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Hidalgo Grau LA, Ruiz Edo N, Llorca Cardeñosa S, Heredia Budó A, Estrada Ferrer Ó, Del Bas Rubia M, García Torralbo EM, Suñol Sala X. Circular mucosal anopexy: Experience and technical considerations. Cir Esp 2016; 94:287-93. [PMID: 26997121 DOI: 10.1016/j.ciresp.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 11/12/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Circular mucosal anopexy (CMA) achieves a more comfortable postoperative period than resective techniques. But complications and recurrences are not infrequent. This study aims to evaluate of the efficacy of CMA in the treatment of hemorrhoids and rectal mucosal prolapse (RMP). METHOD From 1999 to 2011, 613 patients underwent surgery for either hemorrhoids or RMP in our hospital. CMA was performed in 327 patients. Gender distribution was 196 male and 131 female. Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade. Major ambulatory surgery (MAS) was performed in 79.9%. Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared. Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications. RESULTS A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade). No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age. In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week. Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain. CONCLUSIONS Recurrence rate is higher in CMA than in resective techniques. CMA is a useful technique for the treatment of hemorrhoids in MAS. Pain and the rate of complications are both low.
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Affiliation(s)
- Luis Antonio Hidalgo Grau
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Neus Ruiz Edo
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
| | - Sara Llorca Cardeñosa
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Adolfo Heredia Budó
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Óscar Estrada Ferrer
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Marta Del Bas Rubia
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Eva María García Torralbo
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Xavier Suñol Sala
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
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Hong YK, Choi YJ, Kang JG. Correlation of histopathology with anorectal manometry following stapled hemorrhoidopexy. Ann Coloproctol 2013; 29:198-204. [PMID: 24278858 PMCID: PMC3837085 DOI: 10.3393/ac.2013.29.5.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 05/14/2013] [Indexed: 02/04/2023] Open
Abstract
Purpose The removal of smooth muscle during stapled hemorrhoidopexy raises concerns regarding its effects on postoperative anorectal function. The purpose of this study was to evaluate the correlation between the amount of muscle removed and changes in anorectal manometry following stapled hemorrhoidopexy. Methods Patients with symptomatic II, III, or IV degree hemorrhoids that underwent stapled hemorrhoidopexy between January 2008 and May 2011 were included in this study. Anorectal manometry was performed preoperatively and at three months postoperatively. The resected doughnuts were examined histologically, and the thicknesses of muscle fibers were evaluated. Results Eighty-five patients (34 males) with a median age of 47 years were included. Muscularis propria fibers were identified in 63 of 85 pathologic specimens (74.1%). The median thickness of the muscle fibers was 1.58 ± 1.21 mm (0 to 4.5 mm). The mean resting pressure decreased by approximately 7 mmHg after operation in the 85 patients (P = 0.019). In patients with muscle incorporation, there was a significant difference in mean resting pressure (P = 0.041). In the analysis of the correlation of the difference in anorectal manometry results ([the result of postsurgical anorectal manometry] - [the result of presurgical anorectal manometry]) to the thickness of muscle fibers, no significant differences were seen. No patients presented with fecal incontinence. Conclusion Although the incidence of fecal incontinence is very low, muscle incorporation in the resected doughnuts following stapled hemorrhoidopexy may affect anorectal pressure. Therefore, surgeons should endeavor to minimize internal sphincter injury during stapled hemorrhoidopexy.
