Evaluation of the results of surgical treatment of patients with hemorrhoids by classical traditional and minimally invasive methods

Abstract

Background. The HAL-RAR method aims to reduce arterial blood flow to the hemorrhoidal nodules, which leads to a decrease in the volume of the nodules and their fixation on the intestinal wall. The method of surgical treatment is selected individually for each patient, depending on the main symptoms. Objective of the study. Comparative analysis of the results of surgical treatment of hemorrhoidal disease by using traditional classical methods and minimally invasive: HAL and HALRAR. Material and Methods. The results of the surgical treatment of 90 patients with the diagnosis: chronic mixed hemorrhoids gr. III-IV were evaluated. Group I (LI) of patients treated by traditional classical surgical methods (Milligan-Morgan, Whitehead) -30 patients, Group II (LII) by the combined method (HAL with excision of external hemorrhoidal nodules) -30 patients, group III (LIII) by HALRAR method -30 patients Results. Postoperative pain VAS (0-10): LI (7-10)> LII (3-6)> LIII (1-4). Hospitalized days LI (4-8)> LII (2-5)> LIII (1-4). Duration of surgery (min) during adoption the HALRAR method (2014-2016): LI (25-40) <LII (30-60) = LIII (30-60), In the years 2016-2020: LI (25-40 ) = LIII (25-40) <LII (30-50). Recovery and professional integration LI> LII> LIII. Severe complications were not detected. Conclusion. The differentiated, complex and individual surgical approach in patients with hemorrhoidal disease, allows to obtain positive results and reduces the risk of complications. Introducere. Metoda HAL-RAR are scopul de a reduce fluxul de sânge arterial spre nodulii hemoroidali, ceea ce duce la micșorarea în volum a nodulilor și fixarea lor pe peretele intestinului. Metoda de tratament chirurgical este selectată individual pentru fiecare pacient, în dependență de simptomatologie. Scopul lucrării. Analiza comparativă a rezultatelor tratamentului chirurgical a bolii hemoroidale prin utitlizarea metodelor clasice tradiţionale şi minim invazive: HAL şi HALRAR. Material și Metode. Au fost evaluate rezultatele tratamentului chirurgical a 90 de pacienţi cu diagnosticul: hemoroizi cronici micști gr. III-IV. Lotul I (LI) de pacienţi trataţi prin metode chirurgicale clasice tradiţionale (Milligan-Morgan, Whitehead) – 30 de pacienţi, Lotul II (LII) prin metoda combinată (HAL cu excizia nodulilor hemoroidali externi) –30 de pacienţi, lotul III (LIII) prin metoda HAL-RAR – 30 de pacienţi. Rezultate. Durerea postoperatorie VAS(0-10): LI(7-10) > LII(3-6) > LIII(1-4). Zile spitalizate LI(4-8)>LII(2-5)>LIII(1-4). Durata intervenţiei chirurgicale (min) la însuşirea metodei HAL-RAR (2014-2016): LI(25-40)<LII(30-60)=LIII(30-60), În anii 2016-2020: LI(25- 40)=LIII(25-40)<LII(30-50). Recuperarea şi intergrarea profesională LI>LII>LIII. Complicaţii severe nu au fost depistate. Concluzii. Abordarea chirurgicală diferenţiată, complexă şi individuală la pacienţii cu boala hemoroidală, permite obţinerea rezultatelor pozitive şi scade riscul de apariţie a complicaţiilor.