The aim of the work was to analyze the use of Transanal Hemorrhoidal Dearterialization (THD) in the surgical treatment of hemorrhoids of various degrees. The use of THD for complicated hemorrhoids in 514 patients for the period 2008–2021 was analyzed on the clinical basis of the Department of Surgery No.3 of the Bogomolets National Medical University (Ukraine). The average age of the patients was 39.1 years. 159 (30.9%) patients had grade II hemorrhoid, 299 (58.2%) – grade III, 56 (10.9%) – grade IV. All patients had manifestations of rectal bleeding and periodic prolapse of hemorrhoidal nodes, 75 (14.6%) patients had a pain syndrome associated with anal fissures, 19 (3.7%) patients underwent THD for recurrent (after performing other operations) hemorrhoids. No severe postoperative complications were observed. The average length of stay in the hospital was 1.3 days. The working capacity of the patients was restored after 3–5 days. Since 2015, THD has been performed according to the method updated by the authors, which was called Distal Doppler-controlled Dearterialization (DDD). We compared the results of performed THD before and after supplementing her DDD. When comparing THD before and after supplementing its DDD, a significant (p=0.00007) increase in the specific gravity of surgical interventions in stage III hemorrhoids while preserving the quality and duration of the postoperative course was revealed. Also, the number of THD in combination with surgery for chronic anal fissure, the number of operations for recurrent hemorrhoids increased significantly (p<0.05), which indicates the validity and effectiveness of the technique as an operation of choice in the surgical treatment of stage II–IV hemorrhoids. Application of the updated technique using DDD facilitates the performance of mucopexy, allows performing operations at later stages of complicated hemorrhoids. Keywords: proctology, THD, DDD, Doppler-controlled dearterialization.

Modern technologies in surgery lead to an increase in the number of surgical interventions, which in turn increases the number of patients with peritoneal adhesions disease. Patients with acute adhesive small intestinal obstruction make up to 70 %. Acute adhesion small intestinal obstruction takes the leading place among mechanical forms of intestinal obstruction and reaches 63–80 %, and the mortality rate is 5.1–8.4 %. The aim. Improvement of minimally invasive technologies in the treatment of patients with adhesive small intestinal obstruction. Materials and methods. The main group – 99 (58.6 %) patients with adhesions of the small intestine, who underwent minimally invasive treatment technologies. The comparison group included 70 (41.4 %) patients with acute adhesion small intestinal obstruction, who were treated with traditional methods. Results. Based on clinical laboratory and instrumental research results, 21 (12.4 %) patients out of 169 patients underwent emergency surgery: 7 (10.0 %) patients of the comparison group and 14 (14.1 %) patients of the main group. Minimally invasive surgical intervention was performed in 45 (45.5 %) patients of the main group with viscerolysis in 29 (29.3 %) patients and conversion was performed in 16 (16.2 %) patients. Median laparotomy was performed in 54 (54.5 %) patients of the main group and in 70 (100.0 %) patients of the comparison group. The complications of acute adhesive small intestinal obstruction and the complications of the postoperative period in the comparative analysis of the results of the treatment of patients were taken into account. The grading of postoperative complications was carried out in accordance with the classification of P. A. Clavien and D. Dindo (2009), according to which a statistically significant difference is noted in the studied groups: 14 (14.1 %) of the main group and 23 (32.8 %) of the comparison group, III, IV and V degrees of complications were preferred. Relaparotomy was performed in 5 (7.1 %) patients of the comparison group and in 2 (2.0 %) patients of the main group. Mortality decreased from 6 (8.5 %) in the comparison group to 2 (2.0 %) in the main group. Conclusions. The use of an improved approach in diagnostics and treatment of patients with acute adhesion small intestinal obstruction ensured improved results of surgical treatment. The use of mini-invasive technologies in diagnosis and treatment made it possible to reduce the frequency of postoperative complications from 32.8 % to 14.1 %, the mortality rate from 8.5 % to 2.0 %, which confirms the effectiveness of the use of mini-invasive technologies in the treatment of patients with acute adhesion small intestinal obstruction.