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Pei X, Song S, Li H, Lu D. Efficacy and safety of acupoint catgut embedding in treating postoperative pain of mixed hemorrhoids: A randomized controlled trial protocol. Medicine (Baltimore) 2021; 100:e25948. [PMID: 34106667 PMCID: PMC8133192 DOI: 10.1097/md.0000000000025948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Pain is a common complication after mixed hemorrhoids, which seriously affects the recovery of patients and prolongs the length of hospital stay. Acupoint catgut embedding has advantages in improving a variety of acute and chronic pain diseases, but there is still a lack of rigorous randomized controlled studies to verify its efficacy and safety in the treatment of postoperative pain of mixed hemorrhoids. Therefore, the purpose of this randomized controlled trial is to evaluate the clinical efficacy of acupoint catgut embedding in the treatment of postoperative pain of mixed hemorrhoids. METHODS This is a prospective randomized controlled trial to study the efficacy and safety of acupoint catgut embedding in the treatment of postoperative pain of mixed hemorrhoids. Approved by the clinical research ethics committee of our hospital, the patients were randomly divided into observation group and control group according to 1:1. The observation group received acupoint catgut embedding before the operation, while the control group received no special treatment. The efficacy and safety indexes were concerned after the operation, and the observation indexes included: resting state and visual analogue scale (VAS) score during defecation, postoperative hospitalization time, total amount of analgesic use, adverse reactions, etc. Finally, we carried on the data statistical analysis through the SPSS version 19.0. DISCUSSION This study will evaluate the efficacy and safety of acupoint catgut embedding in the treatment of postoperative pain of mixed hemorrhoids, and the results of this study will provide a new idea for the selection of postoperative analgesia for mixed hemorrhoids resection. TRIAL REGISTRATION OSF Registration number: DOI 10.17605/OSF.IO/T2ZGY.
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Affiliation(s)
- Xiaorui Pei
- Department of General Surgery, Tianjin TEDA Hospital
| | - Shijun Song
- Department of Hepatobiliary and Pancreatic Surgery, Tianjin Nankai Hospital, Tianjin, China
| | - Haotian Li
- Department of General Surgery, Tianjin TEDA Hospital
| | - Debao Lu
- Department of General Surgery, Tianjin TEDA Hospital
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Maejima T, Kono T, Fukahori S, Yoshikawa D, Karasaki H, Araki Y, Ohta T, Nagashima K. Evacuatory Dysfunction after Stapled Hemorrhoidopexy: A Case Report of Rectal Pocket Syndrome. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:85-88. [PMID: 32346647 PMCID: PMC7186010 DOI: 10.23922/jarc.2019-024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
A 60 year-old male was referred to the authors' hospital with a persistent urge to defecate. The patient had undergone stapled hemorrhoidopexy (SH) for the treatment of prolapsed hemorrhoids approximately 10 years earlier. He started to have difficulty with defecation and a false sense of urgency shortly after the surgery. Computed tomography showed a diverticulum-like fistula along the circumference of the rectum. Colonoscopy revealed communication between the diverticular cavity and the rectal lumen. The cavity contained a thumbnail-sized fecalith. When the fecalith was removed, the patient's urge to defecate dissipated. The patient was diagnosed with rectal pocket syndrome secondary to SH. The lower rectum was transected, and the remaining rectum and the anal canal were anastomosed by manual suture. Temporary ileostomy with double orifices was performed. The ileostomy was closed 3 months later. The patient experienced no subsequent difficulty with defecation or urgency.
