OBJECTIVE
To assess the effectiveness of a comprehensive postoperative medical rehabilitation program, including ozone therapy, laser therapy, recto-tibial myostimulation, and biofeedback therapy in patients undergoing hemorrhoidectomy.
MATERIAL AND METHODS
The study included 160 patients with stage IV chronic hemorrhoids (ICD-10 code: K64.3) aged 20 to 65 years (mean age 41.4±2.1 years). All patients underwent Milligan-Morgan hemorrhoidectomy using an ultrasonic scalpel. The patients were assigned into two groups by random sampling. The test group included 80 patients who, from Day 2 after surgery, underwent a comprehensive 4-component medical rehabilitation program, including intravenous ozone therapy, rectal laser therapy, recto-tybial myostimulation, and biofeedback therapy. The control group included 80 patients who received standard-of-care treatment in the early postoperative period, including painkillers, topical antibacterial ointments (Levomecol and others), and rectal suppositories (Relief Pro and others), which served as the background therapy in the test group.
RESULTS
In the early postoperative period, in patients receiving a complex 4-component medical rehabilitation program, pain was statistically significantly less severe, and more rapid pain relief was observed across all postoperative periods, indicating a pronounced analgesic effect of the medical rehabilitation complex. Patients in the control group received analgesics (including narcotic drugs) for pain control in 68.9% of cases. The duration of postoperative incapacity for work in the test group patients was 12.9±2.4 days vs. 24.1±2.3 days in the control group patients (p<0.001). The analysis of the quality of life in the early and the late postoperative period using the SF-36 scale showed a significant difference between the groups according to the physical health component and psychological component, both in the early and in the late postoperative period (after 6 months), indicating a higher quality of life in the test group patients. Assessment of late-period quality of life using the I.Yu. Alimzhanova and Yu.M. Sheptunov’s questionnaire showed good results in 76 (95%) patients of the test group. Only in 1 (1.3%) patient in the test group, anal stenosis was observed. Good outcomes were reported in 67 (83.8%) patients of the control group, 5 (6.3%) patients developed scar strictures of the anal canal, and 1 (1.3%) had a pararectal fistula, which in 2 (2.6%) of 6 patients led to persistent pain.
CONCLUSIONS
Introduction of the medical rehabilitation program in the early postoperative period after hemorrhoidectomy contributes to faster relief of pain and other signs and symptoms, a significant decrease of average postoperative wound healing time due to acceleration of adequate scar formation (according to ultrasound sonoelastography), improvement of life quality, reduction of hospital stay, a decrease of incapacity for work duration, and prevention of postoperative complications.
