Нospital-replacing technologies:Ambulatory surgery最新文献

{"title":"Excisional biopsy of a dysplastic nevus in a district polyclinic is a path to early detection of skin melanoma","authors":"Н. Г. Артемьева, Nadezhda G. Artemeva","doi":"10.21518/1995-1477-2020-3-4-66-72","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-66-72","url":null,"abstract":"Introduction. Russia has a high mortality rate of cutaneous melanoma – 2.5 per 100,000 population whereas the incidence rate is 7.7 per 100,000 population, i.e. one in every three patients dies. In the foreign countries (the USA, Australia), melanoma mortality rate is 10-15%. Such high rates are explained by the fact that patients with early-stage disease do not seek medical advice, as in early stages a tumour does not cause inconvenience to a patient and looks like an ordinary mole.The purpose of the study was to confirm the advisability of removing a progressive dysplastic nevus (grade 3 lentiginous melanocytic dysplasia) with a view to prevent and make early diagnosis of cutaneous melanoma.Materials and methods. The authors removed 180 pigmented lesions that were clinically diagnosed as a progressive dysplastic nevus in the Surgery Department of Central Polyclinic of Literary Fund from 2009 to March 2020. The patients were referred to the Surgery Department by physicians, dermatologists and other specialists of the polyclinic. Following an oncologist consultation, excisional biopsy of a nevus was performed under local anesthesia.Results. Histological examination revealed 29 (16%) dysplastic nevi with grade 3 LMD and 18 (10%) early-stage melanomas.Conclusions. If excisional biopsy of a dysplastic nevus becomes routine in Ambulatory Surgery practice, it will increase the early diagnosis of melanoma and significantly reduce mortality rates of this disease. For excisional biopsy, the authors recommend to excise at a distance of 0.5 to 1.0 cm from the lesion boundaries, since it is not possible to clinically distinguish a progressive dysplastic nevus from early melanoma.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127981740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Botulinum toxin type A injections for treatment of chronic anal fissures","authors":"M. V. Abritsova, N. R. Torchua","doi":"10.21518/1995-1477-2020-3-4-95-100","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-95-100","url":null,"abstract":"An anal fissure is one of the most common diseases of the anal canal with the incident rate of 20–23 cases per 1000 citizens. Most of acute anal fissures are healed spontaneously but a few of them can become chronic process. Chronic anal fissures are characterized by any two of the criteria: pain after defecation lasts longer than 3 months, sentinel pile is present, fibers of internal sphincter at the base of the anoderm.The spasm of the internal sphincter is a guiding pathogenetic mechanism in the development of chronic anal fissures. It leads to circulatory disorder in the anoderm and non-healing wounds. Therefore, the treatment of anal fissures primarily must be focus on eliminating of internal sphincter spasms and then excising of fissures.Recently, botulinum toxin type A injection in treatment of chronic anal fissures has become popular as a noninvasive method of eliminating internal sphincter spasms.Botulinum toxin as a medical agent has been studied since the late 1960s. Botulinum toxin type A has been used to treat of various pathologies including coloproctology diseases for more than 40 years.The botulinum toxin injections make the internal sphincter relax, and as a result create optimal conditions for healing chronic anal fissures.Using of botulinum toxin type A does not cause dangerous complication. Fecal incontinence after using botulinum toxin is transitory.The review describes the use of botulinum toxin type A injections to treat chronic anal fissures.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133085726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The experience of hospital-replacing surgery for varicose veins in St Petersburg outpatient clinics","authors":"V. V. Davydenko, A. N. Galileeva, O. P. Ivanova, A. V. Romanov, B. Afanasyev, R. R. Reytel","doi":"10.21518/1995-1477-2020-3-4-124-129","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-124-129","url":null,"abstract":"Introduction. Over the last 20 years the widespread introduction of ultrasound imaging into clinical practice and the emergence of new endovascular technologies in the treatment of varicose veins have brought about a paradigm shift in the surgical treatment and the introduction of innovative minimally invasive technologies (thermoobliteration, chemical obliteration, microphlebectomy), which can be performed on outpatient basis under local anesthesia. Therefore, the widespread introduction of these technologies into the outpatient practice is the foremost task.Objective of the study. Analyse the results of the experience gained in the St Petersburg polyclinics concerning the introduction of hospital-replacing surgical treatment of varicose vein diseases and appropriate training. Materials and methods. We have performed 854 surgeries including endo-venous laser coagulation (EVLС), sclerobliteration (SO) and Varadi miniflebectomy (MF) under local infiltration anesthesia: EVLC + MF in 71%, MF in 12%, EVLC + SO in 9%, EVLC + MF + SО in 3%, EVLC in 3% and SО in 2% of cases. The patients operated on ranged in age from 19 to 78 years (53 ± 21 g), among them there were 611 women and 202 men. The clinical distribution of patients was in accordance with CEAP classification: C2 – 62%, C3 – 22%, C4a/b – 12%, C5 – 2.5%, C6 – 1.5%.Results and discussion. The evaluation of treatment results based on a retrospective analysis of patients’ examination findings after 1, 39, 180 and 365 postoperative days has demonstrated that there is no evidence of intra- and postoperative complications requiring hospitalization, disease recurrence. However, ecchymosis in 35% of cases, limited superficial infiltrates - in 18%, limited superficial thrombophlebitis - in 0.8% have been reported after MF. They have been treated using topical agents. According to the questionnaire, after a year of treatment 96% of patients appear to be satisfied with the results obtained. After a year payback financial costs have been achieved. An effective practical training program has been developed and implemented for innovative technologies for surgery of varicose veins of lower extremities. 