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Affiliation(s)
- Taku Maejima
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toru Kono
- Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Susumu Fukahori
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Daitaro Yoshikawa
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Hidenori Karasaki
- Department of Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yasumi Araki
- Department of Surgery, Kurume Proctology Center, Kurume, Japan
| | - Tomoyuki Ohta
- Department of Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Kazuo Nagashima
- Department of Pathology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Bhatti MI, Sajid MS, Baig MK. Milligan–Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg 2016; 40:1509-19. [DOI: 10.1007/s00268-016-3419-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ala S, Eshghi F, Enayatifard R, Fazel P, Rezaei B, Hadianamrei R. Efficacy of cholestyramine ointment in reduction of postoperative pain and pain during defecation after open hemorrhoidectomy: results of a prospective, single-center, randomized, double-blind, placebo-controlled trial. World J Surg 2013; 37:657-62. [PMID: 23229850 DOI: 10.1007/s00268-012-1895-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the efficacy of cholestyramine ointment (15 %) in reducing postoperative pain at rest and during defecation after open hemorrhoidectomy. METHODS A total of 91 patients with third and fourth degree hemorrhoids undergoing open hemorrhoidectomy were included in this prospective, double-blind, randomized controlled trial. The patients were randomly assigned to either cholestyramine ointment or placebo immediately after surgery, 12 h after surgery, and then every 8 h for 14 days. The primary outcomes were intensity of pain at rest and during defecation, measured with a visual analog scale, and the analgesic requirement, measured by amount of tramadol consumption. RESULTS The cholestyramine group had less postoperative pain than the placebo group at the 24th hour (1.84 ± 2.54 vs. 4.07 ± 3.35; P = 0.001) and 48th hour (0.18 ± 0.88 vs. 3.57 ± 3.45; P < 0.001) and less pain during defecation starting at the 48th hour (2.28 ± 2.96 vs. 4.77 ± 4.09; P = 0.001). Similarly, the average tramadol consumption at hours 24 and 48 was significantly lower for the cholestyramine group (5.32 ± 21.45 vs. 43.18 ± 61.56 mg at 24 h, and 4.48 ± 16.65 vs. 57.63 ± 65.47 mg at 48 h; P < 0.001). The only adverse event was pruritus, which had a lower frequency in the cholestyramine group but the difference was not significant until postoperative week 4 (P < 0.001). CONCLUSIONS Compared with placebo, cholestyramine ointment (15%) reduced postoperative pain at rest and on defecation, and consequently lowered the analgesic requirement after open hemorrhoidectomy.
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Affiliation(s)
- Shahram Ala
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, 18th Kilometer Farahabad Boulevard, 48175861, Sari, Mazandaran Province, Iran.
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Wu ZS, Liu LB, Tang GH, Deng QL. Efficacy of phloroglucinol in the treatment of patients after surgery for mixed hemorrhoid. Shijie Huaren Xiaohua Zazhi 2012; 20:1259-1262. [DOI: 10.11569/wcjd.v20.i14.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy and safety of phloroglucinol in the treatment of patients after surgery for mixed hemorrhoid.
METHODS: One hundred and thirty-two patients after surgery for mixed hemorrhoid were randomly divided into two groups and were intravenously infused with 40 mg phloroglucinol in 5% glucose solution (study group) and 5% glucose solution (control group), respectively. The analgesic effect and side effects were analyzed. Post-operative complications were also observed.
RESULTS: The pain degree at 12, 24, and 24 h after operation was significantly lower in the study group than in the control group (1.15 ± 0.43 vs 3.85±2.59, 4.67 ± 2.47 vs 6.68 ± 1.88, 4.99 ± 0.26 vs 3.15 ± 2.65, all P < 0.05). There is a significant difference in the consumption of analgesics between the study group and the control group within 48 h after operation (P < 0.01). The incidences of post-operative complications, such as urinary retention and edema of the anal edge, and adverse reactions were lower in the study group than in the control group (all P < 0.05).
CONCLUSION: Phloroglucinol has a remarkable analgesic effect and is associated with few adverse effects in the management of patients after surgery for mixed hemorrhoid.
