SURGICAL TREATMENT OF CHRONIC HEMORRHOIDS (LITERATURE REVIEW)

Abstract

Summary. An analysis of clinical guidelines and literary articles on the treatment of patients with chronic hemorrhoids was carried out. Clinical recommendations do not differ in different countries regarding the approaches in terms of choosing options for conservative or operative therapy and methods of surgical treatment. Changing the diet, which allows you to eliminate constipation, normalize intestinal motility and obtain soft and voluminous stools, is an important stage of treatment. Pharmacological therapy has a low evidence base. Studies on the effectiveness of flavonoids for the treatment of chronic hemorrhoids are very heterogeneous, which does not allow for unequivocal conclusions. Rubber band ligation is the most effective procedure for the rapid elimination of chronic hemorrhoid symptoms, but it cannot effectively eliminate hemorrhoidal prolapse. Injection sclerotherapy has severe specific complications, which is why it is predicted to decrease in frequency for the treatment of chronic hemorrhoids. The only surgical approaches that experts recommend are open and closed hemorrhoidectomy. Stapler hemorrhoidopexy has a high frequency of specific complications, so it is necessary to approach its choice for the treatment of chronic hemorrhoids with caution. Doppler-guided hemorrhoid artery ligation is a physiological method of treatment, but it has a very high cost and is not economically viable. Conclusions. In patients with chronic hemorrhoids Goligher-1, Goligher-2, and in some cases - Goligher-3, “office procedures” can be chosen, but the patient should be informed about questionable results in the remote period. The operation of choice for patients with chronic Goligher-3 and Goligher-4 hemorrhoids remains open hemorrhoidectomy, the current modifications of which mainly include various technological approaches to cutting out nodes. Techniques in which a slightly different principle was proposed can be used as an alternative approach due to worse results when observing in distant terms.