ABSTRACT
The authors conducted comparative appraisal of the results of treatment of hemorrhoids in 3 groups of patients at a higher surgical risk in 1989-1990. Group 1 consisted of 79 patients given the traditional nonoperative treatment. Group 2 was made up of 17 patients in whom the hemorrhoidal nodes were ligated by means of latex rings. Forty-three patients of group 3 were treated by the traditional nonoperative methods and, in addition, by infrared photocoagulation, 33 at in-patients and 10 at out-patient clinics. The follow-up periods range from 3 to 12 months. The study showed that nonoperative therapy produced a temporary effect, clinical manifestations of hemorrhoids recurred in 100% of patients. In group 2 59% of patients were cured, which is evidence of the pathogenetic substantiation of the method. The treatment, however, in this group was marked by a great number of complications of an inflammatory character. The best effect was produced among patients of group 3; 37 (86%) patients were cured. Thus, the results of comparative analysis of the efficacy of these methods of treatment in patients at a higher surgical risk showed the advantages of infrared photocoagulation over nonoperative treatment and ligation of hemorrhoids with latex rings. The method of infrared photocoagulation is technically simple, convenient, and can be applied both in in- and out-patient clinics.
Subject(s)
Hemorrhoids/therapy , Aged , Aged, 80 and over , Evaluation Studies as Topic , Female , Hemorrhoids/surgery , Humans , Infrared Rays , Ligation , Light Coagulation , Male , Middle Aged , RecurrenceABSTRACT
The article discusses 15-year experience in the treatment of 280 patients with various forms of rectovaginal fistulas. The choice of the operative method was differentiated on basis of complex appraisal of the etiology of the disease, pronouncement of the cicatricial and inflammatory changes, the level of the communication, relation of the fistula to the sphincter ani, and the functional condition of the rectal obturator apparatus. Most of the patients were subjected to combined interventions--excision of the fistula and local myoplasty (62%). Pyoinflammatory phenomena were the most frequent complications (17.2%) in the immediate postoperative period. The late-term results were studied in 249 patients, recurrent fistulas were found in 10.4% of cases, postoperative sphincter ani incompetence which called for plastic operations was discovered in 2.4% of patients. A differentiated choice of the method of surgical intervention made it possible to reduce in the recent years the frequency of recurrent fistulas from 15.2 to 6.4%, and the postoperative incompetence of the sphincter ani from 4.4 to 2.2%.
Subject(s)
Rectovaginal Fistula/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications , Prognosis , Retrospective StudiesABSTRACT
From experience in treatment of 104 patients with rectal fistulas of traumatic origin the authors distinguished the specific features of the clinical manifestations of the disease which must be taken into consideration in choosing the therapeutic tactics. In contrast to the management of common chronic paraproctitis, the treatment of traumatic rectal fistulas differs in principle, particularly when the internal opening of the fistula is in the wall of the rectal ampulla++. The authors determined the indications for various methods of treatment and techniques of operative interventions, including multistage surgical treatment with the creation of temporary colostomy.