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Diathermy excisional hemorrhoidectomy: a prospective randomized study comparing pedicle ligation and pedicle coagulation. Dis Colon Rectum 2011; 54:1405-11. [PMID: 21979186 DOI: 10.1097/dcr.0b013e318222b5a9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In hemorrhoidectomy, pedicle coagulation has been claimed to be associated with less postoperative pain compared with pedicle ligation. OBJECTIVE This study was designed to compare the effects of pedicle ligation vs pedicle coagulation on postoperative pain in patients undergoing diathermy excisional hemorrhoidectomy. DESIGN The study was conducted as a single-blind prospective randomized clinical trial. SETTING Patients were treated at a single tertiary-level teaching hospital (Main University Hospital) in Alexandria, Egypt, from February 2009 to October 2010. PATIENTS Patients with symptomatic grade III or IV hemorrhoids were eligible. INTERVENTION Patients were randomly allocated to receive either pedicle coagulation or pedicle ligation during 3-quadrant diathermy excision hemorrhoidectomy. MAIN OUTCOME MEASURES Patients reported postoperative pain daily on a visual analog scale (0-10, with 10 corresponding to the most severe pain) during the first 10 postoperative days. On-demand parenteral analgesic requirements were recorded during the first 24 hours after surgery. Operative time, postoperative complications, and wound healing rates at 6 weeks postoperatively were also recorded. LIMITATIONS No a priori power calculation could be performed, so it was not possible to tell whether nonsignificant differences were real or a result of chance. RESULTS A total of 136 patients were randomly assigned, and 120 patients completed the study (60 in each group). The overall median pain score for the first 10 postoperative days was significantly lower in the pedicle coagulation group than in the pedicle ligation group (4.65 vs 6.56, P < .001), and daily median pain scores were significantly lower for pedicle coagulation than for pedicle ligation throughout the first 6 postoperative days (P < .001). Postoperative pain scores followed different courses in the 2 groups. In the coagulation group, pain levels were lowest during the first 3 postoperative days, increasing from day 4 and then falling after day 8. In the ligation group, pain levels were highest during the first 4 postoperative days, then gradually decreased. The median number of analgesic ampoules required during the first 24 hours was also significantly lower for pedicle coagulation than for ligation: 1 (range, 0-3) vs 3 (range, 1-3); P < .001). The median operative time was 15 (range, 14-20) minutes with coagulation and 14.5 (range, 12-18) minutes with ligation (P < .001). No significant differences were observed in the incidence of postoperative complications or wound healing rates at 6 weeks postoperatively. No anal stenoses or recurrences were observed. CONCLUSIONS Pedicle coagulation is safe and provides a superior alternative to pedicle ligation by decreasing postoperative pain in the first 6 postoperative days, as well as reducing parenteral analgesic requirements during the first 24 hours postoperatively.
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[Adequate management of postoperative pain in surgery for hemorrhoidal disease]. Cir Esp 2010; 88:283-4. [PMID: 20851389 DOI: 10.1016/j.ciresp.2010.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 07/22/2010] [Indexed: 11/22/2022]
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Residual skin tags following procedure for prolapse and hemorrhoids: differentiation from recurrence. World J Surg 2010; 34:344-52. [PMID: 20012615 DOI: 10.1007/s00268-009-0295-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE The aim of this study was to compare the incidence of recurrence and residual skin tag after the procedure for prolapse and hemorrhoids (PPH) versus conventional hemorrhoidectomy (CH) in the Chinese- and English-language literature to explore the definition of recurrence after PPH. METHODS Related Chinese- and English-language literature was collected by several methods. Meta-analysis was used to compare the incidence of recurrence and residual skin tag of PPH versus CH. RESULTS In China, 13.94% of hemorrhoids had a skin tag after PPH. The mean recurrence rate after PPH was 3.23% (range 0.40-26.44%). Our meta-analysis of PPH versus CH of the Chinese studies showed that PPH had a significantly lower recurrence rate-13 studies, odds ratio (OR) 0.27, 95% confidence interval (CI) 0.17-0.42, p < 0.00001-and a higher incidence of skin tags with no significance-6 studies, OR 3.42, 95% CI 0.49-24.04, p = 0.22. Our meta-analysis of PPH versus CH among the English-language studies showed that PPH had a significantly higher recurrence rate-17 studies, 636 patients in the PPH group vs. 625 patients in the CH group, OR 2.96, 95% CI 1.57-5.56, p = 0.0008-and a significantly higher incidence of residual skin tags-8 studies, 297 patients in the PPH group vs. 289 patients in the CH group, OR 1.88, 95% CI 1.15-3.05, p = 0.01. However, the recurrence of prolapse was stated to be ascertained by anorectal examination in only six studies; meta-analysis of the six studies showed that PPH was not associated with a higher recurrence-six studies, 230 patients in the PPH group vs. 220 patients in the CH group; OR 1.87, 95% CI 0.70-5.00, p = 0.22. CONCLUSIONS PPH is not associated with a higher recurrence rate but is associated with a higher incidence of skin tags compared with CH. The reported high recurrence rates are probably caused by improper inclusion of residual skin tags into the recurrence data. Surgeons should perform anorectal examinations to differentiate a residual skin tag from a recurrence.
