Optimization of management of patients with coloproctological profile in outpatient surgical treatment of hemorrhoids

Objective. Various aspects of the organization and optimization of diagnosis and treatment, including surgical, in patients with hemorrhoids – one of the most common diseases in coloproctology – are still the subject of discussion. Problems of the postoperative period can be prolonged spasm of anal sphincter, severe pain syndrome and delayed postoperative bleeding.

Materials and methods. We conducted a one-center prospective study in 214 patients, undergoing surgical treatment for stage 3–4 chronic hemorrhoids. The most common surgery for hemorrhoids was a different combination of hemorrhoidal artery ligation (HAL), rectomucopexy (RAR) and excision of one to three external hemorrhoids in one and the same patient. In all the observations, we used a specially developed questionnaire, including a visual-analog scale (VAS) and registration of taking anesthetiсs per day, so as to objectify the assessment of the level of pain after surgery. Identification of local inflammation included taking a blood sample in an amount of 0.1 ml when punctured with a GU insulin syringe during anoscopy and enzyme-linked immunosorbent assay in accordance with test system instructions and determining interleukin 1 (IL-1), interleukin 4 (IL-4), tumor necrosis factor (FNO-α) and interleukin 8 (IL-8). Results. According to the results obtained (severity of pain syndrome and amount of anesthetics, absence of complications), patients were conditionally divided into three groups – with mild reaction to surgery – 44 (20.5 %), moderate – 100 (46.5 %) and severe – 70 (32.5 %). In the group with mild reaction, the level of the analyzed indices was almost consistent with the norm; in group II, there was an elevation of two of them; in group III, the level of at least three tests was higher than the norm.

Conclusions. More favorably, the postoperative period proceeds against the background of initially unexpressed local inflammation. The proposed additional examination method, which allows identifying subclinical local inflammation and assessing its severity, should help to optimize the selection and, as a result, increase the efficiency and safety of surgical treatment of hemorrhoids on an outpatient basis.