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Stapled hemorrhoidectomy: present status
Lacerda-Filho, Ant?nio;Silva, Rodrigo Gomes da;
Arquivos de Gastroenterologia , 2005, DOI: 10.1590/S0004-28032005000300013
Abstract: aim: to evaluate cost-effectiveness of stapled hemorrhoidectomy comparing its results with conventional technique. source of data: we retrospectively analyzed the medline data basis from 2000 to 2004 studying randomized clinical trials which compared pain intensity, recovery period, return to work and occurrence of anal incontinence, in addition to postoperative complications and costs evaluation between stapled and conventional hemorrhoidectomy during different periods of follow-up. conclusions: stapled hemorrhoidectomy provides lesser postoperative pain and earlier return to work than conventional hemorrhoidectomy. however, its efficacy could not be determined, since rigorous prospective and randomized clinical trials with long-term follow-up periods and large size samples are not available at this time.
Stapled hemorrhoidectomy for the treatment of hemorrhoids
Nahas, Sergio Carlos;Borba, Marcelo Rodrigues;Brochado, Maria Cecília Teixeira;Marques, Carlos Frederico Sparapan;Nahas, Caio Sérgio Rizkallah;Miotto-Neto, Boulanger;
Arquivos de Gastroenterologia , 2003, DOI: 10.1590/S0004-28032003000100008
Abstract: background: the use of circular staplers in the treatment of hemorrhoidal disease is known as a simple procedure, with low morbidity, less post-treatment pain and with the same efficacy when compared to the classical hemorrhoidectomy. aim: analyze the operative technique, intra-operative and immediate postoperative complications and late results in 100 patients treated for hemorrhoid disease by stapling technique. patients and methods: the group included 53 males and 47 females with mean age of 49.8 years, operated during the period june 2000 to june 2002 in the "hospital universitário" (s?o paulo university hospital) and "hospital sírio libanês", in s?o paulo, sp, brazil. results: the majority of patients (78%) were discharged on the first post-operative day. eight patients required supplementary analgesia and were given intramuscular diclofenac sodium and four of them received intramuscular tramadol. one intraoperative complication was bleeding which was difficult to control and required a blood transfusion. one patient was reoperated on the first postoperative day due to intermittent and persistent bleeding, however without hemodynamic changes or a drop in hematocrit. two patients presented hemorrhoidal thrombosis in the early postoperative stage. the postoperative follow-up displayed: recurrence of prolapse, five cases (5%); anal sub-stenosis, two cases (2%); anal fissure, one case (1%); persistent pain, two cases (2%). seven reoperations were performed: one due to bleeding, one due to sub-stenosis and five due to recurrence of hemorrhoidal prolapse and persistence of symptoms. conclusions: stapling is simple to accomplish, has low postoperative pain and rate of complications, however, the incidence of late reoperations is rather high and therefore major follow-up for better analysis is required.
Stapled hemorrhoidectomy for the treatment of hemorrhoids  [cached]
Nahas Sergio Carlos,Borba Marcelo Rodrigues,Brochado Maria Cecília Teixeira,Marques Carlos Frederico Sparapan
Arquivos de Gastroenterologia , 2003,
Abstract: BACKGROUND: The use of circular staplers in the treatment of hemorrhoidal disease is known as a simple procedure, with low morbidity, less post-treatment pain and with the same efficacy when compared to the classical hemorrhoidectomy. AIM: Analyze the operative technique, intra-operative and immediate postoperative complications and late results in 100 patients treated for hemorrhoid disease by stapling technique. PATIENTS AND METHODS: The group included 53 males and 47 females with mean age of 49.8 years, operated during the period June 2000 to June 2002 in the "Hospital Universitário" (S o Paulo University Hospital) and "Hospital Sírio Libanês", in S o Paulo, SP, Brazil. RESULTS: The majority of patients (78%) were discharged on the first post-operative day. Eight patients required supplementary analgesia and were given intramuscular diclofenac sodium and four of them received intramuscular tramadol. One intraoperative complication was bleeding which was difficult to control and required a blood transfusion. One patient was reoperated on the first postoperative day due to intermittent and persistent bleeding, however without hemodynamic changes or a drop in hematocrit. Two patients presented hemorrhoidal thrombosis in the early postoperative stage. The postoperative follow-up displayed: recurrence of prolapse, five cases (5%); anal sub-stenosis, two cases (2%); anal fissure, one case (1%); persistent pain, two cases (2%). Seven reoperations were performed: one due to bleeding, one due to sub-stenosis and five due to recurrence of hemorrhoidal prolapse and persistence of symptoms. CONCLUSIONS: Stapling is simple to accomplish, has low postoperative pain and rate of complications, however, the incidence of late reoperations is rather high and therefore major follow-up for better analysis is required.