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Nyström PO, Qvist N, Raahave D, Lindsey I, Mortensen N. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. Br J Surg 2009; 97:167-76. [PMID: 20035531 DOI: 10.1002/bjs.6804] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Background
This multicentre randomized clinical trial studied how symptoms improved after either stapled anopexy or diathermy excision of haemorrhoids.
Methods
The study involved 18 hospitals in Sweden, Denmark and the UK. Some 207 patients were randomized to either anopexy or Milligan–Morgan haemorrhoidectomy, of whom 90 in each group were operated on. Patients reported symptoms before surgery and after 1 year. Daily postoperative pain scores were recorded in a patient diary. Surgeons evaluated the anal anatomy before surgery and after 1 year.
Results
Correction of prolapse in the anopexy and haemorrhoidectomy groups was similar at 1 year (88 and 90 per cent respectively; P = 0·80). Freedom from symptoms was obtained in 44 and 69 per cent respectively (P = 0·002). Stapled anopexy was associated with less postoperative pain, which resolved more quickly (P = 0·004). Significant improvements were noted in anal continence and well-being 1 year after both operations (P < 0·001). Excessive pain was the most common complication after diathermy excision and disturbed bowel function after stapled anopexy.
Conclusion
Haemorrhoidal prolapse was corrected equally by either operation. Diathermy haemorrhoidectomy gave better symptom relief but was more painful. Neither operation provided complete cure but well-being was greatly improved. Registration number: ISRCTN68315343 (http://www.controlled-trials.com).
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Affiliation(s)
- P-O Nyström
- Department of Clinical Sciences, Intervention and Technology, CLINTEC, Karolinska Institute, and Department of Gastrointestinal Surgery, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - N Qvist
- Department of Surgery, University Hospital, Odense, Denmark
| | - D Raahave
- Department of Surgery, North Sealand Hospital, Helsingor, Denmark
| | - I Lindsey
- Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK
| | - N Mortensen
- Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK
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Primary and repeated stapled hemorrhoidopexy for prolapsing hemorrhoids: follow-up to five years. Dis Colon Rectum 2008; 51:334-41. [PMID: 18204883 DOI: 10.1007/s10350-007-9102-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/15/2007] [Accepted: 06/25/2007] [Indexed: 02/08/2023]
Abstract
PURPOSE Treating hemorrhoids by stapled hemorrhoidopexy has become increasingly common, because the procedure results in less pain and allows the patient to return to work earlier than with open hemorrhoidectomy. However, the durability of stapled hemorrhoidopexy has not been evaluated. This study was designed to assess initial results, analyze complications and failures, and document both the need for repeated procedures and the outcomes of follow-up to five years. METHODS From 1998 to 2004, 258 patients underwent modified stapled hemorrhoidopexy. The appearance of the anus was scored preoperatively, immediately after the procedure, at three months, and at one to five years postoperatively. The anatomy score ranged from 1 (normal anus) to 7 (worst prolapse). We also evaluated operation time, analgesia, staple line position, postoperative pain score, technical failures, postoperative complications, need for repeated procedures, and patient satisfaction. Statistical analyses were used to identify correlations and differences, and the variables were analyzed in relation to the final outcome. RESULTS The patients were observed for a median of 34 (range, 18-78) months. The median postoperative pain score was 4 (Visual Analog Scale 1-10) on the day of stapled hemorrhoidopexy; additional external procedures resulted in significantly higher pain (P<0.05). Stapled hemorrhoidopexy was repeated in 31 patients (12 percent), and 38 patients (14.7 percent) had subsequent excisions. Technical failures occurred in 18 of 258 patients (7 percent). The median anatomy score decreased from 6 (range, 3-7) preoperatively to 1 (range, 1-6) at last follow-up, irrespective of one or a repeated stapled hemorrhoidopexy, surgical excision, or technical failure. The risk of reintervention was greatest during the first year after a stapled hemorrhoidopexy. Overall, patient satisfaction was high and correlated significantly with the anatomy score (r=0.46, P<0.05). CONCLUSIONS The pain after stapled hemorrhoidopexy was low, recovery was rapid, complications were few, and patient satisfaction was high. A recurrent (or persistent) prolapse was alleviated by a repeated stapled hemorrhoidopexy for cure. However, there was a high risk of reintervention after a stapled hemorrhoidopexy, and this should be further evaluated.