42 physicians of outpatient clinics underwent the program.Conclusions. It can therefore be concluded that the further introduction of innovative technologies into the polyclinics is reasonably practicable as it is safe, effective, expands the population’s access to modern technologies, is economically feasible and is perceived positively by patients, reduces the burden on surgical hospitals, improves professional qualifications and expands the professional competencies of surgeons in outpatient settings.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123683922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of compression therapy in chronic venous insufficiency","authors":"S. Dunaevskaya","doi":"10.21518/1995-1477-2020-3-4-13-19","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-13-19","url":null,"abstract":"The article provides an overview of modern literature on the problem of etiology, pathogenesis and principles of complex therapy of chronic venous insufficiency. Data on possible surgical correction methods of this pathology are given. Also, modern tactics assign a significant role to pharmacotherapy, and an overview of the phleboprotectants used is given. Efficiency of compression therapy application is evaluated. A critical review of literature of modern compression agents was carried out, advantages and disadvantages of elastic binting, compression knitting and application of variable compression are described. In comparison with elastic bandages, compression knitting has a number of advantages, such as: patients independently and correctly use compression laundry, the created therapeutic pressure does not depend on the correct application of compression, is more convenient and aesthetic when wearing, is air-permeable and can be used at any time of the year. Evaluation of efficiency of application of compression knitwear in therapy of chronic venous insufficiency is given. The effect of the compression article is due to a decrease in capillary permeability, a decrease in blood viscosity, which leads to a decrease in edema, lymphoprotective action and an increase in vascular wall tone. Modern means of compression have proved to be effective due to the polyvalent mechanism of action on all factors of disease pathogenesis, high bioavailability and minimal side effects. Early application of compression knitwear allows to buy or reduce clinical manifestations of venous insufficiency and its complications, as well as to influence indicators of patients quality of life. Detailed study of literary data will help to correctly select the method and type of compression therapy in case of chronic venous insufficiency.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114335903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical experience with adjustable, non-extensible compression bandages in patients with nonhealing trophic ulcers","authors":"S. Zotov, N. B. Shishmentsev, V. Vladimirskiy, V. Bogachev","doi":"10.21518/1995-1477-2020-3-4-52-58","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-52-58","url":null,"abstract":"Introduction. The adjustable non-extensible compression bandage is a new product recently registered and approved for clinical use in the Russian Federation. The main indications for its use are severe chronic venous insufficiency and lymphedema, which cannot be corrected with traditional bandages and flat knit medical compressions. On the affected limb, an adjustable, non-extensible compression bandage allows high working pressure to be created at low, approaching zero, resting pressure. And depending on the tension of the velcro fastener, the working pressure can be adjusted between 20 and 50 mmHg or more. At the same time, the patient can maintain the actual pressure independently, regardless of the reduction in the volume of the limb. Low resting pressure makes it possible to use this type of bandage all day without the discomfort that is typical for traditional bandages and therapeutic compression knitwear felt by patients during sleep.Clinical case. Patient diagnosed with chronic lymphovenous insufficiency in both lower limbs. CEAP class C5 on the left, CEAP class C5 on the right. After undergoing acute iliofemoral thrombosis on the left, complicated by thromboembolism of small branches of the pulmonary artery, he was treated in a specialized vascular unit, where anticoagulant, antiplatelet and phlebotropic therapy was carried out. After the second episode of deep vein thrombosis, pain in the lower extremities, swelling of the tibia, skin itching and the appearance of small trophic ulcers started to worry, which temporarily closed against the background of increased compression therapy, prescription of phlebotropic drugs and local treatment. Subsequently, large trophic ulcers were formed on the inner surface of both shins above the ankle joint. An adjustable, non-extensible compression bandage was used on the right shin to correct chronic venous insufficiency and heal a trophic ulcer. The use of an adjustable, non-extensible compression bandage within 2 to 4 weeks resulted in the disappearance of chronic swelling, reduction of the pain syndrome, and then 5 months later – led to a reduction in trophic ulcer and the disappearance of infection signs.Conclusions. This clinical case of the successful closure of a large infected trophic ulcer that occurred after deep vein thrombosis against the background of coxarthrosis and which remained unhealed for 7 years clearly illustrates the broad possibilities of an adjustable, nonextensible compression bandage.