1
|
Lie H, Lukito PP, Sudirman T, Purnama AA, Sutedja R, Setiawan A, Jeo WS, Irawan A, Satriya W, Koerniawan HS, Hariyanto TI. Utility of botulinum toxin injection for post-operative pain management after conventional hemorrhoidectomy: a systematic review and meta-analysis of clinical trials. Scand J Gastroenterol 2023; 58:116-122. [PMID: 36048469 DOI: 10.1080/00365521.2022.2116292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Botulinum Toxin (BTX) has been found to have anti-spasm and analgesic effects. The utility of BTX after conventional hemorrhoidectomy remains unclear. Thus, a systematic review and meta-analysis are required to find out its utility after conventional hemorrhoidectomy. METHODS Using specific keywords, we comprehensively go through the potential articles on PubMed, ClinicalTrials.gov, and Europe PMC sources until March 27th, 2022. All published studies on botulinum toxin anal sphincter injection after conventional hemorrhoidectomy were collected. We were using Review Manager 5.4 software to conduct statistical analysis. RESULTS Five clinical trial studies with a total of 260 patients undergoing hemorrhoidectomy were included in the analysis Our pooled analysis revealed that BTX injection after hemorrhoidectomy was associated with lower VAS at 24 h post-operative [Mean Difference -1.35 (95% CI -1.90, -0.80), p < 0.00001, I2 = 0%] and shorter time to return work [Mean Difference -8.94 days (95% CI -12.57, -5.30), p < 0.00001, I2 = 0%]. However, BTX injection did not differ significantly from placebo in terms of time to first defecation (p = 0.22), fecal incontinence (p = 0.91) and urinary retention incidence (p = 0.18). CONCLUSION BTX sphincter injection may offer some benefit after conventional hemorrhoidectomy in reducing pain from the first day after the procedure and promoting wound healing without complication. Further randomized clinical trials are still needed to confirm the results of our study.
Collapse
Affiliation(s)
- Hendry Lie
- Surgery Department, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Patrick Putra Lukito
- Surgery Department, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Taufik Sudirman
- Surgery Department, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | | | - Rudy Sutedja
- Surgery Department, Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia
| | - Andre Setiawan
- Surgery Department, Siloam Hospitals Kebon Jeruk, Jakarta, Indonesia
| | - Wifanto Saditya Jeo
- Surgery Department, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Andry Irawan
- Surgery Department, Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Willi Satriya
- Surgery Department, Gunung Maria General Hospitals, Tomohon, Indonesia
| | | | | |
Collapse
|
2
|
Moldovan C, Rusu E, Cochior D, Toba ME, Mocanu H, Adam R, Rimbu M, Ghenea A, Savulescu F, Godoroja D, Botea F. Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review. World J Clin Cases 2023; 11:366-384. [PMID: 36686344 PMCID: PMC9850966 DOI: 10.12998/wjcc.v11.i2.366] [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] [Received: 11/26/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise.
AIM To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities.
METHODS We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons.
RESULTS Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients.
CONCLUSION Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.
Collapse
Affiliation(s)
- Cosmin Moldovan
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Elena Rusu
- Department of Preclinic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
| | - Daniel Cochior
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Sanador Clinical Hospital, Bucharest 010991, Romania
- Department of General Surgery, Monza Clinical Hospital, Bucharest 021967, Romania
| | - Madalina Elena Toba
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Horia Mocanu
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of Ear, Nose and Throat, Ilfov County Clinical Emergency Hospital, Bucharest 022104, Romania
| | - Razvan Adam
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of Orthopedics and Traumatology, Elias Emergency University Hospital, Bucharest 011461, Romania
| | - Mirela Rimbu
- Medical Doctoral School, Titu Maiorescu University of Bucharest, Bucharest 040317, Romania
| | - Adrian Ghenea
- Department of Coloproctology, MedLife SA Băneasa Hyperclinic, Bucharest 013693, Romania
| | - Florin Savulescu
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- 2nd Department of Surgery, Carol Davila Central Military Emergency University Hospital, Bucharest 010242, Romania
| | - Daniela Godoroja
- Department of Anesthesia, Ponderas Academic Hospital, Bucharest 014142, Romania
| | - Florin Botea
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- 2nd Department of Surgery, Fundeni Clinical Institute, Bucharest 022328, Romania
| |
Collapse
|
3
|
