Aim.To generalize and present current data on the development of approaches to hemorrhoidectomy, as well as to analyse the function of the rectal closing apparatus after surgery.Key findings.The haemorrhoid disease is one of the most common human diseases and the most common reason for visiting a coloproctologist. In Russia, the prevalence of haemorrhoids amounts to 130–145 people per 1,000 adult population, with its proportion in the structure of colon diseases varying from 34 to 41 %. Minimally invasive methods for treating such conditions have been shown to be effective in patients with 1–3 stage haemorrhoids. However, these methods have shown little value at stage 4 hemorrhoids, largely because they fail to affect all parts of the disease pathogenesis. Thus, hemorrhoidectomy remains to be the “gold standard” for stage 4 hemorrhoids treatment, which is aimed at eliminating the three main vascular collectors. Hemorrhoidectomy is accompanied by the risk of stricture and postoperative anal sphincter failure. In this regard, it is necessary to assess the functional state of the rectal closing apparatus after hemorrhoidectomy. Improving hemorrhoidectomy, for example, by the use of an ultrasonic scalpel, allows the hemorrhoidectomy to be performed without additional sewing of vessels and coagulation, and the injury of the anal sphincter to be minimized.Conclusion. The possibility of injuring the anal sphincter is a serious problem in anal surgery. Anal sphincter incontinence is a serious illness that exacerbates the patients’ social life. Unfortunately, the issue of anal sphincter incontinence after hemorrhoidectomy is under-investigated, resulting in few rehabilitation programs.

The literature review compares laser and traditional surgery for hemorrhoids. The efficiency and possibility of minimally invasive treatment using laser of different wavelengths were analyzed. The review described the innovative technologies of laser treatment of hemorrhoids which make this method promising.

Aim: to improve the results of treatment of patients with hemorrhoidal disease of the 2nd and 3rd stages by using a diode laser with a wavelength of 1940 nm.Materials and methods. The study included 28 patients with hemorrhoids of the second or third stage. A new treatment method based on the use of a diode laser with a wavelength of 1940 nm was applied to all patients. This technique (laser hemorrhoidoplasty) provides for the thermal effect of laser radiation on the cavernous tissue of the internal hemorrhoid node and the terminal branches of the upper rectal artery. The intensity of postoperative pain syndrome was assessed and the clinical symptoms of hemorrhoidal disease manifestations were studied before and after surgery. To study the effectiveness of the proposed method and to assess the depth of thermal exposure to laser radiation, transrectal ultrasound with Dopplerography and pathomorphological examination were performed. The functional state of the rectal locking apparatus before surgery and in the postoperative period was assessed using sphincterometry. The quality of life of patients who underwent laser hemorrhoidoplasty was studied according to the SF 36 questionnaire.Results. Surgical intervention was performed under both local and spinal anesthesia. Intraoperative complications in the form of hemorrhoidal node bleeding were noted in 3 patients. In the early postoperative period, inflammatory edema of external hemorrhoids was diagnosed in 4 patients. The intensity of the pain syndrome was assessed on the VAS scale and by day 7 in 93 % of patients it did not exceed 1 point. All 28 patients were followed up within 1 to 6 months after the operation. All had no complaints characteristic of hemorrhoidal disease, no relapse of the disease was detected in any observation. Transrectal ultrasound with Dopplerography was performed, which made it possible to diagnose a 2–3-fold decrease in blood flow along the terminal branches of the upper rectal artery, and internal hemorrhoids determined earlier, before surgery, were not visualized already 1 month after surgery. According to sphincterometry, no violations of anal retention function were detected in all 28 patients.Conclusion. Surgical treatment of hemorrhoids of the 2nd and 3rd stages with the use of a diode laser with a wavelength of 1940 nm. with proper technical performance and the choice of optimal energy, it allows to achieve a good clinical effect. The proposed method of intervention ensures the absence of a pronounced pain syndrome, which does not lead to a significant decrease in the quality of life already in the early postoperative period and allows to shorten the period of labor rehabilitation. Laser hemorrhoidoplasty is a highly effective method of treating hemorrhoids at stages 2 and 3 of the disease and opens up the possibility of treatment on an outpatient basis.

