Comparative characteristics of the results of surgical treatment of combined anorectal pathology using modern radiosurgical and high-frequency electrosurgical technologies

Annotation. Surgery of combined anal canal and rectal diseases requires an unconventional tactics and methods of treatment of these pathologies, which provide minimal impact on tissues, preventing postoperative complications. The purpose of the study was conduction a comparative evaluation of the results of surgical treatment of combined anorectal pathology using modern radiosurgery and electrosurgery technologies by analyzing the clinical course of the postoperative period and studying the depth of impact of these technological devices on the structure of operated tissues. The results of treatment of 635 patients with combined diseases of the anal canal and rectum, divided into four study groups, were analyzed. The control group consisted of 112 patients operated with a surgical scalpel. After surgery 30 patients from each study group underwent morphological investigation of rectal and anal tissues for measurement of the thickness of thermal impacts on them, which was performed using an eyepiece-micrometer scale. Statistical analysis of the obtained data was performed using IBM SPSS STATISTICS SUBSCRIPTIONAL TRIAL software. License number: L-CZAA-BHG85V. The following are used in the work: Kolmogorov-Smirnov test with Lilliefors and Shapiro-Wilk correction, Levene's criterion at p<0.05; applied one-way analysis of variance, Bonferroni test; used the Welch test and the Brown-Forsyth test, the Games-Howell test; used the Kruskal-Wallis test, the Mann-Whitney test. It is established that due to the minimal and shallow impact on the tissues during application of electrosurgery devices “KLS Martin”, “EFA” and “ERBE ICC 200”, as well as radiosurgery device “Surgitron”, there were no detected neither scar anal strictures in any of the four study groups nor scarring deformities of the pararectal areas, which contributed to the cosmetic nature of the combined operations and caused rapid rehabilitation of patients in the study groups. In the control group in 2 (1,8%) patients diagnosed the formation of scar anal stricture which required conservative (1 patient) and operative (1 patient) measures to eliminate them. Using of modern radiosurgical and electrosurgical technologies for the treatment of combined anal and rectal diseases reduces the duration of surgery, intraoperative blood loss, postoperative pain and prevents scar strictures of the anal canal.

COMPERATIVE STRUCTURE OF MUCOSA COAT OF THE PIG`S AND THE HUMAN`S RECTUM

The aim: To determine whether the pig could be used as biomodel for study and reconstruction of rectal pathology for development the new approaches for prevention and treatment of rectal diseases. Materials and methods: For the research the rectum of 8 vietnamese pot-bellied pigs were used. Via macro- and microscopy the structure of mucosa coat of the pig`s and human`s rectum was compared. Results: Mucosa coat`s peculiarities of pig`s and human`s rectum in comparative aspect are described in this article. With the help of traditional methods, known as macroscopy the structure of the pig`s rectal mucosa was study and compared wih macrostructure of human`s rectum. The microstucture of pig`s rectal mucosa was study due to histological method too. The macro- and microscopy demonstrated that structure of pig`s and human`s rectal mucosa are similar and includes same structural components. Conclusions: Thus, the research proved that pigs can be used as biomodels in biomedical research for creating various new methods and applications in approaching the prevention and treatment of rectal pathology in humans.

Effect of Ashwini Mudra as an adjuvant on pain in post-operative cases of ano-rectal diseases - An Ayurvedic management protocol

Ano-rectal disorders refer to the illness of the anal canal and rectum. Fissure in ano, Fistula in ano and haemorrhoids are among the most common ano-rectal conditions. In these cases, symptoms like pain, itching, burning, bleeding and swelling can significantly affect a patient's lifestyle. In Today’s Era, for pain management in post-operative cases of ano-rectal diseases, yoga plays an important role in pain management. Yoga is a way of living that aim towards a healthy mind in a healthy body. Ashwini mudra is a tantric practice used to generate and move prana (life force energy) upward along the spine, via the main energy channel of the subtle body known as sushumna nadi. The practice involves contracting the anal sphincter in a rhythmic way, thereby generating and containing intense energy within the lower body before pumping it upwards As the ano-rectal disease require long term conservative treatment and also surgical intervention. Due to this patients are suffering for long term problems. To minimize the side effects of medicine in post-operative cases, certain measures are needed. Yoga is a way of living that aims towards a healthy mind in a healthy body. Sushruta and Vagbhata have described that the total length of Guda is 4½ Angula only. Vagbhata had also told measurement of Guda as Atmapanitala (palm of hand) Ashwini mudra is very easy to perform and can be done during any time and by any age group.

A CASE STUDY AND CHALLENGES IN REPORTING OF ANO-RECTAL DISORDERS

Ano-rectal disorders namely Haemorrhoids, Fissure-in-ano and Fistula-in-ano here includes a variety of pathological disorders having different and various types of clinical presentation. These ano- rectal disorders generates relevant discomfort and disability to the patient. In this work our primary focus is only on these three anorectal disorders. The prevalence of Ano- rectal disorders are much higher than what we see in the hospital or clinics because most of the patient having such disorders do not seek for medical attention at an early stage. The present paper discusses about the hurdles or challenges faced while trying to enroll, update and increase the cases of Haemorrhoids, Fissure-in-ano and Fistula-in-ano reporting to Shalya Tantra OPD and IPD of Government Ayurvedic College and Hospital, Varanasi between year 2009-2019. The study had been also carried out to know the prevalence of diagnosed cases of Haemorrhoids, Fissure-in-ano and Fistula-in-ano and the interpretation of the data on the gender basis for better understanding of the disease. It is an institutional data study of total 5158 patients with an aim to estimate and evaluate the epidemiology of these ano–rectal disorders in eastern UP. This work is exploring scientifically the cause behind the prevalence of these three ano-rectal diseases reporting in our hospital.

SCRUPULOUS REVIEW ON ‘INTEGRATED PROCTOLOGY’

Background- Proctology involves study of rectum and anal canal. Further, in today’s modernized world, shift duties, stressful life, eating of unhealthy foods makes people more prone to the ano-rectal diseases such as fissure, haemorrhoid, abscess, anal fistula and rectal prolapse etc. Modern medical science has treatment alternatives such as conservative treatment for symptomatic relief along with diet- lifestyle modification, and various surgical interventions etc. with due risk and varied prognosis. In Ayurveda, these common ano rectal problems are termed as gud vikar and Ayurvedic texts suggest fourfold treatment for such as Bheshaj (Medicinal treatment), Kshar karma (Herbal caustic paste), Agnikarma (thermal heat burn) and Shastra karma (Surgery). Method- In this review article, information from modern surgery texts in view of definition, aetiology, patho-physiology, sign and symptoms and available treatment options as per stage of disease and a gist of contemporary texts of Ayurveda related to these gud vikaras such as parikartika, gudarsh, gud vidradhi, bhagandar, nadi vran and guda bramsh have been documented to understand integrated and holistic treatment approach towards various ano rectal problems. Result & Conclusion- The article attempts to simplify proctology and touches maximum aspects of common ano rectal diseases with an integrated approach. Hence, this article will certainly prove useful to proctologist and researchers belonging to field of Modern and Ayurveda, to know about integrated proctology.

Hemorrhoids: which is the best therapeutic option?

Hemorrhoids are one of the commonest of rectal diseases seen all across the globe. Constipation and bleeding are the main symptoms associated with this condition. The condition maybe associated with an underlying carcinoma as well. Understanding the pathophysiology will enable the surgeon to determine the best therapeutic option for this condition. A brief review of clinical evaluation and treatment options is presented in this paper.