Comprehensive assessment of hemorrhoidectomy with lateral ultrasonic dissection in the “cut” mode

The effectiveness of the original technique of hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode was analyzed from a clinical standpoint and studied according to pathomorphological changes in tissues during its use. A comparative assessment of the immediate results of treatment as well as pathomorphological changes in the tissue of removed hemorrhoids in two groups of patients was performed. The main group included 30 patients in whom the original hemorrhoidectomy technique with lateral ultrasound dissection in the cutting mode was used. The control group consisted of 30 patients who underwent Milligan Morgan hemorrhoidectomy using electrocoagulation. No significant difference was found between these groups in terms of the age and sex structure of patients, as well as the main clinical characteristics of the disease. In a comparative analysis of the immediate treatment results, the intensity of the pain syndrome and the incidence of postoperative complications were lower in the main group than in the control group. In the assessment of pathomorphological changes, the depth of coagulation necrosis and the severity of necrobiotic changes in the underlying layer after hemorrhoidectomy with lateral ultrasonic dissection in the cutting mode were significantly less than those after Milligan Morgan surgery using electrocoagulation. A significant difference was also revealed in the timing of tissue regeneration. The formation of active granulations in the postoperative wound area in the main group was noted on postoperative days 1416, while this process developed no earlier than on postoperative day 20 in the control group. As a result, complete epithelialization of wounds after hemorrhoidectomy with lateral ultrasound dissection in the cutting mode occurred much earlier, i.e., postoperative days 2630. A similar process after the Milligan Morgan hemorrhoidectomy using monopolar coagulation was completed only on postoperative days 3638. Thus, the use of the original technique of lateral ultrasound dissection provides a more sparing effect on tissues, which is the key to a favorable course of the postoperative period and rapid rehabilitation of patients.

ELECTROSURGICAL AND ULTRASOUND DISSECTION AND COAGULATION TISSUE EFFECT FEATURES DURING OPERATIONS ON STOMACH AND INTESTINES

The work is devoted to the problem of reducing intra- and postoperative complications in patients with surgical gastrointestinal tract pathology. The aim of the study is to comprehensively investigate electrosurgical and ultrasound dissection and coagulation features to prevent intra- and postoperative complications, improve the results of treatment of patients with surgical gastrointestinal tract pathology. The study included experimental and clinical parts. The use of ultrasound scanning in the main group of patients revealed significant advantages of this method compared to MES. This device allowed not only to carry out the dissection of the gastrointestinal tract organs, but also to mobilize them, thereby simplifying and speeding up the operation. Intersection of vessels of both omenta, small and large intestines mesentery vessels was carried out with alternating regimes of coagulation and cutting, while ligating only large blood vessels. The study showed that thanks to the use of ultrasound scanning it was possible to reduce the number of postoperative complications from 16.2% to 6.7%, postoperative mortality decreased from 6.11% to 1.55%, and postoperative bed-day decreased from an average of 17.5+ 3.75 to 12.5 + 2.58, which in the complex allowed to improve the parameters of treatment and rehabilitation of patients.