Yang Y, Feng K, Lei Y, Qiu L, Liu C, Li G. Comparing the efficacy and safety of different analgesic strategies after open hemorrhoidectomy: a systematic review and network meta-analysis. Int J Colorectal Dis 2023; 38:4. [PMID: 36609578 DOI: 10.1007/s00384-022-04294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the clinical efficacy and safety of different analgesic interventions in the treatment of pain after open hemorrhoidectomy by systematic review and network meta-analysis. METHODS Randomized controlled trials that met the inclusion criteria in PubMed, Cochrane Library, Embase, Web of Science, Scopus, CNKI, WANFANG DATA, and VIP were searched from the date of database construction to June 28, 2022. RESULTS Among the 13 randomized controlled trials (RCTs), 731 patients were included in the network meta-analysis. Most interventions are more effective than placebo in relieving postoperative pain. 24 h postoperative Visual Analogue Scale (VAS): glyceryl trinitrate (GTN) (mean difference (MD) - 4.20, 95% CI - 5.35, - 3.05), diltiazem (MD - 1.97, 95% CI - 2.44, - 1.51), botulinum toxin (BT) (MD - 1.50, 95% CI - 2.25, - 0.75), sucralfate (MD - 1.01, 95% CI - 1.53, - 0.49), and electroacupuncture (EA) (MD - 0.45, 95% CI - 0.87, - 0.04). 48 h postoperative VAS: diltiazem (MD - 2.45, 95% CI - 2.74, - 2.15), BT (MD - 2.18, 95% CI - 2.52, - 1.84), and sucralfate (MD - 1.41, 95% CI - 1.85, - 0.97). 7 d postoperative VAS: diltiazem (MD - 2.49, 95% CI - 3.20, - 1.78) and sucralfate (MD - 1.42, 95% CI - 2.00, - 0.85). The first postoperative defecation VAS: EA (MD - 0.70, 95% CI - 0.95, - 0.46). There are few data on intervention safety, and additional high-quality RCTs are expected to study this topic in the future. CONCLUSION Diltiazem ointment may be the most effective medication for pain relief following open hemorrhoidectomy, and it can dramatically reduce pain within one week of surgery. The second and third recommended medications are BT and sucralfate ointment. GTN has a significant advantage in alleviating pain 24 h after open hemorrhoidectomy, but whether it causes headache is debatable; thus, it should be used with caution. EA's analgesic efficacy is still unknown. There was limited evidence on the safety of the intervention in this study, and it was simply presented statistically.
Collapse
Affiliation(s)
- Yue Yang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Ke Feng
- Department of General Surgery, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Yuting Lei
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Li Qiu
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Guofeng Li
- Department of Anorectal Diagnosis and Treatment Center, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China.
| |
Collapse
|
4
|
New Findings at the Internal Anal Sphincter on Cadaveric Dissection and Review of Sphincter-Related Surgery in a Newer Prospective. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03537-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
5
|
Li W, Xu J, Li T, Bi Y, Ren W, Wei S. Efficacy of posterior median anal incision with incision and drainage of the anal sinus on chronic anal fissure. Am J Transl Res 2022; 14:432-439. [PMID: 35173862 PMCID: PMC8829648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND To explore the efficacy of posterior median anal incision plus incision and drainage of anal sinus on chronic anal fissure (CAF), and its influence on incidence and recurrence of postoperative infection. METHODS Altogether 130 patients with CAF treated during January 2017 and January 2021 were included and divided into a research group (RG) and control group (CG). Among them, 80 patients in the RG were treated with posterior median anal incision and expansion plus anal sinus incision and drainage, while 50 in the CG were treated with lateral internal sphincterotomy. Clinical indexes (wound healing time, recovery time of bowel sounds, intraoperative blood loss, length of stay), levels of inflammatory factors (IL-6, IL-8, CRP) before and one week after treatment, changes of psychological and emotional scores (SAS, SDS scores) before and 6 months after treatment, sleep and scores of daily activities after admission and 6 months after treatment, VAS scores at 1 day, 1 week and 2 weeks after operation, compliance, total effective rate, and incidence and recurrence rate of postoperative incision infection were compared between the groups. RESULTS Compared with the CG, the wound healing time, recovery time of bowel sounds and length of stay were shorter, and intraoperative blood loss was lower in the RG; the levels of IL-6, IL-8 and CRP were lower in RG one week after treatment. Six months after treatment, the SAS, SDS and PSQI scores were lower, the ADL scores were higher, the compliance and total effective rate were higher, and the incidence and recurrence rate of postoperative incision infection were lower in the RG. CONCLUSION Posterior median anal incision plus incision drainage of the anal sinus has better efficacy on CAF, and can effectively reduce the incidence of postoperative infection and recurrence.