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Affiliation(s)
- Young Ki Hong
- Department of Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
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Chen SQ, Cai AZ, Wang N, Chen L. Single purse string with four-point traction for better haemorrhoid retraction. ANZ J Surg 2012; 82:742-6. [PMID: 22882767 DOI: 10.1111/j.1445-2197.2012.06179.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Traction method is important to stapled haemorrhoidopexy (SH) for its impact on haemorrhoidal prolapse reduction. Single purse string with one-point traction is most commonly used in SH. This traction method often results in an irregular mucosal doughnut with inadequate height, which leads to insignificant and uneven haemorrhoidal prolapse reduction. Single purse string with two-point traction is a modified traction method. According to some authors, it has significantly improved the height and regularity of the mucosal doughnut in SH. However, the reduction of haemorrhoidal prolapse is not always satisfactory, especially in patients with large prolapse. Our assumption is that single purse string with four-point traction, a more balanced traction method, will provide better control to increase the doughnut height using the same amount of traction. This study was designed to evaluate the outcomes of single purse string with four-point traction as compared with two-point traction in SH. METHODS Consecutive patients with symptomatic grade III haemorrhoids were randomized to two groups: Group 1, G(1) ; Group 2, G(2) . Each group underwent SH by colorectal surgeons. The patients in G(1) underwent single purse string with two-point traction. The patients in G(2) underwent SH using single purse string with four-point traction. Preoperative, intraoperative and post-operative patient characteristics were evaluated. RESULTS Sixty patients with a median age of 44 (range, 21-78) years were identified. Patient demographic and clinical characteristics were similar in the two groups. The height of the mucosectomy specimens significantly increased in patients of G(2) (P < 0.01, t-test). The variation in mucosal doughnut height significantly decreased in patients of G(2) (P < 0.01, t-test). The anatomy score after SH also significantly decreased in patients of G (2) (P = 0.029, Mann-Whitney U-test). No significant difference in complications was observed between the two groups. Median follow-up was 14 (range, 6-22) months. No haemorrhoidal symptoms were found in these patients. CONCLUSION Single purse string with four-point traction ensures a taller and more regular mucosal doughnut during SH, thus it brings a more satisfactory haemorrhoid retraction.
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Affiliation(s)
- Shao-Quan Chen
- Department of General Surgery, PLA General Hospital, Beijing, China
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Fu WP, Quah HM, Tang CL, Ooi BS, Eu KW. Stapled anastomosis for anterior resection is safe even after previous stapled haemorrhoidectomy--a report of five cases. Int J Colorectal Dis 2010; 25:1503-6. [PMID: 20577746 DOI: 10.1007/s00384-010-0994-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2010] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Stapled haemorrhoidectomy has become popular for the treatment of symptomatic bleeding or prolapsing piles. There are concerns about the safety of another stapled low colorectal anastomosis after rectal resection if a patient who has had previous stapled haemorrhoidectomy subsequently develops colorectal neoplasia requiring an anterior resection. METHODS A retrospective review of patients who underwent stapled haemorrhoidectomy and subsequently had anterior resection from 1999 to 2008 was performed. RESULTS Five patients (all male) were found to have distal sigmoid or rectal tumours on surveillance colonoscopy after stapled haemorrhoidectomy. Median age was 65 years (range 58-71). All underwent anterior resection with stapled end-to-end colorectal anastomosis at median of 29 months (range 18-60 months) after the initial stapled haemorrhoidectomy. Median anastomotic height was 12 cm (range 1-12 cm). A defunctioning ileostomy was created for three out of five patients. All the colorectal anastomoses healed uneventfully. CONCLUSIONS Stapled colorectal anastomosis may be safely performed after previous stapled haemorrhoidectomy.
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Affiliation(s)
- Wan-Pei Fu
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore, Republic of Singapore
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Naldini G, Martellucci J, Moraldi L, Romano N, Rossi M. Is simple mucosal resection really possible? Considerations about histological findings after stapled hemorrhoidopexy. Int J Colorectal Dis 2009; 24:537-41. [PMID: 19169693 DOI: 10.1007/s00384-009-0636-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2009] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The common removal of smooth muscle during stapled hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function. The purpose of the study is to confirm the high frequency of the involvement of smooth muscle fibers in stapled hemorrhoidectomy and to determine its association with postoperative findings. METHODS This retrospective study evaluated 241 cases of stapled hemorrhoidopexy treated from 2003 to 2006. Data include the most common postoperative complications such as bleeding, anal pain, and recurrence. Histological doughnuts were examined, and the presence of muscle fibers was evaluated. RESULTS Early complications occurred in 27/241 patients (11.2%) including bleeding (14), anal pain (eight), incontinence (two), abscess (two), hematoma (one). Recurrence was observed in 11 cases (4.5%). Muscularis propria fibers were identified in 217 of 241 (90%) pathologic specimens. Five complications occurred in the group in which muscle fibers were not identified (4/24). The frequency of complications in the group with and without smooth muscle tissue in the resected specimens was 9.6% and 25%, respectively. CONCLUSIONS The presence of muscle fibers is not an occasional finding in the histological specimens, even if the presence of smooth muscle does not seems to influence the outcome of stapled hemorrhoidopexy. The idea of a simple mucosal resection needs to be revised.
