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Khirurgii

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Year 2022 Vol. 30 No 4

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.J. NOYES, J.P. FELESHTYNSKY, V.Y. PIROGOVSKY

SURGICAL TREATMENT FOR ANAL FISSURE COMBINED WITH HEMORRHOIDS

National University of Health of Ukraine named after P.L. Shupyk, Kiev,
Ukraine

Objective. Simultaneous surgical treatment of patients with anal fissure and hemorrhoids improves the results of treatment of these patients.
Methods. 177 patients with anal fissure and hemorrhoids were studied. GI – fissure excision and hemorrhoidectomy, GII – anal fissure excision without intervention for hemorrhoids, GIII – proposed method used. Result assessment by following criteria: pain intensity, urinary retention, wound suppuration, recurrence, incontinence, hospital stay. For assessment of blood flow intensity in fissure area Laser Doppler flowmetry was performed.
Results. Pain intensity: GI – 8±1, GII – 6±2, GIII – 4±1. Urinary retention: GI – 19(31.6%), GII – 8(13%), GIII – 6 (10.5%). Wound suppuration: GI – 5 (8.3%), GII – 1 (1.7%), GIII – 1 (1.7%). Days of hospital stay: GI – 6±1.2, GII – 4±1.3, GIII – 3±1.1. Fissure recurrences: GI – 5 (8.3%), GII – 2 (3.3%), GIII – 1 (1.7%). Recurrence of hemorrhoids: GI – 6 (10%), GIII – 2 (3.5%). Iatrogenic incontinence: GI – 4 (6.7%), GII –
1 (1.7%), GIII – 0. We observed significant decrease in relative risk of complications (by 88%) in GIII compared with GI – OR=0.12 (0.04-0.29), p=0.0001, and a tendency to reduction of complication risk by 15% compared with GII – OR=0.85 (0.29-2.4), p=0.734. Blood flow intensity (flowmetry results) in GII and GIII was comparable.
Conclusion. Surgical treatment of patients with a combination of anal fissure and hemorrhoids by combining fissure excision with transanal hemorrhoidal deartherialization improves treatment outcomes. Surgical treatment of patients with anal fissure combined with hemorrhoids, by the proposed method can improve treatment results. This method does not impair blood flow in the area of anal fissure. Thus, the proposed method is both minimally invasive and radical. Therefore it can be easily implemented in surgical practice.

Keywords: hemorrhoids, anal fissure, laser Doppler flowmetry, hemorrhoidal dearterialization, anal sphincterotomy
p. 351-357 of the original issue
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Address for correspondence:
04112, Ukraine,
Kiev, st. Dorogozhitskaya, 9,
National University of Health
of Ukraine. P.L. Shupika,
Department of Surgery and Proctology
tel. +38 063 323 64 33,
e-mail: noyesdoc@gmail.com,
Noes Andrew Jimmy
Information about the authors:
Noes Andriy Jimmy, Graduate Student, PhD, Department of Surgery and Proctology, National University of Health of Ukraine named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0003-4463-9044
Feleshtinsky Yaroslav P., MD, Professor, Head of the Department of Surgery and Proctology, National University of Health of Ukraine named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0003-4376-4265
Sorokin Bogdan V. MD, Professor, Department of Oncology, National University of Health of Ukraine named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0003-0511-7550
Pirogovsky Volodymyr Y., PhD, Assistant, Department of Surgery and Proctology, National University of Health of Ukraine Named after P.L. Shupyk, Kiev, Ukraine.
https://orcid.org/0000-0002-7453-991X
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