The use of rectal balloon compression in the conservative treatment of external hemorrhoids in children in Tashkent

BACKGROUND. The main factors in the pathogenesis of hemorrhoids are vascular dysfunction and dystrophic changes in the fibromuscular framework of the anal canal. The main methods of surgical treatment of the disease are hemorrhoidectomy, sclerosis, infrared photocoagulation and ligation with latex rings. These methods, which are widely used in adult patients, are limited in use in children due to frequent side effects, possible complications, and difficulties in postoperative care. The pathogenetic aspects of hemorrhoid formation in children, taking into account the anatomical and physiological features of the fibrous-muscular framework and the vessels of the anal canal, determine the possibility of conservative treatment. Optimization and development of special methods of conservative treatment of hemorrhoids in children remains relevant.

OBJECTIVE. To improve the results of treatment of haemorrhoids in children by optimising diagnosis and developing tactics of complex approach using non-invasive method of rectal balloon compression (RBC).

METHODS. The study included 118 patients diagnosed with hemorrhoids. At the first stage, a retrospective analysis of the medical and epidemiological characteristics of the disease was performed. The gender, age, type of hemorrhoids, and treatment methods used were evaluated. At the second stage, a non-randomized comparative study was performed: The main group included 55 patients, who were treated the RBC method with traditional conservative therapy from 2020 to 2025. The comparison group consisted of 57 patients whose treatment in the period from 2014 to 2020 used only conservative methods. To assess the effectiveness of the RBC method in the complex conservative treatment of hemorrhoids in children, long-term results were studied in 88 (78.6%) patients in the study groups. To justify the use of RBC, a pathoanatomical examination of the autopsy material of the rectum with Van Gieson staining was performed. The RBC method consists in inserting a two-mantled Foley catheter into the rectum with sequential inflating of the cuffs. This creates compression of the hemorrhoidal node on both sides (outside and inside), which helps to repair the nodes and restore hemorrhoidal blood flow.

RESULTS. Our multicenter study conducted on the basis of children's surgical clinics in Tashkent showed that children of preschool age suffer from hemorrhoids most often (72.9%). The main trigger for the development of hemorrhoids in preschool children is dysplastic changes in the fibromuscular framework of the anal canal against the background of chronic constipation or diarrheal syndrome. Against the background of treatment of the underlying disease dysplastic changes in the anal canal in children are reversible, which determines the possibility of using the non-invasive RBC method in complex conservative treatment. Excellent and good results when using the non-invasive RBC method were obtained 1.7 times more often than in the control group, and indicate the high effectiveness of the noninvasive RBK method, especially in children of early and preschool age.

CONCLUSION. The RBC method in the complex conservative treatment of hemorrhoids in preschool children is pathogenetically justified and effective.