Results of topical application of autologous regenerative products in hemorrhoidectomy

Backgorund. Hemorrhoidal disease (HD) is the most common proctological disorder. In the last decade, LigaSure and an ultrasound scalpel have been used for hemorrhoidectomy (HE). The problem of pain syndrome and prolonged discomfort in the postoperative period currently remains one of the main complications, despite minimal traumatization of tissues. This is related to prolonged healing under conditions of high microbial contamination and constant mechanical impact. The use of autologous regenerative products can solve this problem. Objective. To study the effect of topical application of platelet-rich autoplasma (PRP) and stromal vascular fraction (SVF) on wound healing rate, pain syndrome level and quality of life (QL) of patients after HE. Material and methods. The study included 90 patients with stage II—IV HD who underwent hemorrhoidectomy using LigaSure apparatus. Subjects of the 1st study group were administered with PRP to the postoperative wounds after the surgery, patients of the 2nd study group — with SVF. In the control group, autologous regenerative agents were not administered. After the surgery, the cellular composition in the post-operative wounds was evaluated by cytology, pain syndrome level by the Visual Analogue Scale of Pain, QL by the EQ-5D-3L questionnaire. Results. The change in the cellular composition of wounds in all groups demonstrates a natural dynamics of the wound process course. Nevertheless, an earlier and more statistically significant increase in the level of fibroblasts that synthesize the extracellular matrix and collagen responsible for wound healing has been noted in application of SVF. Topical use of PRP and SVF after HE does not affect the change in the level of pain syndrome at an early stage after surgery compared to such after standard HE. The quality of life of patients in the long-term period after surgery without the use of autologous regenerative products does not change statistically significantly. At the same time, the use of PRP and SVF has an impact on improving such parameters as anxiety/depression levels and overall health status. The specified positive changes have been observed in a greater degree in the SVF group. Conclusion. The use of autologous regenerative products after HE accelerates the dynamics of the wound process and improves the quality of life of patients in the long-term post-operative period without affecting the level of pain syndrome in the first days after surgery.