Initial experience with stapled hemorrhoidopexy for treatment of hemorrhoids
Sobrado, Carlos Walter;Cotti, Guilherme Cutait de Castro;Coelho, Fabricio Ferreira;Rocha, Júlio Rafael Mariano da;
Arquivos de Gastroenterologia , 2006, DOI: 10.1590/S0004-28032006000300016
Abstract: background: introduction of stapled hemorrhoidopexy by longo in 1998 represented a radical change in the treatment of hemorrhoids. by avoiding multiple excisions and suture lines in the perianal region, stapled hemorrhoidopexy is intended to offer less postoperative pain than with conventional techniques. objective: to report and analyze the intra and postoperative results gained during initial experience with stapled hemorrhoidopexy. methods: one hundred and fifty five patients (67 males) with average age of 39.5 years (21-67 years) underwent stapled hemorrhoidopexy between june 2000 and december 2003 with symptomatic third-degree (n = 74) and fourth-degree (n = 81) hemorrhoids. mean follow-up period was 20 months (14-60 months). results: preoperative symptoms were prolapse (96.7%) and anal bleeding (96.1%). overall mean operative time was 23 minutes (16-48 minutes). we observed one case of stapler failure and one case of failure to introduce the stapler occurred in a patient with previous anal surgery. additional sutures for hemostasis were required in 103 patients (66.5%). resection of skin tags was performed in 45 cases (29%). postoperatively scheduled analgesia with oral dipyrone and celecoxib was enough for pain control in 131 patients (84.5%). rescue analgesia was necessary in 24 cases (15.5%). five patients needed opiates for pain control. hospital discharge took place on the first postoperative day in 140 patients (90.3%). first defecation without pain was reported by 118 patients (76.1%). postoperative complications were anal bleeding (10.3%), severe pain (3.2%), urinary retention (3.9%), fever without any signs of perianal infection (1.9%), incontinence for flatus (1.9%), hemorrhoidal thrombosis (1.3%). two patients presented symptoms of recurrent hemorrhoidal disease and were successfully treated by conventional hemorrhoidectomy. they were no cases of anal stenosis, permanent incontinence, chronic pain or deaths in this series. conclusions: hemorrhoidope
Randomized clinical trial of Stapled hemorrhoidopexy versus Ferguson hemorrhoidectomy  [PDF]
Oktay Büyüka??k,Ahmet O?uz Hasdemir,A ?lker Keskin,Bilal Ar?kan
Medical Journal of Bakirk?y , 2008,
Abstract: Objective: The purpose of this study was to compare stapled hemorrhoidopexy (SH) with that of the Ferguson hemorrhoidectomy (FH) for the surgical treatment of hemorrhoidal disease. Material and Methods: Fifthy patients with grade III or IV haemorrhoids were randomized to undergo either the SH (n=25) or FH (n=25). Operative time, length of hospital stay, postoperative pain, early and late complications, time to return to normal daily activities (both professional and social) and recurrence were evaluated. Follow up was one year. Results: Operative time, postoperative pain, the time to return to normal activities and recurrence were significantly less for patients in SH group. In the FH group early complications were more frequent but not statistically significant and there were no statistically significant differences regarding the frequency of late complications. Conclusion: Provided further clinical trials confirm these findings, SH may become a future gold standard.
Stapled hemorrhoidopexy: The Aga Khan University Hospital Experience  [cached]
Athar Ali,Chawla Tabish,Turab Pishori
Saudi Journal of Gastroenterology , 2009,
Abstract: Background: Stapled hemorrhoidopexy for prolapsing hemorrhoids is conceptually different from excision hemorrhoidectomy. It does not accompany the pain that usually occurs after resection of the sensitive anoderm. This study was carried out to evaluate the clinical outcome of stapled hemorrhoidopexy at The Aga Khan University Hospital. Methods: A sample of 140 patients with symptomatic second-, third-, and fourth-degree hemorrhoids and circumferential mucosal prolapse underwent stapled hemorrhoidopexy from July 2002 to July 2007. They were evaluated for postoperative morbidity, analgesic requirement, and recurrence. Results: Seventy-eight percent were males and the mean age was 45 (range 16-90) years. The mean operative time was 35 (15-78) min. The mean parenteral analgesic doses during the first 24 h were 2.1. All patients received oral analgesics alone after 24 h. No significant postoperative morbidity was observed. The mean in-patient hospital stay was 1.3 (0-5) days. Patients were followed-up for 24 (range, 2-48) months. Minor local recurrence of hemorrhoids was seen in four patients and was managed by band ligation. Conclusion: Stapled hemorrhoidopexy procedure was found safe, well tolerated by patients with minimal parenteral analgesic use and early discharge from the hospital.
Intractable bleeding from hemorrhoid piles after Stapled Hemorrhoidopexy: Case report  [PDF]
Aziz Sümer,Ne?et K?ksal,Ediz Alt?nl?