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Intraoperative ligation of residual haemorrhoids after stapled mucosectomy. Tech Coloproctol 2009; 13:5-10. [PMID: 19288251 DOI: 10.1007/s10151-009-0452-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 12/15/2008] [Indexed: 12/29/2022]
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Young CJ. STAPLED HAEMORRHOIDECTOMY, MUCOSECTOMY OR ANOPEXY: THE OPERATION IS WHAT THE PURSE STRING MAKES IT. ANZ J Surg 2008; 78:330. [DOI: 10.1111/j.1445-2197.2008.04464.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Modified Longo's stapled hemorrhoidopexy with additional traction sutures for the treatment of residual prolapsed piles. Int J Colorectal Dis 2008; 23:237-41. [PMID: 18026965 DOI: 10.1007/s00384-007-0404-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2007] [Indexed: 02/07/2023]
Abstract
PURPOSE Residual prolapsed piles is a problem after the stapled hemorrhoidopexy, especially in large third- or fourth-degree hemorrhoids. We have developed a method using additional traction sutures along with modified Longo's procedure to manage this problem. MATERIALS AND METHODS From January 2005 to October 2005, 30 consecutive patients with symptomatic third- or fourth-degree hemorrhoids who underwent the modified Longo's stapled hemorrhoidopexy with additional traction sutures in a single institution were collected. The demographics, postoperative pain score, surgical features, outcomes, and early and late complications were recorded. All patients were followed for a mean duration of 8.8 (range, 4-15) months. RESULTS Thirty patients (17 males) with a mean age of 45 (range, 27-63) years were identified. The mean postoperative pain score on the morning of the first postoperative day was 2.8 (range, 1-4). The mean duration of operation was 30.7 (range, 25-37) min. The mean duration of hospital stay was 2 (range, 1-3) days. The mean days for patients to resume normal work was 6.7 (range, 4-9) days. No other procedure-related complications occurred in all patients. There was no early complication except for fecal urgency found in one patient during the first postoperative days. Regarding the late complications, no residual prolapsed piles, persistent anal pain, incontinence, anal stenosis, or recurrent symptoms were found. CONCLUSIONS Our preliminary experiences indicated that this modified procedures truly contributed to reduce the residual internal hemorrhoids and maintained the benefits of stapled hemorrhoidopexy. Randomized trial and long-term follow-up warrant to determine possible surgical and functional outcome.
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Hourigan J, Luchtefeld M. Excisional Hemorrhoidectomy. SEMINARS IN COLON AND RECTAL SURGERY 2007. [DOI: 10.1053/j.scrs.2007.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Koh PK, Seow-Choen F. Mucosal flap excision for treatment of remnant prolapsed hemorrhoids or skin tags after stapled hemorrhoidopexy. Dis Colon Rectum 2005; 48:1660-2. [PMID: 15981055 DOI: 10.1007/s10350-005-0089-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Stapled hemorrhoidopexy may leave residual skin tags or external components following its use in large prolapsed piles. Excision of redundant mucosa above the dentate line and reconstitution to the staple line reduces these prolapsed elements. We describe a novel technique that removes residual skin tags and piles while remaining true to the spirit of stapled hemorrhoidopexy.