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"208 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123253879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What you need to know to avoid constipation","authors":"Konstantin A. Shemerovskii","doi":"10.21518/1995-1477-2020-3-4-102-107","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-102-107","url":null,"abstract":"Introduction. Constipation is one of the most common human diseases. Doctors in England consider constipation a “secret national problem” because 50% of the population takes laxatives.The aim of this work was the introduction of chronomedicine approach to the problem of constipation.Method the study was chronoenterographia – week monitoring of the circadian rhythm of defecation.Materials. More than 2,500 people aged 24–75 years, 66% of women, were examined. The frequency and acrophase of the defecation rhythm and quality of life were analyzed.Results: circadian regular defecation rhythm (Euenteria – 7 times/wk) and irregular (Bradyenteria – 1–6 times/week) was isolated. It is shown that the presence of the morning phase of the defecation rhythm contributes to its regularity, and the absence of this phase increases the risk of constipation by 4 times. The earlier defecation occurs – the less often constipation occurs. Euenteria associated with a high level of quality of life, but Bradyenteria – on the contrary. According to the frequency of defecation, there are 3 stages of Bradyenteria: light (5–6 times/week), moderate (3–4 times/week), severe (1–2 times/week, constipation). The Roman-IV criteria for constipation recommend diagnosing only the severe stage of Bradyenteria (less than 3 times/week), and the first 2 stages of it are not diagnosed.Conclusion. Late diagnosis of constipation leads to complications: hemorrhoids, diverticulitis and colorectal cancer. For the regularity of defecation, the contribution of timely stool phase is commensurate with the complex of adequate nutrition, sufficient physical activity and optimal sleep. In order not to suffer from constipation, you need to know about regularity, timeliness and complexity. In outpatient surgery, polyethylene glycol, psyllium and sodium picosulfate are most often used to restore the regular rhythm of defecation.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133905303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to properly examine the veins of the lower limbs: lying, sitting or standing?","authors":"V. Bogachev, D. A. Churikov","doi":"10.21518/1995-1477-2020-3-4-108-112","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-108-112","url":null,"abstract":"The article is a discussion of the advantages of a patient’s position during an ultrasound examination of the lower-limb venous system. The presented material is intended to objectively assess the advantages of this or that position of an examined patient in order to obtain necessary information about the state of the veins of the lower limbs from the position of doctors who have years of experience in diagnostics and treatment of acute and chronic diseases of the lower-limb venous system. The material of the article is primarily designed for doctors who, in addition to the ability to use an ultrasound scanner to some extent, know about venous hemodynamics and can afford to think outside the generally accepted concepts and clinical recommendations.The characteristics of the state of the lower-limb venous system at vertical and horizontal position of the patient are given. Schemes of venous pressure distribution in the system of the inferior vena cava in the horizontal and vertical position of the patient are presented. Methods of manual compression of the muscular mass and straining at different patient positions are described.The vertical position of the patient (or sitting position) is the most reliable way to identify the peculiarities of anatomical structure and pathological changes of the subcutaneous vein walls, which may be of great importance for planning and carrying out subsequent invasive manipulations, but there is a question about the expediency of making linear measurements in this position, if the invasive intervention is carried out while lying down. Carrying out compression ultrasound, assessment of hemodynamic parameters of venous blood flow, including the use of samples with straining and manual compression of muscle masses of the limb, it is much more convenient to perform in the lying position.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"208 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114311874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical case of a patient with subungual melanoma","authors":"Y. Pavlov, V. V. Volkov, I. A. Gromov, A. A. Kholopov","doi":"10.21518/1995-1477-2020-3-4-61-65","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-61-65","url":null,"abstract":"Subungual melanoma is a rare malignant tumor, little known to practitioners. Its location makes diagnosis difficult and requires differentiation with conditions such as onychomycosis, panaritium, hematoma, etc. Unsymptomatic onset brings more problems, the error level during visual examination even among experienced oncologists reaches 25–40%, and the average life expectancy of patients with fully manifested melanoma is limited to 3–4 years.So we present a clinical case to emphasize the need for oncological alertness during an outpatient examination of the subungual lesions. A 32-year-old woman