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Aim: To compare two methods of hemorrhoid treatment., Material and Methods: This prospective study included 240 patients with hemorrhoids stage III-IVA. Stages III and IVA were diagnosed in 156 (65%) and 84 (35%) patients respectively. Randomization was performed using envelopes method in one to one distribution. In group 1 (n=120) Doppler-assisted dearterialization of internal hemorrhoids with mucopexy was performed (DDM), in group 2 (n=120) - hemorrhoidectomy using harmonic scalpel (HE)., Results: Duration of surgery was 17.9±6.1 and 34.5±10.1 minutes in DDM and HE groups respectively (p<0.01). Postoperative pain severity was higher in group 2 (4.8 compared with 2.5 scores of the first group (p<0.01). Narcotic analgesics were used less often in DDM group (1.3 doses compared with 6.1 doses in HE group (p<0.01). Disability period was 14.4±5.2 and 30.3±5.4 days in both groups respectively (p<0.01). Immediate postoperative complications occurred in 9 (7.5%) and 19 (15.8%) patients of DDM and HE groups respectively. Recurrent prolapse of internal hemorrhoids was diagnosed in 2 (1.7%) patients of the 1st group in terms of up to 45 days., Conclusion: DDM is reliable minimally invasive method of hemorrhoids stage III-IVA treatment and has similar efficacy with HE. DDM reduces postoperative pain severity, hospital stay and disability period.

The results of treatment of 182 patients, suffering an acute thrombosis of hemorrhoidal nodes of various severity, were studied. In 93 (51.1%) patients (main group) an active surgical tactics was applied. There were conducted urgent, early and postponed operations. In 89 (48.9%) patients (control group) a conservative-expectant tactic was applied. The patients were operated on in terms of 9 - 10 days after admission to hospital. The terms of operation and the method of hemorrhoidectomy were choosed without taking into account the disease severity. Complications in the main group have occurred in 27 (29%) patients, their stationary treatment have lasted 7 - 11 days. In a control group complications were revealed in 27 (30.3%) patients, their stationary stay have lasted from 9 to 28 days.

Hemorrhoids is believed by right to be one of the most widely spread human sufferings ranking first among diseases of the rectum and large intestine. According to the data of numerous studies devoted to this problem, from 2.9 to 27.9%% of population of different countries suffer from hemorrhoids. Most authors agree that men suffer from hemorrhoids more often than women do and that its frequency increases with the aging. For the sake of justice, it is necessary to note that some researchers insist that men and women suffer from this disease equally often but that men ask for medical care 1.5 times more often.

Histological examination of the hemorrhoids in 67 preparations of the rectum of adult persons showed the significance, in their development, of glomus and glomus blocking arteriovenous anorectal cavernous bodies, the two-three-fold increase of their volume was established. The dilatation of the glomus body lumen (from 20-30 to 270-480 microns) in the cavernous body wall is due to the epithelioid cell atrophy and sclerosis. When persistent dilatation and shortening of the distance between glomus mouths occurs, arterial blood passes from the peripheral branches of the superior rectal artery directly to the vena lumen, resulting, first, in the development of a simple compensatory and then varicose angioma-like flebectasia.

Complex histological and injection methods, including roentgenovasography and morphometry, in different age group persons in intraoperative and autopsy materials, total of 333 observations (225 cases with hemorroid and 108 control cases) have demonstrated direct relations of rectal arteries and veins with cavernous bodies of the rectum at sites of the selected localization of internal hemorrhoidal nodes (predominantly at the 2d--4th and 8--10th hour divisions on a clock-face). It was shown that insufficiency of locking mechanisms of portacaval and arteriolar-venular anastomoses of rectal cavernous bodies resulting from impeded blood outflow and hypervolemia underlie the structural basis of hemorrhoid pathogenesis.

Section and operative materials in persons of various age groups (108 cases in the norm and 197 cases with hemorrhoids) were investigated. Histometrically and macromicroscopically there were revealed veins of a trabecular structure and cavernous bodies in places of the most numerous contacts of the initial roots of the superior, middle and posterior rectal veins in the submucous base of anal columellas. At different stages of formation of hemorrhoids in various forms of phlebectasis (simple, varicous, and cavernous) most pronounced were histostructural changes in the form of endophlebitis and characteristic hypertrophic-atrophic processes of the media. In the process of varicous phlebectasis and formation of hemorrhoids in the cavernous form the ratio of the venous sinus wall thickness to the diameter of the lumen of the venous sinuses are drastically changed at the expense of enlargement of the latter.