Medical Journal of Bakirk?y , 2007,
Abstract: Stapled hemorrhoidopexy is a new approach to the treatment of hemorrhoids. Stapled hemorrhoidopexy has recently become a widely accepted procedure for second and third degree hemorrhoids. In comparison to conventional hemorrhoidectomy, the reduction of postoperative pain and the shorter hospital stay made stapled hemorrhoidopexy a recommended surgical procedure. Various authors have reported multiple complications, including persistent anorectal pain, faecal urgency, stricture formation, recurrent prolapses, pelvic sepsis, rectal perforations and bleeding. The aim of this study is to evaluate a case along with literature who had intractable bleeding from hemorrhoid piles after stapled hemorrhoidopexy.
HEMORRHOIDECTOMY VS RUBBER BAND
MUHAMMAD DILAWAIZ,MUHAMMAD ABID BASHIR,ABID RASHID
The Professional Medical Journal , 2011,
Abstract: Objectives: To compare open hemorrhoidectomy and Rubber Band Ligation (RBL) in the management of 2nd and 3rd degree hemorrhoids in terms post operative and hospital stay. Design: Experiential Randomized Control Trial. Setting: Department of surgery, Allied Hospital and Independent University Hospital Faisalabad. Period: Dec 2008 to May 2009. Patients & Methods: 100 consecutive patients with second and third degree hemorrhoids were randomly divided into two groups. Group A (50 patients) were operated by open hemorrhoidectomy (Milligan morgan technique) while in group B (50 patients) rubber band ligations was performed. Open hemorrhoidectomy was performed underspinal anesthesia while rubber bands were applied with local xylocaine gel using Barron’s rubber band ligator. All the three hemorrhoids wereligated in single session. Results: Average hospital stay was 24 hours in patient operated by open hemorrhoidectomy as compared to one hour in rubber band ligation. 60% patients in group A developed moderate to severe pain requiring I/V morphine derivatives while 40% developed mild pain and treated with NSAIDS. In group B only 20% patients developed moderate pain and were dealt with I/M diclofenac sodium. Eightyeight percent patients in group A and 60% patients in group B developed mild to moderate bleeding in first postoperative week, which was self limiting. 6 patients developed severe bleeding after hemorrhoidectomy requiring blood transfusion. During six month follow up, two patients (4%) of open hemorrhoidectomy and 3 patients (6%) of RBL presented with recurrence and respective procedures were repeated. Conclusions: Rubber band ligation is safe, quick, economical and effective method for the treatment of 2nd and 3rd degree hemorrhoids.
Ileal pouch anal anastomosis with modified double-stapled mucosectomy-the experience in China  [cached]
Ya-Jie Zhang,Yi Han,Mou-Bin Lin,Yong-Gang He
World Journal of Gastroenterology , 2013, DOI: 10.3748/wjg.v19.i8.1299
Abstract: AIM: To investigate the feasibility and long-term functional outcome of ileal pouch-anal anastomosis with modified double-stapled mucosectomy. METHODS: From January 2002 to March 2011, fourty-five patients underwent ileal pouch anal anastomosis with modified double-stapled mucosectomy technique and the clinical data obtained for these patients were reviewed. RESULTS: Patients with ulcerative colitis (n = 29) and familial adenomatous polyposis (n = 16) underwent ileal pouch-anal anastomosis with modified double-stapled mucosectomy. Twenty-eight patients underwent one-stage restorative proctocolectomy, ileal pouch anal anastomosis, protective ileostomy and the ileostomy was closed 4-12 mo postoperatively. Two-stage procedures were performed in seventeen urgent patients, proctectomy and ileal pouch anal anastomosis were completed after previous colectomy with ileostomy. Morbidity within the first 30 d of surgery occurred in 10 (22.2%) patients, all of them could be treated conservatively. During the median follow-up of 65 mo, mild to moderate anastomotic narrowing was occurred in 4 patients, one patient developed persistent anastomotic stricture and need surgical intervention. Thirty-five percent of patients developed at least 1 episode of pouchitis. There was no incontinence in our patients, the median functional Oresland score was 6, 3 and 2 after 1 year, 2.5 years and 5 years respectively. Nearly half patients (44.4%) reported “moderate functioning”, 37.7% reported “good functioning”, whereas in 17.7% of patients “poor functioning” was observed after 1 year. Five years later, 79.2% of patients with good function, 16.7% with moderate function, only 4.2% of patients with poor function. CONCLUSION: The results of ileal pouch anal anastomosis with modified double-stapled mucosectomy technique are promising, with a low complication rate and good long-term functional results.
Experience With Routine Vaginal pH Testing in a Family Practice Setting  [PDF]
Adriana J. Pavletic,Stephen E. Hawes,Jenenne A. Geske,Kathy Bringe,Susan H. Polack
Infectious Diseases in Obstetrics and Gynecology , 2004, DOI: 10.1080/10647440400009839
Abstract: Background: Despite recommendations by Centers for Disease Control and the American College of Obstetricians and Gynecologists, pH testing is infrequently performed during the evaluation of vaginitis. Consequently, little information exists on its use in a primary care setting.
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