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Affiliation(s)
- Poh-Koon Koh
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Kam MH, Mathur P, Peng XH, Seow-Choen F, Chew IWC, Kumarasinghe MP. Correlation of histology with anorectal function following stapled hemorrhoidectomy. Dis Colon Rectum 2005; 48:1437-41. [PMID: 15906119 DOI: 10.1007/s10350-005-0046-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The inadvertent removal of smooth muscle during the use of stapled hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function. We correlated the amount of smooth muscle removed with anorectal function in the early postoperative period. METHODS Patients were assessed preoperatively with an Eypasch quality-of-life questionnaire and underwent anorectal manometry and physiology testing. This was followed by a similar examination at three months postoperatively. Patients were operated on by a single surgeon and the excised anorectal mucosa was sent for histologic examination. The amount of smooth muscle excised was expressed semiquantitatively as a percentage of the total tissue removed. RESULTS Sixty-eight patients (33 males) were recruited prospectively, with median age of 44 years. Six patients were lost to follow-up. Removal of anal transitional zone did not increase the incidence of incontinence. Both median preoperative and postoperative continence scores were good. Only one patient had incontinence to gas as a result of the operation. Median preoperative and postoperative quality-of-life scores were 114 and 131, respectively, out of a total of 144, the higher postoperative scores showing an improvement. Correlation of quality-of-life scores and mean resting anal pressures with percentage of smooth muscle removed did not show any statistical significance. CONCLUSIONS Some smooth muscle will invariably be excised in stapled hemorrhoidectomy but the amount of smooth muscle removed did not significantly affect the continence score, quality of life, or mean anal resting pressure after stapled hemorrhoidectomy. It remains a safe and preferred procedure for the treatment of hemorrhoids.
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Affiliation(s)
- M H Kam
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Bikhchandani J, Agarwal PN, Kant R, Malik VK. Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg 2005; 189:56-60. [PMID: 15701493 DOI: 10.1016/j.amjsurg.2004.03.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2003] [Revised: 03/20/2004] [Accepted: 03/20/2004] [Indexed: 01/25/2023]
Abstract
BACKGROUND The new technique of circular stapler for the treatment of hemorrhoids has shown early promise in terms of minimal or no postoperative pain, early discharge from hospital, and quick return to work. This study was designed to compare stapled technique with the well-accepted conventional Milligan Morgan hemorrhoidectomy. METHODS After fulfilling the selection criteria, 84 patients were randomly allocated to the stapled (n = 42) or open group (n = 42). All patients were operated on under spinal anesthesia. The 2 techniques were evaluated with respect to the operative time, pain scores, complications, day of discharge, return to work, and level of satisfaction. RESULTS The mean age of patients was 46.02 years (SD, 12.33) in the stapled group and 48.64 years (14.57) in the open group. Grade III or IV hemorrhoids were more common in men (ie, 80.9% and 85.7% in the stapled and open group, respectively). The mean operative time was shorter in the stapled group 24.28 minutes (4.25) versus 45.21 minutes (5.36) in the Milligan-Morgan group (P < .001). The blood loss, pain scores and requirement of analgesics was significantly less in the stapled group. Mean hospital stay was 1.24 days (0.62) and 2.76 days (1.01) (P < .001) in the stapled and open group, respectively. The patients in the stapled group returned to work or routine activities earlier (ie, within 8.12 days [2.48]) as compared with 17.62 (5.59) in the open group. Only 88.1% of patients were satisfied by the open method compared with 97.6% after the stapled technique. The median follow-up period was 11 months with a maximum follow-up of 19 months (range 2-19 months). CONCLUSIONS Stapled hemorrhoidectomy is a safe and effective day-care procedure for the treatment of grade III and grade IV hemorrhoids. It ensures lesser postoperative pain, early discharge, less time off work, complications similar to the open technique, and in the end a more satisfied patient with no perianal wound. However, more such randomized trials are essential to deny any long-term complication.
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Affiliation(s)
- Jai Bikhchandani
- Department of Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, AG-I/9C, Vikaspuri, New Delhi 110018, India.