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Sobrado CW, Cotti GCDC, Coelho FF, Rocha JRMD. Initial experience with stapled hemorrhoidopexy for treatment of hemorrhoids. ARQUIVOS DE GASTROENTEROLOGIA 2007; 43:238-42. [PMID: 17160242 DOI: 10.1590/s0004-28032006000300016] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 12/16/2005] [Indexed: 11/22/2022]
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 Hemorrhoidopexy can be considered a feasible and safe alternative technique to conventional hemorroidectomy for select patients.
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Kecmanovic DM, Pavlov MJ, Ceranic MS, Kerkez MD, Rankovic VI, Masirevic VP. Bulk agent Plantago ovata after Milligan-Morgan hemorrhoidectomy with Ligasure. Phytother Res 2006; 20:655-8. [PMID: 16708408 DOI: 10.1002/ptr.1926] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to determine usefulness of the bulk agent Plantago ovata in reducing postoperative pain and tenesmus after open hemorrhoidectomy (Milligan-Morgan with Ligasure). Ninety-eight patients were randomized into two groups of 49 patients each. In both groups Milligan-Morgan open hemorrhoidectomy with Ligasure was performed. The first group received postoperatively two sachets daily of 3.26 g of the bulk agent, Plantago ovata, for 20 days. The control group was treated postoperatively with glycerin oil. There was no statistically significant difference in age, gender distribution and hemorrhoid grading, between the two groups. The pain score after first defecation (p < 0.001) and after 10 days (p < 0.01) and the global pain score (p < 0.001) was statistically significantly lower in the group treated with Plantago ovata, while there was no statistically significant difference in the pain level after 20 days (p > 0.05). The hospital stay was statistically significantly shorter in the group receiving Plantago ovata (2.6 +/- 0.6 vs 3.9 +/- 0.7 days, p < 0.001). The incidence of tenesmus was higher in the control group (40.8% vs 10.2%, p < 0.01). Treating patients with Plantago ovata after open hemorrhoidectomy, reduces pain, tenesmus rate and shortens postoperative hospital stay.
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Affiliation(s)
- Dragutin M Kecmanovic
- First Surgical University Hospital, Institute for Digestive Diseases, Clinical Center of Serbia, 6 Koste Todorovica St, Belgrade, Serbia.
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Anghelacopoulos SE, Tagarakis GI, Pilpilidis I, Kartsounis C, Chryssafis G. Albumin-glutaraldehyde bioadhesive ("Bioglue") for prevention of postoperative complications after stapled hemorrhoidopexy: a randomized controlled trial. Wien Klin Wochenschr 2006; 118:469-72. [PMID: 16957977 DOI: 10.1007/s00508-006-0642-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Accepted: 05/09/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hemorrhoidopexy using the circumferential stapler is an established method for surgical treatment of patients with prolapsing hemorrhoids. Despite its advantages, complications such as anal canal stenosis, hemorrhage and anastomosis leak with eventual intrapelvic sepsis can cause serious postoperative problems. The aim of this study was to evaluate the utility of a surgical adhesive, the biological albumin-glutaraldehyde glue "Bioglue", in reduction of these postoperative complications. PATIENTS AND METHODS Between January 2002 and November 2004, 200 patients undergoing stapled hemorrhoidopexy were enrolled in a prospective, randomized clinical trial. One hundred patients were randomly assigned to the control group; the study group consisted of 100 patients who received Bioglue in the mucosa anastomosis area. All patients received standardized postoperative analgesic, laxative and antibiotic treatment. We then evaluated the two groups for postoperative complications (after surgery and 6 months postoperatively). RESULTS From the control group (no Bioglue application), two patients presented with anal stenosis, two with hemorrhage, three had anastomosis leak and one had thrombosis, whereas none of the patients from the Bioglue group had any of these complications. Both groups had patients with severe postoperative pain (3 each) and fecal incontinence (1 patient each). The overall difference in the number of complications in the two groups was statistically significant (p < 0.05). CONCLUSION In this first study using Bioglue in patients undergoing circumferential stapled hemorrhoidopexy we have shown that application of the glue is effective in reducing postoperative complications.
