Clinical and immunohistochemical rationale for selection of method hemorrhoidectomy

Clinical and immunohistochemical justification of hemorrhoidectomy method selection. A. Selivanov, A. Butyrsky, S. Leonenko, A. Tagayeva. Crimean Medical Academy named after S. Georgievsky. А. Selivanov et al. suggested a new method of closed separated hemorrhoidectomy that includes separate dissection of internal and external hemorrhoids with leaving a stripe of anoderm (7-8 mm) intact, stitching rectal wound with corrugating suture and stitching perianal suture with two sutures (haemostatic subcutaneous and cosmetic intracutaneous). The aim of study - demonstrating advantages of our method with morphological and physiological comparison with other surgical interventions. The study included 108 patients been shared to 2 groups: I - who underwent Milligan-Morgan /Ferguson surgery, II - who underwent closed separated hemorrhoidectomy. Меthods of investigation: immunohistochemical study of removed hemorrhoids and sphincterometry with following statistical processing. In both groups in investigation with SMA antigen one notes disorganization of Parks ligament that promotes the disease progress. In reaction with antigen PGP9.5 one demonstrated that maximal concentration of nervous elements in anoderm (24,03 ± 0,12), which, probably, plays the role of the main conducting zone in anal canal. Evident less innervation is noted in external piles in the II group that testifies to less denervation. Comparing anatomical and physiological parameters we see in sphincterometry: in I group in 30 days they are evident lower (sphincter tonus 365 ± 7,4 g, maximal power of will contraction - 490 ± 7,2 г), than in group II (sphincter tonus 390 ± 9,4 г, maximal power of will contraction - 540 ± 12,8 г; р