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Mathur P, Ng KH, Seow-Choen F. Stapled mucosectomy for rectocele repair: a preliminary report. Dis Colon Rectum 2004; 47:1978-80; discussion 1980-1. [PMID: 15622595 DOI: 10.1007/s10350-004-0670-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is no optimum surgical method of repair for rectoceles; however, recent interest in the use of the circular hemorrhoidal stapler gun to treat rectoceles has stirred interest. We describe our early results using the circular hemorrhoidal stapler gun for repair of rectoceles. Seven patients (median age, 45 (range, 31-62) years; all females) have been treated. All seven patients presented with incomplete or difficult defecation, four patients required digital vaginal manipulation, and all patients had tried a variety of aperients to aid defecation. The procedure involved two purse-strings and one firing of the circular hemorrhoidal stapler gun. No perioperative complications were encountered. At a median of six (range, 1-10) months follow-up, all patients were able to defecate without difficulty or manipulation. None of the patients required any medication to aid bowel evacuation after surgery. These promising early results support the use of stapled mucosectomy for the repair of rectoceles.
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Affiliation(s)
- Pawan Mathur
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Mathur P, Ho T, Spalinger R, Chirurgie FMH, Seow-Choen F. The "winged" circular anal dilator in stapled hemorrhoidectomy. Dis Colon Rectum 2004; 47:542-3. [PMID: 14994106 DOI: 10.1007/s10350-003-0068-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Stapled hemorrhoidectomy is gaining popularity worldwide. One problem that is often encountered is difficulty with insertion of the circular anal dilator because of very protuberant and fatty buttocks and a narrow interischial tuberosity distance. We describe a modification of this device for easier introduction in such patients.
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Affiliation(s)
- P Mathur
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Maw A, Concepcion R, Eu KW, Seow-Choen F, Heah SM, Tang CL, Tan AL. Prospective randomized study of bacteraemia in diathermy and stapled haemorrhoidectomy. Br J Surg 2003; 90:222-6. [PMID: 12555300 DOI: 10.1002/bjs.4057] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The incidence and consequences of bacteraemia associated with diathermy and stapled haemorrhoidectomy have not been studied previously. METHODS Two hundred and five healthy patients randomized to stapled haemorrhoidectomy or diathermy haemorrhoidectomy had perioperative blood cultures taken. The clinical sequelae of bacteraemia and complications of surgery were assessed prospectively. RESULTS Six patients were excluded for protocol violations. Eleven (11 per cent) of 101 patients with stapled and five (5 per cent) of 98 who had diathermy haemorrhoidectomy had positive blood cultures for organisms after haemorrhoidectomy, predominantly anaerobes commonly found within the bacterial flora of the anorectum (P = 0.19). Transient postoperative pyrexia in several patients did not correlate with detected bacteraemia and settled spontaneously without treatment. There were no serious complications from either operative technique, and no clinical consequences from proven bacteraemia. CONCLUSION Transient bacteraemia may complicate surgical haemorrhoidectomy but has no serious clinical consequences for healthy adults.
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Affiliation(s)
- A Maw
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, Singapore 169608
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Abstract
BACKGROUND Recent reports of serious sepsis following stapled haemorrhoidectomy have raised concerns about the appropriate treatment of haemorrhoidal disease. METHODS A Medline search was undertaken for reports of sepsis following the commonly practised conservative and surgical treatments of haemorrhoids. RESULTS Published accounts of significant septic complications after injection sclerotherapy, rubber-band ligation, cryotherapy, open and closed haemorrhoidectomy, and stapled haemorrhoidectomy are discussed. This is supplemented by the authors' own experiences of stapled haemorrhoidectomy. CONCLUSION Septic complications following both conservative and surgical treatment of haemorrhoids are rare but may be catastrophic. Immunological compromise poses an additional risk for many treatment modalities. The technique of stapled haemorrhoidectomy should be learned diligently to avoid septic complications.
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Affiliation(s)
- R J Guy
- Department of Colorectal Surgery, Outram Road, Singapore 169608.
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Affiliation(s)
- F Seow-Choen
- Department of Colorectal Surgery, Singapore General Hospital, Singapore.
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Roig Vila JV. Anopexia grapada. ¿Un antes y un después en el tratamiento de las hemorroides prolapsadas? Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)72064-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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