Comparative estimation of a pain syndrome in patients after combined operations for coexistent pathology of anal channel and rectum with application of modern and standard surgical technologies

Keywords: the pain syndrome; concomitant pathology; anal channel; rectum; combined operations; apparatuses of a high-frequency surgery «ERBE ICC 200», «KLS Martin», «EFA»; apparatus of a radio-wave surgery «Surgitron».

Abstract

Objective. Comparative estimation of the pain syndrome in patients with concomitant pathology of anal channel and rectum after performance of combined operations, using modern high-frequency electro-surgical and radio-surgical apparatuses, as well as conventional scalpel.

Materials and methods. The results of surgical treatment of 689 patients with concomitant pathology of anal channel and rectum, using apparatuses of a high-frequency electro-surgery and radio-wave surgery, were analyzed, using the pain syndrome estimation on 1-7th postoperative day. The patients were distributed into 4 investigation groups and a control group, consisting of 112 patients, operated on using metallic conventional surgical scalpel.

Results. The pain syndrome on the first postoperative day was mostly expressed in patients of control group, for anesthesia they needed (4 ± 1) ml of 2% solution of promedol, while the patients of the first, third and fourth groups investigated, in which, accordingly, apparatus of radio-wave surgery «Surgitron» and high-frequency electro-surgical apparatuses «EFA» and «KLS Martin» were used, needed for anesthesia (2 ± 1) ml of 2% solution of promedol. While application of the electro-surgical high-frequency apparatus «ERBE ICC 200» the necessity for the 2% solution of promedol for anesthesia have constituted (3 ± 1) ml.

Conclusion. Combined operations, using modern apparatuses of high-frequency electro-surgery and radio-wave surgery give significantly better results, than application of conventional surgical metallic scalpel, because it produces significantly reduced pain syndrome due to thin layer of coagulation necrosis, promoting formation of delicate elastic cicatrix and preventing development of cicatricial strictures of anal channel in postoperative period.

Author Biography

V. V. Balytskyy, National Pirogov Memorial Medical University, Vinnytsya, Khmelnytskyi Regional Hospital

Vitaliy Victorovych Balytskyy - MD, PhD, Associate Professor
Surgery Department of Faculty of Postgraduate Education,
National M. I. Pyrogov Memorial Medical University, Vinnytsya,
Khmelnytskyi regional hospital,
1 Pilotska str., Khmelnytskyi, Ukraine

+0382 65-13-17 ; +38097-235-96-85.

v.balytskyy@ukr.net

http://orcid.org/0000-0003-1076-5237

References

Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014 Aug;109(8):1141-57; (Quiz) 1058. doi: 10.1038/ajg.2014.190. Epub 2014 Jul 15. PMID: 25022811.

Borota AV, Kukhto AP, Baziian-Kukhto NK, Borota AA. Comparative analysis of surgical treatment of the combined non-tumor anorectal pathology. Novoobrazovanie (Neoplasm). 2018;10(1):18-22. Russian. doi: 10.26435/neoplasm.v10i1.242.

Medina-Gallardo A, Curbelo-Peña Y, De Castro X, Roura-Poch P, Roca-Closa J, De Caralt-Mestres E. Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients. Int J Surg Case Rep. 2017;30:73-5. doi: 10.1016/j.ijscr.2016.11.018. Epub 2016 Nov 15. PMID: 27960130; PMCID: PMC5153430.

Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg. 2016 Jun;40(6):1509-19. doi: 10.1007/s00268-016-3419-z. PMID: 26813541.

Emile SH, Youssef M, Elfeki H, Thabet W, El-Hamed TM, Farid M. Literature review of the role of lateral internal sphincterotomy (LIS) when combined with excisional hemorrhoidectomy. Int J Colorectal Dis. 2016 Jul;31(7):1261-72. doi: 10.1007/s00384-016-2603-9. Epub 2016 May 27. PMID: 27234042.

Thaha MA, Campbell KL, Kazmi SA, Irvine LA, Khalil A, Binnie NR, et al. Prospective randomised multi-centre trial comparing the clinical efficacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy. Gut. 2009 May;58(5):668-78. doi: 10.1136/gut.2008.151266. Epub 2008 Dec 17. PMID: 19091821.

Ortiz H, Marzo J, Armendáriz P, De Miguel M. Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum. 2005 Apr;48(4):809-15. doi: 10.1007/s10350-004-0861-z. PMID: 15785901.

Bakhtiar N, Moosa FA, Jaleel F, Qureshi NA, Jawaid M. Comparison of hemorrhoidectomy by LigaSure with conventional Milligan Morgan's hemorrhoidectomy. Pak J Med Sci. 2016 May-Jun;32(3):657-61. doi: 10.12669/pjms.323.9976. PMID: 27375709; PMCID: PMC4928418.

Fareed M, El-Awady S, Abd-El monaem H, Aly A. Randomized trial comparing LigaSure to closed Ferguson hemorrhoidectomy. Tech Coloproctol. 2009 Sep;13(3):243-6. doi: 10.1007/s10151-009-0520-4. Epub 2009 Jul 24. PMID: 19629378.

Chen CW, Lai CW, Chang YJ, Hsiao KH. Modified LigaSure hemorrhoidectomy for the treatment of hemorrhoidal crisis. Surg Today. 2014 Jun;44(6):1056-62. doi: 10.1007/s00595-013-0650-1. Epub 2013 Jun 29. PMID: 23812901.

Haksal MC, Çiftci A, Tiryaki Ç, Yazıcıoğlu MB, Özyıldız M, Yıldız SY. Comparison of the reliability and efficacy of LigaSure hemorrhoidectomy and a conventional Milligan-Morgan hemorrhoidectomy in the surgical treatment of grade 3 and 4 hemorrhoids. Turk J Surg. 2017 Dec 1;33(4):233-6. doi: 10.5152/turkjsurg.2017.3493. PMID: 29260125; PMCID: PMC5731556.

Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech. 2015 Apr;25(2):106-10. doi: 10.1097/SLE.0000000000000136. PMID: 25738704.

Mushaya CD, Caleo PJ, Bartlett L, Buettner PG, Ho YH. Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials. Tech Coloproctol. 2014 Nov;18(11):1009-16. doi: 10.1007/s10151-014-1169-1. Epub 2014 Jun 13. PMID: 24925353.

Tsunoda A, Takahashi T, Kusanagi H. A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids. Tech Coloproctol. 2017 Aug;21(8):657-65. doi: 10.1007/s10151-017-1673-1. Epub 2017 Sep 4. PMID: 28871428.

Lim DR, Cho DH, Lee JH, Moon JH. Comparison of a Hemorrhoidectomy With Ultrasonic Scalpel Versus a Conventional Hemorrhoidectomy. Ann Coloproctol. 2016 Jun;32(3):111-6. doi: 10.3393/ac.2016.32.3.111. Epub 2016 Jun 30. PMID: 27437393; PMCID: PMC4942526.

Published
2021-10-28
How to Cite
Balytskyy, V. V. (2021). Comparative estimation of a pain syndrome in patients after combined operations for coexistent pathology of anal channel and rectum with application of modern and standard surgical technologies. Klinicheskaia Khirurgiia, 88(5-6), 36-41. https://doi.org/10.26779/2522-1396.2021.5-6.36
Section
General Problems of Surgery