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Person B, Wexner SD. Novel technology and innovations in colorectal surgery: the circular stapler for treatment of hemorrhoids and fibrin glue for treatment of perianal fistulae. Surg Innov 2005; 11:241-52. [PMID: 15756393 DOI: 10.1177/155335060401100407] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of new techniques and technologies in medical science is both stimulating and controversial. This article is a review of the current status of two such advances. Since its first description, the so-called "stapled hemorrhoidectomy" has been gaining increasing popularity, at first in Asia and Europe, and more recently in the United States. It is obviously a misnomer, since no excision of hemorrhoidal tissue is undertaken in this procedure. It is probably the most significant change in the surgical treatment of hemorrhoids since the introduction of conventional hemorrhoidectomy. Patients routinely experience less postoperative pain and have excellent control of symptoms, with few serious complications in most series. Despite a relatively simple operative technique, the procedure still has specific steps and features that must be followed and mastered to help insure success. The use of fibrin glue for treatment of perianal fistulae has also been a controversial issue, thus it is seldom included in any algorithm as a therapeutic step for fistula-in-ano. The reported success rates of the treatment range from 0% to 100% owing to the heterogeneity of the clinical trials, treatment protocols, patients, etiologies, and types of fistulae. However, the benign nature, simplicity, negligible morbidity, and repeatability of the treatment, potentially makes fibrin glue an attractive first line treatment for perianal fistulae.
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Affiliation(s)
- Benjamin Person
- The Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Wexner SD. Recent advances in colorectal surgery. Surg Innov 2005; 11:221-4. [PMID: 15756390 DOI: 10.1177/155335060401100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Izadpanah A, Hosseini SV. Comparison of electrotherapy of hemorrhoids and Ferguson hemorrhoidectomy in a randomized prospective study. Int J Surg 2005; 3:258-62. [PMID: 17462295 DOI: 10.1016/j.ijsu.2005.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 09/25/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ferguson hemorrhoidectomy has been shown to be associated with significant amount of post-operative (post op) pain and complications. However, electrotherapy in which hemorrhoidal tissue is not excised might not be associated with severe complications. OBJECTIVE Our aim was to compare the results of Ferguson hemorrhoidectomy with electrotherapy methods using 16 and 30 mA (milliampers) direct current (DC). METHODS Four hundred and eight patients with symptomatic hemorrhoids, grades 1, 2 and 3, were randomly assigned into 3 groups. Group A (136 patients) underwent Ferguson hemorrhoidectomy, group B1 (136 patients) and group B2 (136 patients) were subjected to electrotherapy using 16 and 30 mA, respectively. The groups were compared in terms of duration of procedures, duration of hospital stay, post op pain severity and post op complications including recurrence, infection and non-healing ulcers. RESULTS All patients in group A had severe pain for 7-14 days of post op. However, in group B1, 88(65%) patients had mild pain during the treatment and 1st post op day; 28(21%) of them could not tolerate the operation; 20(15%) of them had mild pain and 10(7.5%) of them had moderate pain up to day 7. In group B2, 47(35%) of patients had sever pain for 6 h and 20(15%) of them experienced mild pain for 2-7 days post op. The one day hospital stay in group A and group B2 were 82 and 97%, respectively, while patients in group B1 were treated as out patients. Mean procedure time for one hemorrhoidectomy in group A was 23 min, in electrotherapy using 16 and 30 mA was 9.7 and 6.1 min, respectively. The overall success rate with the first application in group B1 was 57% and in group B2 was 93%. CONCLUSION Electrotherapy method using 30 mA DC could significantly decrease post op pain, operation time and hospital stay. This method had good success rate and very low post op complications compared to Ferguson hemorrhoidectomy and using 16 mA method. Therefore, due to its effectiveness, less pain, rapidity and safeness, we recommend it.
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Affiliation(s)
- Ahmad Izadpanah
- Division of Colorectal Surgery, Department of General Surgery, University of Medical Sciences, Shiraz, Iran.
