pathology, which leads to more severe course of the underlying disease and exacerbation of chronic pathology, prolongs the length of hospitalization and increases its cost, that is why it has prompted us to study the use of venoprotectors in the postoperative period in patients with combined pathology of the anorectal area. The aim of our study is to improve the results of surgical treatment of patients with combined pathology by using flavonoids in the postoperative period. On the clinical material - 64 patients, who were hospitalised in the surgical department of Ivano-Frankivsk CCCH from February to December 2019 with proctologic pathology, the peculiarities of venoprotectors administration in the postoperative period for the acute and chronic anorectal diseases treatment were studied to improve the results of surgical treatment of patients with combined pathology. Trial group: patients with combined pathology, who received flavonoids in the early postoperative period. Control group: patients with combined pathology who did not receive flavonoids. Daily dose in the first 4 days was 3000 mg (2400mg of diosmin + 600 mg of hesperidin), the frequency was 2 tablets 3 times a day during meals. The daily dose in the next 6 days was 2000 mg (1600 mg of diosmin + 400 mg of hesperidin), the frequency was 2 tablets 2 times a day. Course duration was 10 days. Age of patients ranged from 18 years to 73 years. There were 38 men (65.6%) and 26 women (35.4%). Among them, 32 patients (50%) were diagnosed with acute paraproctitis and hemorrhoids, 20 (31.25%) – with chronic anal fissure and hemorrhoids, and 12 patients (18.75%) - with chronic paraproctitis and hemorrhoids. All patients were operated. In case of third and fourth stages of hemorrhoids and combined anal fissure, combined surgery was performed. In case of the combination of chronic and acute paraproctitis, surgical interventions were done only for the elimination of paraproctitis in any degree of chronic hemorrhoids. The effect of venoprotectors (Normoven) consists in venotonic and angioprotective action, improving microcirculation in the cavernous tissue of the anal canal, reducing capillary permeability and decreasing the injuring effect of inflammatory mediators on hemorrhoidal plexuses. Visual examination of the anal canal was done on the 3, 7, 14 days (perianal edema, thrombosis or enlargement of hemorrhoids were evaluated), visual-analogue scale of pain was used. Hemorrhoids edema: control group - 33.3%, trial group - 8.3%. Hemorrhoid thrombosis: control group - 1 case, trial group - 0 cases. Perianal area edema: control group - 44.5%, trial group - 12.3%. The obtained data indicate that prescribing of venoprotective agents to the patients with combined pathology - chronic hemorrhoids and inflammatory diseases of anorectal area, is effective and reasonable, which leads to shortening of the hospitalization period, reducing pain and improving the psychological and physical comfort of patients in the postoperative period.