Morphofunctional substantiation of hemorrhoidectomy with lateral ultrasound dissection in the cutting mode

The immediate and long-term results of the surgical treatment of hemorrhoids in two patient groups were compared. In the main group, the original technique of lateral ultrasound dissection in the cutting mode was used, whereas in the control group, hemorrhoidectomy using monopolar electrocautery was performed. The dynamics of the intensity of postoperative pain syndrome was analyzed using a specialized questionnaire. Pathomorphological changes in the removed hemorrhoids were studied as part of a comparative assessment of the damaging effects of ultrasound and electrosurgical scalpel on the tissues. To assess the extent of the influence of the surgical intervention on the function of the rectal locking apparatus, impairments in the contractile activity of the anal sphincter were analyzed by balloon manometry. The intensity of the pain syndrome and the frequency of postoperative complications were significantly lower in the main group than in the control group. The depth of coagulation necrosis and severity of necrobiotic and reactive changes when using lateral ultrasound dissection in the cutting mode were significantly less than that after electrosurgical hemorrhoidectomy. In the comparative analysis of transanal manometry data, significantly less pronounced impairment of the tonic activity of the sphincter in the postoperative period was noted in patients who underwent lateral ultrasound dissection in the cutting mode. Thus, the original technique of lateral ultrasound dissection in the cutting mode is characterized by less tissue injury, reduces the frequency of complications and intensity of postoperative pain syndrome, and contributes to faster restoration of the function of the rectal locking apparatus..