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Abstract
PURPOSE This prospective, randomized, clinical trial compared the outcome of surgical hemorrhoidectomy by open and closed techniques in terms of postoperative pain, wound healing, and morbidity. METHODS All consecutive patients with Grade III internal hemorrhoids with prominent external components or Grade IV hemorrhoids were randomly allocated to one of two groups. The entire wound was left open in the open group and completely closed using 5-0 chromic sutures in the closed group. Postoperative pain was assessed by a linear analog scale. Additional consumption of oxycodone hydrochloride on the day of surgery and at defecation during the first week was recorded. Patients were followed up 1, 2, and 3 weeks after the procedure. RESULTS There were 40 patients in each group. Pain score at recovery from the anesthesia was significantly lower in the closed group (P < 0.05). Altogether, 15 percent of patients in the closed group required additional oxycodone hydrochloride for pain compared to 45 percent in the open group (P < 0.01). The pain score at the first bowel movement was significantly lower in the closed group (P < 0.01). Wound healing was significantly faster in the closed group: 75 percent of patients in the closed group had healed at 3 weeks after the procedure compared to 18 percent in the open group (P < 0.001). CONCLUSIONS The closed technique is more advantageous with respect to less pain during the early postoperative period and faster wound healing.
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Affiliation(s)
- Seong Y You
- Department of Colon and Rectal Surgery, Hang Clinic Gangnam, Seoul, Korea.
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Abstract
Stapled hemorrhoidopexy is a new procedure for the treatment of symptomatic internal hemorrhoids. Experience and prospective trials are helping to define this procedure's role. Published data confirm that stapled hemorrhoidopexy offers similar control of symptoms with the benefits of reduced postoperative pain when compared with excisional techniques. Reduction in pain is the most significant benefit of this operation. Clearly, the cost of the stapling device exceeds the cost of the sutures required to perform an excisional hemorrhoidectomy. Patients should undergo medical therapy and rubber band ligation first; however, patients being considered for excisional hemorrhoidectomy should be offered stapled hemorrhoidectomy as a less painful alternative.
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Affiliation(s)
- Marc Singer
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Herand Abcarian
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Zmora O, Colquhoun P, Abramson S, Weiss EG, Efron J, Vernava AM, Nogueras JJ, Wexner SD. Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model. Surg Endosc 2004; 18:757-61. [PMID: 14735346 DOI: 10.1007/s00464-003-8141-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2003] [Accepted: 07/29/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND The procedure for prolapsing hemorrhoids (PPH) is a new surgical method for the treatment of symptomatic hemorrhoids. In cases of recurrent prolapse, the performance of a second PPH may result in a ring of mucosa and submucosa between the two circular staple lines. In this study, we used a porcine model to assess whether PPH can be safely performed twice. METHODS Five adult pigs underwent two PPH procedures in one session, leaving a ring of approximately 1 cm of mucosa between the two staple lines. One month later, the pigs were examined under anesthesia. The anal canal was assessed using the following four methods: (a) clinical examination, (b) evaluation of mucosal blood perfusion at different levels of the anal canal via a laser Doppler flow detector, (c) measurement of concentrations of hydroxyproline and collagen to check for fibrosis, and (d) histopathological examination. RESULTS At the completion of the study period, all five pigs showed no clinical evidence of anorectal dysfunction. On examination under anesthesia 1 month after surgery, there was no evidence of anal stenosis in any of the pigs. The mean mucosal blood flow between the two staple lines did not differ significantly from the flow measured proximally and distally (394 vs 363 and 339 flow units, respectively; p = NS). The collagen levels, based on hydroxyproline concentration, were 81 mcg/mg between the staple lines, compared to 82 and 79 proximally and distally, respectively ( p = NS). There was no significant difference in degree of fibrosis, as assessed histopathologically, between specimens taken from the ring between the staple lines and specimens taken from the area external to the staple lines. CONCLUSIONS The results of this porcine model suggest that a second synchronous PPH is feasible. A controlled experience involving human subjects is required to determine the safety and usefulness of this technique in cases of metachronous application for recurrent or residual hemorrhoids.
