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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.

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.

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.