came to the reception complaining of a non-healing bleeding, relatively painless wound of the left little toe. The condition was associated with trauma, for about a month she treated the wound herself, “cauterizing” it with antiseptics.After outpatient treatment of a granulating wound, the material was sent for histological diagnosis, which showed the presence of pigmentless melanoma in the stage of active growth. The woman was urgently hospitalized in the oncology department, where 5th finger exarticulation and inguinal-iliac lymphadenectomy were performed successfully. After this, the condition remained stable, but 14 months later there was a formation in the area of the postoperative scar. A study of a new surgical material confirmed the recurrence of malignant melanoma with Clark invasion level 2.In our opinion, outpatient surgeons should not delay histological examination for all ulcerative and granulomatous lesions of the feet, which will improve the differential diagnosis.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124210400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemorrhoids and quality of life: “… two things incompatible”?","authors":"M. V. Abritsova, A. M. Bogomazov, E. B. Golovko, E. Zagriadskiǐ","doi":"10.21518/1995-1477-2020-3-4-74-79","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-74-79","url":null,"abstract":"Hemorrhoids is one of the most common diseases in human. According to the latest data for 2017, the prevalence rates of hemorrhoids per 100 000 population in Russia are 410,3 in adults, 26.7 in children aged 15 to 17 years and 4,0 in children under 14 years old. Quality of life (QoL) is an important non-specific subjective parameter of well-being, representing an integrative characteristic of the physical, psychological, social and emotional status of the patient. Despite the high prevalence of hemorrhoids and the variety of modern methods of surgical treatment, there are very few studies addressing the QoL in this category of patients. There are significant differences between the patient and the Coloproctologist in the perception of HD, which, possibly, can lead to the hypertrophy of indications for surgical treatment. Understanding the effect of HD on social life and the concept of the well-being of a particular patient can help the doctor choose between conservative and surgical approaches in the treatment of hemorrhoids. On the other hand, due to the excessive shyness and mentality in our country, patients with HD tend to adapt to their disease, which leads to later seeking medical help and suboptimal efficacy of conservative therapy and minimally invasive surgical methods.This review presents the first Russian multicenter observational program EQUALISER (impact of different trEatment modalities on QUAlity of life of the patientS with acute and chronic hEmorRhoid disease) aimed at assessing the QoL of patients with HD, as well as the effect of the treatment method and types of surgical treatment on the social adaptation of the population.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128259452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of herbal preparations as topical therapy during pre- and post-surgery in patients with 3–4 grade hemorrhoids","authors":"S. Vasiliev, A. I. Nedozimovanii, D. Popov, A. Vasiliev, I. V. Gor","doi":"10.21518/1995-1477-2020-3-4-89-94","DOIUrl":"https://doi.org/10.21518/1995-1477-2020-3-4-89-94","url":null,"abstract":"Introduction. The market presents a huge amount of topical preparations, which manage the clinical manifestations of hemorrhagic disease, and there is also no shortage of means that affect post-operative pain. However, there is no single consensus of patient management in the preoperative period, and there is no generally recognized protocol for the treatment of pain after hemorrhoidectomy.Aim. To determine the effectiveness of using Fleming’s ointment during pre- and post-surgery in patients with 3–4 grade hemorrhoids.Material and methods. 85 patients with a diagnosis of hemorrhoids III–IV grade were divided into 2 groups. The Milligan-Morgan’s hemorrhoidectomy using standard electrocoagulation methods under intravenous anesthesia was performed in all patients. Fleming ointment was used as a topical agent for 2–3 weeks before the operation and for 2.5 weeks after the operation in Group A (43 patients). In group B (42 patients), depending on the prevalence of symptoms, suppositories with phenylephrine, lidocaine, local, hormonal ointments were used, also Liniment Levomekol was used as a local therapy after surgery in the group B. The results were evaluated according to the following criteria: Pain level, symptoms’ degree of the disease against the background of the use of local agents was evaluated by VAS. The multiplicity of the introduction of NSAIDs in 2 groups was considered. The adequacy of the wound healing correlated with the duration of maintaining inflammation in the wound, we also considered the daystay and days of disability.Results. Pain level according to VAS on the 1, 3, 7, 12 days after surgery in patients from group A is 0,6 points lower than in patients from group B. The average number of NSAIDs intake in the postoperative period in Group A was 1,4 times less than in Group B. There was no significant difference in wound reaction, day-stay and days of disability. The symptoms of hemorrhoids, estimated by VASh, were significantly less pronounced in patients who used Fleming ointment (see table 0)Conclusions. Fleming ointment can be recommended as an adequate topical agent in the perioperative management of patients with 3–4 grade hemorrhoids.","PeriodicalId":285016,"journal":{"name":"Нospital-replacing technologies:Ambulatory surgery","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115751351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}