POSSIBILITIES OF REHABILITATION AND TREATMENT OF PATIENTS AFTER ANAL CANAL OPERATIONS. THE USE OF A COMPLEX BIOLOGICALLY ACTIVE ADDITIVE (DIETARY SUPPLEMENT) FOR THE PREVENTION OF COMPLICATIONS

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Relevance. Chronic anal fissures, chronic hemorrhoids, rectal fistulas are widespread human diseases, the frequency of which reaches 10% of the population [1]. They develop mainly in the working population, and lead to disability and a decrease in the quality of life. Therefore, these diseases can be classified as general medical and socio-economic problems [2, 3].
Surgical intervention – various operations on the anal canal - is an effective method of treatment leading to sustained recovery in long-term forms of chronic anal fissure, chronic hemorrhoids, rectal fistula [4]. To date, excision of a chronic anal fissure, hemorrhoidectomy, excision of rectal fistulas remain the basic, effective methods of treating these diseases [5, 6]. However, after such surgical interventions, patients undergo a long period of rehabilitation and, in addition to disability, there is a pain syndrome in the postoperative wound, its prolonged non-healing and a number of other signs that reduce the quality of life [7, 8, 9].
The use of medicines and dietary supplements is an important component of rehabilitation [10]. The proposed complex dietary supplement "ReliBalns", which contains active ingredients: rutin, diosmin and inulin, has an anti-inflammatory, hemostatic effect in hemorrhoidal bleeding, improves microcirculation, reduces the permeability of the vascular wall, promotes regeneration of the intestinal mucosa, improves digestion, normalizes the work of the intestine and is a mild laxative [11, 12].
The purpose of the study. To improve the results of postoperative management of patients after surgical interventions on the anal canal. To study the effectiveness of "Relibalance" in this group of patients.
Materials and methods. A review of domestic and foreign literature on the active substances of the drug "Relibalance" was conducted. The biological active additive "Relibalance" was used as an auxiliary agent, which was taken by patients operated in the coloproctology department of the city Clinical Hospital No. 6 in Tver for the period September 2022 - March 2023.
Results and discussion. To study the effectiveness, we selected 3 main pathologies: chronic anal fissure, chronic hemorrhoids and fistulas on the anal canal.
During the period from September 28, 2022 to March 3, 2023, a total of 289 patients were treated in the coloproctology department of the State Clinical Hospital No. 6 in Tver. Among them, we studied the result of surgical treatment of 143 patients (49.48% of all treated) for anal canal diseases. The following diseases were diagnosed in these patients: chronic hemorrhoids account for 83 cases (58.04%), anal fissure 37 (25.87%), rectal fistulas 24 (16.09%). Our patients were divided into 2 groups: experimental - 61 people (42.66%) who received this dietary supplement 1-2 cups a day before discharge from the hospital; the control group included patients who did not take the dietary supplement "Relibalance" 82 people (57.34%).
A comparative analysis of the rehabilitation process of patients in the control and experimental groups was carried out according to the following indicators: pain - the duration and frequency of the need for painkillers and their cancellation, a visual analog scale (VAS) of the intensity of pain; the time of the first defecation and the consistency of stool; the development of complications and other signs (bloating, false urges, assimilation of food).
When observing patients from the experimental group taking therapeutic treatment and dietary supplements "Relibalance", it was noted that on day 2-3, on average, on day 2.5, intestinal function normalized in patients, spastic pain significantly decreased, on a scale of 1 to 3 points (on average 2 points), gases departed regularly, bloating the abdomen has significantly decreased. On the 3rd day there was the first stool, and already on the 5th-6th day, on an average of 5.5 days, there was a cancellation of analgesics. On 5-10 days, an average of 7.5 days, the patients noted that the stool became regular, defecation did not cause pain in the anus, and unlike taking laxatives that they used earlier, there were no painful urges to defecate.
In the control group, on 2-3.5 days, on an average of 2.75 days, intestinal function normalized in patients, pain decreased, gases left regularly, abdominal bloating was insignificant, some had false urge to urinate, pain on the VAS scale from 1 to 4 points, an average of 2.5 points. On average, on the 3rd day there was the first stool. On the 6th day, analgesics were canceled, the stool became regular, soft and decorated, defecation caused tolerable pain, there are no painful urges to defecate. The pain disappeared completely for 5-10 days, on average for 7.5 days. In this group, hemostatic drugs were prescribed only in one case.
Analysis of the results of the study showed that such indicators differed in the two groups: the average period of normalization of intestinal function in the experimental 2.5 day, in the control 2.75 day, on the VAS scale, the average values of points 2 points and 2.5 points, the average period of withdrawal of analgesics 5.5 day and 6 day, respectively, Equal indicators in the two groups: education for 3 the day of the first stool, the complete disappearance of pain and discomfort for an average of 7.5 days.
When comparing the analysis of the results, it can be judged that the early onset of marginal epithelialization and the increased appearance of granulation occurred faster in the experimental group: the time for normalization (or restoration) of intestinal functions was reduced by 7.14%, the pain score was 5% lower on the VAS scale. Also, the need for the use of analgesics decreases by 8.33% and the use of hemostatic drugs disappears altogether in the experimental group.
Conclusions.Thus, the dietary supplement "Relibalance", containing various active and auxiliary substances, is an effective additional tool for the rehabilitation of patients and can be recommended to patients who have undergone surgery on the anal canal.
The results of the study obtained by us can help the coloproctologist to perform extremely important tasks - improving the management of patients in the early postoperative period, contributing to accelerated rehabilitation, improving the quality of life and restoring the ability to work of patients who have undergone anal canal surgery.

About the authors

Gulfara Askarovna Kilyazhova

Email: alanablum001@gmail.com
ORCID iD: 0009-0006-3545-1786
SPIN-code: 4843-2123
Russian Federation, 1, Ivan Sedykh str., Tver, 170100, Russia

Azizakhon Sultanjonovna Dzhabarova

Author for correspondence.
Email: zizka_98@bk.ru
ORCID iD: 0009-0005-7244-2494
Russian Federation, 1, Ivan Sedykh str., Tver, 170100, Russia

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