Амбулаторная хирургия (Nov 2023)

Desarterization of hemorrhoidal arteries in outpatient treatment of chronic hemorrhoids

  • I. A. Matveev,
  • A. I. Matveev,
  • V. T. Dgebuadze,
  • N. N. Povarnin,
  • S. N. Zobov,
  • L. A. Morozova,
  • K. E. Kurakina

DOI
https://doi.org/10.21518/akh2023-022
Journal volume & issue
Vol. 20, no. 2
pp. 249 – 257

Abstract

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Introduction. Desarterization of hemorrhoidal arteries with mucopexia, a pathogenetically caused minimally invasive operation, is more often performed in stationary conditions under regional or general anesthesia. Aim. To study the results of desarterization of hemorrhoidal arteries in patients with hemorrhoids operated on an outpatient basis under local anesthesia.Materials and methods. 459 patients with chronic hemorrhoids of stage 2–4 with varying degrees of node prolapse under local infiltration anesthesia with Ultracaine were operated on by one surgeon. The duration of the intervention, the intensity of the pain syndrome, and the complications of treatment were studied. Results. The median duration of the operation is 25 minutes, the intensity of pain during the operation on a 10-point scale is 2 points, on the 3rd day of the postoperative period-2 points. Complications occurred in 6 (1.3%) people, in the 1st urinary retention, paraproctitis, and in the 4th – bleeding. Discussion. The obtained results of a longer procedure in patients with stage II hemorrhoids are associated with the training period. The intensity of pain during the HAL-RAR procedure performed under local anesthesia, including in patients of stage III-IV and IV, was acceptable and was tolerated by patients satisfactorily. The structure of the complications that have arisen is limited by a narrow range of pathology: bleeding, acute urinary retention, paraproctitis. Conclusion. Hemorrhoidal artery desarterization is an effective method of treating patients with chronic hemorrhoids on an outpatient basis: low duration ofsurgery, low frequency of complications. Local anesthesia during the ligation of hemorrhoidal arteries with mucopexia provides adequate anesthesia, patients tolerate the procedure and pain in the postoperative period, regardless of the stage of the disease, therefore, this method of treatment is advisable to use in outpatient practice.

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