Hybrid methods treatments for III and IV grade hemorrhoids

Aim: to evaluate hybrid techniques in patients with stage III and IV hemorrhoids.Patients and Methods: from January 2017 to December 2021, 154 patients with external and internal hemorrhoids of the 3rd and 4th stages were treated at the Moscow Medical Center “ON CLINIC”, including men — 118 (76.6%) and women — 36 (23.4%), aged of 45.8 ± 10.3 (27–72) years. The history of the disease was 8.8 ± 2.2 (5–15) years. All patients underwait transanal dearterialization with mucopexy. With its inefficiency, a hybrid operation technique was performed.Results: all patients were operated under spinal anesthesia in a one-day hospital. Operation time was 38.05 ± 4.7 (27–55) min. Postoperative pain syndrome on the first day was 34.1 (30–40) mm on the VAS scale, due to the elective use of Ketorolac tromethamine, 30.1 ± 1.2 (30–40) mg. By the 5–6th day, the pain syndrome decreased to 24.2 (20–30) mm and 15.3 (0–30) mm. Hospital stay was 24.5 ± 2.3 (21–38) hours. The mean period of disability was 12.8 ± 3.1 (10–14) days. When comparing the clinical results of treatment with a follow-up period of 29.9 months, there was no progression of the disease manifestation.Conclusion: the use of hybrid techniques in the treatment of complex forms of hemorrhoids allows to minimize trauma of the anal canal and to reduce the rehabilitation period.