Background. Despite the improvement of surgical techniques for the treatment of chronic hemorrhoids, the problem of incontinence of the components of the intestinal contents in the postoperative period remains relevant. Aim. Evaluation of the functional state of the rectal obturator in patients with grade 4 hemorrhoids before and after surgical treatment with an ultrasonic scalpel. Material and methods. At the National Medical Research Centre for Coloproctology named after A.N. Ryzhikh of the Ministry of Health of Russia, 500 patients with grade 4 hemorrhoids operated on with an ultrasonic scalpel for the period 20152017 were examined using anorectal manometry (profilometry). The mean age of the patients was 49.212.4 years (from 22 to 65 years). At the same time, initially, 11/500 (2.2%) patients even before the operation had periodic complaints of gas incontinence (grade I anal sphincter insufficiency; 2.51.3 points on the Wexner scale). For statistical processing, the Student's t-test or the nonparametric single-sample Wilcoxon criterion were used. Results. On average, manometric indicators for the group before surgery were within the physiological norms. In 11 patients with complaints of incontinence, the pressure in the anal canal was initially reduced both at rest and during volitional contraction. At the same time, among the rest of the patients without any complaints of incontinence, 55/489 (11.2%) cases of subclinical (without manifestations) form of anal incontinence were identified only by a decrease in the manometric indicators of the sphincter rest tone, which made it possible to refer these patients to the group risk for the development of postoperative anal incontinence. After surgery, clinical complaints of gas incontinence appeared in 14/55 (25.5%) patients with subclinical anal sphincter insufficiency. In total, by the 45th day, anal incontinence according to complaints and the results of an objective study was registered in 25/500 (5.0%) patients. Conclusion. Clinical and instrumental signs of anal sphincter insufficiency after surgical treatment of stage 4 hemorrhoids with an ultrasonic scalpel were registered in 5.0% of cases, while in 2.2% they were at baseline (in patients with a decrease in intraanal pressure and complaints), and in 2,8% appeared after surgery (in patients with subclinical anal incontinence).

Цель обзора. Представить данные литературы по применению низкотемпературной аргоновой плазмы в лечении послеоперационных и длительно незаживающих ран. Основные положения. Низкотемпературная аргоновая плазма-это ионизированный газ, одно из четырех классических агрегатных состояний вещества. Ее терапевтическое воздействие достигается за счет газодинамического эффекта-потока аргона с высоким теплосодержанием, рекомбинационного излучения с широким спектром-от области вакуумного ультрафиолета до ближнего инфракрасного диапазона, а также за счет выраженных каталитических свойств газа аргона, являющегося важным для ряда биохимических реакций. Низкотемпературная аргоновая плазма обладает выраженным антибактериальным действием. В ряде исследований было продемонстрирован ранозаживляющий эффект от применения низкотемпературной аргоновой плазмы. Заключение. Применение низкотемпературной аргоновой плазмы позволяет сократить сроки заживления ран, снизить титр клинически значимых микроорганизмов, сократить время пребывания пациентов в стационаре, улучшить качество жизни в послеоперационном периоде. Ключевые слова: заживление раны, низкотемпературная аргоновая плазма, хронические раны, длительно незаживающие раны, аргон, плазменный поток Конфликт интересов: авторы заявляют об отсутствии конфликта интересов. Aim. To review available information on the use of low-temperature argon plasma in the treatment of postoperative and long-term non-healing wounds. General findings. Low-temperature argon plasma is an ionised gas, one of the four classical aggregate states of matter. Its therapeutic effect is achieved by means of the gas-dynamic effect, i.e. an argon flow with a high heat content and wide-spectrum recombination radiation-from the vacuum ultraviolet region to the near infrared range, as well as by means of the pronounced catalytic properties of gaseous argon, which is important for a number of biochemical reactions. Low-temperature argon plasma has a pronounced antibacterial effect. In a number of studies, the wound healing effect of low-temperature argon plasma was demonstrated. Conclusion. The use of low-temperature argon plasma can reduce the time of wound healing, the titre of clinically significant microorganisms and the time spent by patients in hospital. In addition, the use of low-temperature argon plasma can improve patients' quality of life in the postoperative period.