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.

Мета. Покращення результатів хірургічного лікування пацієнтів з поєднаною патологією анального каналу (АК) і прямої кишки (ПК) шляхом застосування високочастотних (ВЧ) електрохірургічних (ЕХ) апаратів «ERBE ICC 200», «ЕФА»,  «KLS Martin» та апарата радіохвильової (РХ) хірургії «Surgitron» і їх порівняльна характеристика. Матеріали і методи. Проаналізовані результати лікування 564 пацієнтів з поєднаною патологією АК і ПК з використанням ВЧ ЕХ апаратів «ERBE ICC 200», «ЕФА», «KLS Martin» та апарата РХ хірургії «Surgitron». Результати. Дослідженням встановлено, що застосування ВЧ ЕХ апаратів «ERBE ICC 200», «ЕФА», «KLS Martin» та апарата РХ хірургії «Surgitron» зменшує тривалість операції до (20 ± 5) хв, об’єм інтраопераційної крововтрати до (20 ± 10) мл, потребу в наркотичних аналгетиках до (2 ± 1) мл, строки стаціонарного лікування до (5 ± 1) доба. Висновки. Використання ВЧ ЕХ апаратів «ERBE ICC 200», «ЕФА», «KLS Martin» та апарата РХ хірургії «Surgitron» забезпечує скорочення тривалості операції, зменшення об’єму крововтрати під час операції, інтенсивності больового синдрому в післяопераційному періоді, а також незначну глибину некрозу тканин (від 0,055 до 0,43 мм), що обумовлює хороший косметичний результат операції.

Surgery of combined anal and rectal diseases requires an unconventional tactics and methods of treatment of these pathologies, which provide minimal impact on tissues, preventing postoperative complications. The aim of the study was to conduct a comparative evaluation of the effectiveness of new radiosurgical and electrosurgical technologies in the treatment of combined anal and rectal diseases by analyzing the clinical course of the postoperative period and the impact of these energy devices on the morphostructure of operated tissues. The results of treatment of 747 patients with combined anal and rectal diseases divided into four research groups and control group have been analyzed. In the first research group 169 (22,6%) patients with electrosurgery device “ERBE ICC 200” have been operated on in the second research group – 114 (15,3%) patients with  electrosurgery device "EFA", in the third research group – 107 (14,3%) patients – with electrosurgery device "KLS Martin" and in the fourth research group – 245 (32,8%) patients with radiosurgery device "Surgitron". The control group consisted of 112 (14,9%) 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. Due to the minimal and insignificant impact on the tissues during application of electrosurgery devices “KLS Martin”, “EFA” and “ERBE ICC 200”, as well as radiosurgery device "Surgitron", there were 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 (2%) patients the formation of scar anal stricture was diagnosed, which required conservative (1 patient) and operative (1 patient) measures to eliminate them. Using modern radiosurgery and electrosurgery technologies for treatment of combined anal and rectal diseases reduces the operation duration, volume of bleeding and intensity of the postoperative pain. Application of these above technologies prevents the occurance of anal strictures and scar pararectal deformations.

The aim – to analyze the results of treatment of patients with combined pathology of the anal canal and rectum using Surgitron radio wave surgery and high-frequency electrosurgery "KLS Martin". Materials and methods. The analysis of surgical treatment of 236 patients with combined anal canal and rectum with Surgitron radio wave surgery, 50 patients using KLS Martin high-frequency electrosurgery and 112 patients who have been traditionally operated using a metal scalpel. After surgical interventions using radio-wave and high-frequency electrosurgery devices, morphological examination of tissues was conducted to study the depth of their necrosis. Results. It has been established that the use of Surgitron, as well as the high-frequency electrosurgical apparatus "KLS Martin", reduces the duration of the surgery to 15 ± 5 minutes, reduces the volume of blood loss to 20 ± 10 ml, the need for narcotic analgesics to 2 ± 1 ml, and terms of inpatient treatment of patients up to 4 ± 1 day. The results of the morphological study indicate that the application of the above-mentioned surgical techniques leads to a negligible depth of tissue necrosis from 0.165 ± 0.11 mm using the Surgitron apparatus to 0.192 ± 0.12 mm when used with the KLS Martin apparatus, ensuring cosmetic operations. Conclusions. The use of the Surgitron radio-wave surgery and the KLS Martin electrosurgical apparatus for the treatment of patients with combined pathology of the anal canal and rectum due to insignificant tissue effects contributes to reducing the duration of the operation, reducing the volume of intraoperative blood loss, significantly reducing the pain in the postoperative period, reduction of the terms of inpatient treatment of patients, which determines their rapid medical and social rehabilitation. Also due to the minimal effect on the tissue, the healing of the postoperative wound is faster, which contributes to the formation of a delicate elastic scar and prevents the formation of scar strictures of the anal canal, as well as insufficiency of the anal sphincter in the postoperative period.

Вінницький національний медичний університет імені М.І. Пирогова 2 Хмельницька обласна лікарня 3 Державна наукова установа "Науково-практичний центр профілактичної та клінічної медицини" Державного управління справами 4 Національний медичний університет імені О.О.Богомольця, Київ