EFFECTIVENESS OF LASER OPEN HEMOROIDECTOMY IN PATIENTS WITH IN-VETERATE HEMORROIDS

Objective. To evaluate the effectiveness of different options for surgical treatment of patients with chronic hemorrhoids of III-V degree after Goligher. Materials and methods.140 patients with chronic hemorrhoids of III-IV degree were operated after Goligher. The patients were divided into three groups: 60, who were performed Milligan-Morgan operation; 40 were performed a laser open hemorrhoidectomy and 40, who were performed a laser open hemorrhoidectomy, supplemented with laser transcutaneous submucosal mucopexia. Patients in the groups were presentable by basic сriteria. Results. For resection of hemorrhoids, as a scal-pel, we used an optical laser with a fiber of 600 μm, a working wavelength of 1470 and a power of 15 watts. Carrying out a hemorrhoidectomy by means of a laser coagulator had the features which are absent at its per-formance by means of the traditional cutting instrument. The cutting effect can also be enhanced by ma-nipulating the tissues of the operating area. When they were stretched, the dissection was better, and when the tension was reduced, the coagulation effect was en-hanced. Manipulations with the surgical nozzle should be performed at a distance of 1-2 mm from the operating field. This allowed to keep the working surface of the optical fiber clean, as evidenced by a fairly bright beam of the laser pilot. Any contamination led to a deteriora-tion in the quality of the light beam, which complicated the technical characteristics of the operation. In patients of the third group laser open hemor-rhoidectomy, supplemented by laser transcutaneous submucosal mucopexy at 9, 2 and 5 hours clockwise. After removal of the nodes at 3, 7 and 11 hours, the submucosal layer of the anal canal for 9 hours was saturated with 0.25% solution of novocaine, which acted as a luminescent solution. An optical fiber with a diameter of 600 μm was inserted into a puncture needle, which pierced the mucous membrane of the anal canal in the area of the white Hilton line, held the needle submucosally above the dentate line and placed the tip of the fiber for 9 hours on the clock face. The Parks ligament was then sclerosed with laser radiation at a working wavelength of 1470 nm and a power of 5 watts. Laser submucosal mucopexy was performed for a second and fifth hour using a similar technique. Parks ligament sclerosis at 9, 2, and 5 hours allowed the mucosa to be lifted by submucosal scar formation. Along with this, the areas for 3, 7 and 11 hours remained elastic. The median of the first voiding in the first group was 5.0 days. In patients of the second and the third groups, the first stool was observed between the third and the fifth day with a median of 4.0 days. Patients in the second and the third groups did not indicate the pain syndrom during the first act of defecation. The anal canal hematoma was found only in patients of the first group (p <0.01). Anal canal infiltrate was more common in the third group (p <0.01). Infections of wounds were not found in any group. 7 patients of the first group had one-time febrile increase of body temperature on 3-4 postoperative day. This complicacy did not require spe-cific therapy. Conclusions. Currently, Milligan-Morgan sur-gery is the surgical choice in patients with chronic hem-orrhoids of III-V degree after Goligher, however, the operation of laser open hemorrhoidectomy, supplemented with laser transcutaneous submucosal mucopexia is the most pathogenetically justified. In patients who underwent laser open hemorrhoidectomy physical and psychological rehabilitation in the postoperative period was faster.