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Affiliation(s)
- O Zmora
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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Habr-Gama A, e Sous AHS, Roveló JMC, Souza JVS, Benício F, Regadas FSP, Wainstein C, da Cunha TMR, Marques CFS, Bonardi R, Ramos JR, Pandini LC, Kiss D. Stapled hemorrhoidectomy: initial experience of a Latin American group. J Gastrointest Surg 2003; 7:809-13. [PMID: 13129562 DOI: 10.1016/s1091-255x(03)00102-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of the present study was to determine the value of circular hemorrhoidectomy (procedure for prolapse and hemorrhoids [PPH]) on the basis of data collected prospectively during the initial experience of a group of Latin American surgeons. Between 2000 and 2001, PPH was performed using a circular stapler in 177 patients who had third- and fourth-degree hemorrhoidal disease. The average age of the patients was 47.7 years (range 26 to 85 years). Anal bleeding was the most common preoperative complaint (93.2%) followed by anal pain (60.2%), anal itching (43%), and constipation (41%). Hemorrhoids were classified as third degree in 132 patients (74%) and fourth degree in 45 patients (25.4%). Skin tags were detected in 86 patients (48.8%) and rectocele in 14 patients (7.9%). Data collected included patient demographics, type of anesthesia, and specific details of the surgery such as duration of the operation, distance from the staple line to the dentate line, need for complementary hemostasis, and any unexpected occurrences. Postoperative data collected included the degree of pain, which was evaluated on the basis of the type and dosage of analgesics required, laxative consumption, and the presence of bleeding, fever, urinary retention, or hematomas. Each patient completed a written questionnaire addressing these events. Patients returned for follow-up visits on days 7, 15, 30, and 90. Responses to pain, bleeding, fever, anal continence, recurrence of hemorrhoids, and level of satisfaction were compiled. The duration of the procedure ranged from 6 minutes to 2 hours (average 23 minutes), and most operations lasted no more than 20 minutes, with the exception of one that lasted 2 hours because of intraoperative bleeding. Intraoperative problems were minor. An additional one or a few sutures were required in 58.7% of patients to achieve perfect hemostasis. In 128 patients (72.3%) the hospital stay was less than 24 hours. Same-day surgery was chosen for 37 patients (20.9%). Pain was controlled with analgesia only using one to six doses of oral dipirona in 126 patients. Five patients were readmitted to the hospital: four for control of bleeding and one for conventional hemorrhoidectomy due to an acute episode of external hemorrhoidal thrombosis. At day 30, patients rated the efficacy of the procedure in alleviating preoperative symptoms as follows: 77.5% excellent; 16% good; 5.3% average, and 1.2% poor. At 3 months postoperatively no patient had had a recurrence of hemorrhoidal prolapse, and there were no instances of stenosis or anal incontinence. Surgeons also rated the efficacy of the procedure as excellent in 75%, good in 19.8%, average in 4.7%, and poor in 0.6%. With proper selection of patients and adequate stapling technique, stapled hemorrhoidectomy may be considered safe; it is easily learned, has a satisfactory degree of pain, and is well accepted by both patients and surgeons.
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Affiliation(s)
- Angelita Habr-Gama
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
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Affiliation(s)
- Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA
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Abstract
Technologic advances have contributed to numerous diverse approaches to the management of hemorrhoid disease over the past centuries. Better understanding of the pathophysiology and anatomy of the anal canal has also added to the increased success in the treatment of hemorrhoids. This article reviews the clinical and pathological aspects of hemorrhoid disease, emphasizing new therapeutic modalities.
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Affiliation(s)
- T Cristina Sardinha
- Department of Surgery, North Shore-Long Island Jewish Medical Center, New Hype Park, NY 11040, USA
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Orrom W, Hayashi A, Rusnak C, Kelly J. Initial experience with stapled anoplasty in the operative management of prolapsing hemorrhoids and mucosal rectal prolapse. Am J Surg 2002; 183:519-24. [PMID: 12034384 DOI: 10.1016/s0002-9610(02)00842-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Excisional hemorrhoidectomy has remained the standard procedure in the operative management of hemorrhoids. Innovations in surgical technique have recently been introduced to try to decrease the pain associated with it. Stapled anoplasty has had promising early results in this regard. The aim of this study was to determine the ease or difficulty in introducing this new procedure, its efficacy, safety, and pain profile. DATA SOURCES Nineteen patients underwent stapled anoplasty and were followed up from 8 weeks to 6 months postoperatively. Data were accrued through clinical evaluation and patient questionnaires. CONCLUSIONS Seventy-two percent of patients had good to excellent results. There were no significant complications. Eighteen patients underwent surgery in an ambulatory setting and were discharged from hospital in a mean of 189 minutes. The procedure is safe and easily mastered. The staple line should be placed precisely at 3.5 to 4 cm from the dentate line to ensure greater efficacy.
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Affiliation(s)
- William Orrom
- Department of Surgery, Capital Health Region, 302-2020 Richmond Ave., Victoria, British Columbia, Canada V8R 6R5
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