Endorectal hemorrhoids prolapse ectomy for Longo method
Science Articles / / April 30, 2016
Pesneva O. The Samara Regional Clinical Hospital.Kalinin
prevalence of hemorrhoids is still quite high in industrialized countries and is 118-120 per 1,000 adult population, and the proportion in the structure coloproctological diseases ranges from 34 to 41%.
In Russia, the most common method of treatment is still a traditional hemorrhoidectomy performed in 75% of patients (GI Vorobiev et al., 1999).The average term disability after hemorrhoidectomy is not less than 28 days (Kalanov P. P., 1988; Yu.V.Dultsev, 1989; L.A.Blagodarny, 1999).The most frequent complications are: pronounced prolonged pain 24%, 15-26% dizuricheskie disorders, anal stricture 6-9%, the lack of anal sphincter 2-4% (V.D.Fedorov, 1984; G.I.Vorobev 1994; A.A.Blagodarny 1999; Stelzner F., 1992; Garveda ML, 1996).All this raises a number of unresolved hemorrhoids in general medical and socio-economic problems.
Purpose - to provide an analysis of the immediate and remote results of operations Longo method.
Surgeries were performed using specially developed for this procedure single set of company "Ethicon endosurgery" Company "Johnson & Johnson", which includes: a circular stapler PPH-01, operating on the principle of a stapler, a special vdevatel thread and anoscope for the imposition of purse-stringseam.
We evaluated the duration of surgery, severity and duration of post-operative pain (pain intensity on a scale MNIOI them. P.A.Gertsena and necessary, the appointment of narcotic analgesics), duration of hospital stay and terms of vocational rehabilitation.In each case, the drug was studied histologically remote pas presence cavernous tissue, muscle cells, vessel end portions.Long-term observation periods of 2 years.
From 2001 to 2003, in the clinic of surgery method Longo operated on 23 patients with stage II-IV chronic hemorrhoids: one with stage II - 6 patients with III - 14, with IV - 3 patients.Mean operative time was 23 minutes
Average length of stay in hospital - 4 days after discharge to outpatient treatment - from Z to 14 days.
Maximum severity of pain reached 2-3 points on the scale of pain intensity MNIOI them.P.A.Gertsena first 2-4 hours and was observed in 17 patients with lII-IV stage, that adequate Cropped appointment of non-narcotic analgesics.By the end of the first day of 20 operated patients noted the disappearance or significant decrease in the intensity of pain in the anal canal 0-1.In 3 patients, preservation of pain intensity score was 2-3 due to the development of edema of external hemorrhoids.All of them carried out with a positive effect of conservative therapy.
In the early postoperative period, 3 patients had dizuricheskie disorder, requiring a single bladder catheterization.
In the study of histological preparation in all cases determined by the presence of mucous and submucosal layer of the rectum with the end members of vessels, in 4 cases - the presence of erectile tissue in the 2 formulations - the presence of muscle cells.
When monitoring for 2 years 20 patients had completely disappearance of symptoms that existed before the operation.At 3 observed with stage IV chronic hemorrhoid relapse of disease after 6 and 10 months after surgery.All of them closed gemorroidekomiya was performed, during which called attention to a significant reduction in the size of hemorrhoids, the lack of the most frequent symptom - hemorrhoidal bleeding.
Failure of the anal sphincter, anal stricture were observed in any patient during the entire period of observation.
Thus, endorectal gemorroidprolapsektomiya Longo method is characterized by short duration of surgery, postoperative unexpressed pain, lack of complications such as failure of the anal sphincter, anal stricture, rapid vocational rehabilitation period.