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.

SURGICAL TREATMENT OF COMBINED ANORECTAL PATHOLOGY USING CURRENT TECHNOLOGIES

Objective. To evaluate the effectiveness of application radio-wave surgery device “Surgitron” and high-frequency electrosurgery devices “ERBE ICC 200”, “EFA”, “KLS Martin” for treatment of patients with combined anorectal pathology. Methods. The treatment results of patients (n=635) with a combined anorectal pathology have been analyzed. The use of the «Surgitron» radio-wave surgery apparatus 245 (38.6%) patients were operated on, the «ERBE ICC 200» high-frequency electrosurgery apparatus - 169 (26.6%) patients, the «EFA» high-frequency electrosurgery apparatus - 114 (17.9 %) patients, «KLS Martin» high-frequency electrosurgery apparatus - 107 (16.9%) patients. After those surgical interventions to assess the effectiveness of the abovementioned current technologies, patients were conducted a morphological examinationto determine the depth of the necrosis of tissues. Results. According to the study results it has been established that application of the “Surgitron” radio-wave surgery device, “ERBE ICC 200” high-frequency electrosurgical devices “EFA”, “KLS Martin” reduces duration of the operation up to 15-30 min, the volume of bleeding - up to 10-30 ml, need in narcotic drugs - up to 1-4 ml, period of hospitalization - up to 3-6 days. Using these technologies prevented the formation of anal strictures and scar pararectal deformations due to the insignificant depth of tissue necrosis (the depth 0,036 -l 0,453 mm), ensuring the cosmetic effect of combined operations. Conclusion. Application of the “Surgitron” radio-wave surgery device and “ERBE ICC 200” high-frequency electrosurgical devices, “EFA”, “KLS Martin” for treatment of patients with combined anorectal pathology reduces the operation duration, volume of bleeding and intensity of the postoperative pain. Use of these current technologies promotes the formation of a delicate elastic scar causing faster healing of postoperative wounds and improving the terms of patients’ rehabilitation. What this paper adds A comparative evaluation of the effectiveness of using high-frequency electrosurgery devices “ERBEICC 200”, “EFA”, “KLSMartin” and radio-wave surgery device “Surgitron” for treatment of patients with combined anorectal pathology has been firstly made; also a degree of pathomorphological changes in tissues of anal canal and rectum after using the aforementioned current technologies has been studied to assess the effectiveness of their use for treatment of combined anorectal pathology.

Modern methods of surgical treatment of anal canal and rectum combined pathology

Objective. To evaluate the effectiveness of surgical treatment of anal canal and rectum combined pathology, through combined surgical interventions using modern electro- and radiosurgical technologies. Materials and methods. A comparative evaluation of the results of surgical treatment of 681 patients with combined pathology of the anal canal and rectum, who underwent combined single-stage operations using high-frequency electrosurgery and radio-wave surgery. Results. In case of application the device for radio-wave surgery "Surgitron", and also devices of high-frequency electrosurgery "ERBE ICC 200", "EFA", "KLS Martin" duration of operation is reduced to (15 - 25 ± 3) minutes, volume of blood loss decreases to (15 ± 6) ml, the need for narcotic analgesics decreases up to (2 ± 1) ml, the duration of inpatient treatment was reduced up to (4 ± 1) days. Conclusions. The use of modern radio- and electrosurgical technologies for the treatment of combined anorectal pathology prevents the occurrence of anal canal strictures and scarring of the perianal areas, causing the cosmeticity of combined operations.

UNCOMMON ANORECTAL PATHOLOGY: ANORECTAL MELANOMA

Anorectal melanoma (AM) is a rare and aggressive tumor, characterized by a poor prognosis. It accounts for 0.4–1.6% of all melanomas, and only 1% of anorectal malignant tumors [1]. It is difficult to diagnose due to the hidden site and nonspecific symptoms, occurring usually at a late stage. The most common symptom is rectal bleeding. There are various histological variants of AM. There is currently no consensus of treatment the typical therapeutic approach remains surgical resection however, this is not associated with improved overall survival [2,3]. We present a case of a 52-year old male complaining of rectal bleeding and pain for about 4 months, which were attributed to hemorrhoids. Rectal examination revealed an irregular mass near the anal verge. Biopsies were taken for analysis, they were fixed in 10% formalin, paraffin embedded and routinely stained with Hematoxylin– Eosin. Immunohistochemical investigations were done by using antibodies against cytokeratin (CK), P40, HMB45 and Melan A.

Plication: an innovative method of treating piles

Background: The cause of haemorrhoids remains unknown. Factors contributing to haemorrhoids are constipation, prolonged squatting, pregnancy, aging, heredity, portal hypertension, abdominal tumour etc.Methods: This prospective study was carried out in department of surgery, M.K.C.G MCH, Berhampur, Odisha, India from 01st August 1995 to 31st July 2017. Patients from both sex and different age groups having haemorrhoids were included. Patients with piles secondary to anorectal tumours, prolapsed and thrombosed piles, anorectal pathology like fissure were excluded from study. Preoperative, intraoperative interventions and postoperative care were carried out according to laid procedure described below.Results: Total 1014 patients of piles were selected for plication and conventional haemorrhoidectomy and most of them were between 31-50 years of age while 362 cases underwent plication, rest 346 cases were treated with haemorrhoidectomy. All patients in this study had bleeding per rectum as the main symptom. Out of 507 patients which has been examined for plication, 272 (53.65%) had 2nd degree, 235 (46.35%) had 3rd degree piles. Results of plication of piles are satisfactory and only 4% patients had pain for which long term analgesics were given.Conclusions: Treatment of haemorrhoids is well debated topic and various methods are being used by surgeons all over world. Plication of piles appears to have significant advantages over conventional methods in terms of patient comfort, duration of stay in hospital and incidence of complications. Literature on this subject is briefly reviewed.

Syphilis? An Unusual Cause of Surgical Emergency in a Human Immunodeficiency Virus-Infected Man

We report on a human immunodeficiency virus-infected man undergoing urgent anorectal surgery, with multi-centimeter fungating masses discovered inside the anus. Initial pathology was inconclusive. After the patient developed a disseminated rash postoperatively determined to be secondary syphilis, the anorectal pathology was reviewed and Treponema pallidum DNA was amplified by polymerase chain reaction from the mass.