COMPARATIVE AND THEORETICAL REVIEW OF SURGICAL TECHNIQUES IN THE TREATMENT OF HEMORRHOIDAL DISEASE

• Published in: Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії Vol. 25; no. 2; pp. 248 - 254
• Main Authors: Ivanyk, M.S., Kryshen, V.P., Makarenko, O.M.
• Format: Journal Article
• Language: English
• Published: 29.05.2025
• ISSN: 2077-1096; 2077-1126
• DOI: 10.31718/2077-1096.25.2.248

Introduction. In contemporary colorectal surgery, both classical techniques and minimally invasive procedures are employed. Over recent years, there has been a steady increase in the number of minimally invasive interventions performed, largely due to their numerous advantages, including reduced postoperative pain and shorter recovery times. However, despite these benefits, such procedures are not without certain limitations and potential drawbacks. Objectives. This review aims to provide a comparative analysis of the advantages and disadvantages of the classical Milligan-Morgan hemorrhoidectomy and various dearterialization techniques in the treatment of different types of hemorrhoidal disease. To conduct a comparative evaluation of the surgical stages and clinical outcomes associated with Milligan-Morgan hemorrhoidectomy, circular stapleless weldingcoagulation dearterialization, and external high-frequency open hemorrhoidectomy, with the goal of identifying their respective strengths, weaknesses, and clinical indications. Materials and methods. An in-depth analysis of professional scientific literature on this topic, mainly for the last 5-7 years, was carried out. The main part of works is made up of studies by foreign authors devoted to dearterilizing operations for the treatment of hemorrhoidal disease. The work notes the significant contribution of Ukrainian surgical scientists to the development of this scientific problem. Results. Since 1937, the method of surgical treatment, the Milligan-Morgan operation, has been used and widely applied in anorectal surgery for the treatment of hemorrhoidal disease. Significant positive results of its application have received high recognition from surgeons all over the world as a highly effective method for the treatment of hemorrhoidal disease. The presented work analyzes both positive and significant negative results of using the classical Milligan-Morgan operation in surgery. The effect of surgical interventions on the body of the operated patient has been studied, as evidenced by the slowdown in the recovery of convalescents in the postoperative period. Over the past three decades of the previous and current centuries, significant changes have been observed in the diagnosis and surgical treatment of the studied pathology of the anorectal region in this field of knowledge. On this basis, minimally invasive dearterializing operations, widely used in proctological surgery, have been developed and introduced into surgical practice. The next factor that contributed to the development of minimally invasive operations was the widespread use of diagnostic Doppler ultrasound in surgical practice. This made it possible to visualize the arterial hemodynamics of the anorectal region for the purpose of performing local dearterilization operations. It is also necessary to emphasize the important role of introduction into surgical practice of various variants of thermocoagulation action, in particular, the EKVZ-300 Patonmed device. Wide clinical application of two-stage surgical treatment of combined hemorrhoids was proposed: circular stapleless welding-coagulation dearterilization and external high-frequency open hemorrhoidectomy. Positive and negative features of these operations after their application are shown in the work. Conclusions. A comparative study of the features of the Milligan-Morgan operation and combined surgical treatment using the EKVZ-300 device used to treat hemorrhoidal disease was conducted. The data are presented indicating significant advantages of using a two-stage, time-spaced operation for the treatment of hemorrhoids compared to the classic Milligan-Morgan operation. Scientific prerequisites have been created for conducting our own comparative clinical studies using these surgical interventions to treat hemorrhoidal disease of different types.