Collapse
Affiliation(s)
- Wei Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Jiacheng Xu
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Tao Li
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Yuhe Bi
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Weicai Ren
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| | - Shengchao Wei
- Department of Anorectal Surgery, Jinan City People's Hospital Jinan 271199, Shangdong, China
| |
Collapse
|
6
|
Cheng YC, Beh JYM, Wu PH, Tsai NY, Jao SW. Early botulinum toxin injection reduces pain after hemorrhoidectomy: a pilot study. Tech Coloproctol 2021; 26:53-60. [PMID: 34705137 DOI: 10.1007/s10151-021-02542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hemorrhoidectomy is the standard procedure for treating high-grade hemorrhoids. However, postoperative pain usually causes patients to delay or refuse surgical treatment. Because maximal resting pressure in the internal anal sphincter plays a major role in post-hemorrhoidectomy pain, Botulinum toxin injections have been proposed to reduce it. However, the optimal timing of Botulinum toxin injections is still unclear. The aim of the present study was to compare the effectiveness of early and intraoperative Botulinum toxin injections for postoperative pain control. METHODS In this pilot study, we enrolled patients who had grade III or IV hemorrhoids and underwent Ferguson hemorrhoidectomy at a single tertiary care center from October 1, 2018 to November 30, 2020. The experimental group received 50 U Botulinum toxin injections to the internal anal sphincter 1 week before the operation, and the control group received injections intraoperatively. The primary endpoint was the daily maximal and resting visual analogue scale (VAS) score recorded from postoperative days 0-6. The secondary endpoints were analgesia requirements, number of bowel movements per day, healing time, and postoperative length of stay. Power of the daily resting VAS score is at least 93%, but the power of the daily maximal VAS is a little lower (71%) (calculated by G*Power 3.1.9.2). RESULTS Sixty-two patients (male: female = 27:35; mean age = 47.6 ± 13.1 years) were randomized to the experimental group (n = 31) or control group (n = 31). The experimental group (n = 31) showed significantly shorter postoperative hospital stay than the controls (n = 31; p = 0.019). A generalized estimating equations model revealed that the group that received Botulinum toxin yielded a significantly lower maximal (OR 0.4, 95% CI 0.2-1.0, p = 0.041) and resting (OR 0.4, 95% CI 0.2-0.7, p < 0.001) VAS compared to controls at all time points. The Botulinum toxin group also had significantly less resting pain from postoperative days 1-5, and lower maximal subjective pain scores on postoperative days 1 (p = 0.024) and 4 (p = 0.044). Similar trends were observed on other days. CONCLUSIONS Early Botulinum toxin injection produced shorter hospital stays, and less reported pain after hemorrhoidectomy than intraoperative injections, especially for pain at rest. TRIAL REGISTRATION Identifier: NCT04485780 on ClinicalTrials.gov (retrospectively registered).
Collapse
Affiliation(s)
- Yi-Chiao Cheng
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Neihu District, Section 2, Cheng-Kong Rd, No. 325, Taipei, 114, Taiwan, ROC
| | | | - Po-Hsien Wu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Neihu District, Section 2, Cheng-Kong Rd, No. 325, Taipei, 114, Taiwan, ROC
| | - Nien-Ying Tsai
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Wen Jao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Neihu District, Section 2, Cheng-Kong Rd, No. 325, Taipei, 114, Taiwan, ROC.
| |
Collapse
|
7
|
Xu S, Qiu J, Zhang H, Lu J, Huang W. Influences of Hiao's double-C nursing model combined with pain care on postoperative satisfaction with pain control and complications in patients with mixed hemorrhoids. Am J Transl Res 2021; 13:10676-10684. [PMID: 34650742 PMCID: PMC8507025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the influences of Hiao's double-C nursing model combined with pain care on postoperative satisfaction with pain control and complications in patients with mixed hemorrhoids. METHODS A total of 80 patients with mixed hemorrhoids admitted to our hospital from January 2019 to October 2020 were selected as the study subjects, and they were divided into a regular group (n = 43) and a combined group (n = 37) based on different nursing methods. The regular group was treated with routine nursing care, while the combined group was treated with Hiao's double-C nursing model combined with pain care. The degrees of pain, duration of pain, satisfaction with pain control, quality of life and complications were compared between the two groups. RESULTS At 6 h, 24 h and 72 h after surgery, the combined group had markedly lower visual analogue scale (VAS) scores and a noticeably shorter duration of pain than that of the regular group (P < 0.05). Compared with the regular group, the combined group scored significantly lower on pain experience and expectation, and influences of pain on emotions, body and life, and significantly higher on satisfactions with pain control education and pain control or relief and overall satisfaction (P < 0.05). After intervention, the scores of quality of life, and physical, social and psychological functions were elevated in both groups (P < 0.05), and the aforementioned scores in the combined group were significantly higher than those in the regular group (P < 0.05). The incidence rate of complications in the combined group was notably lower than that in the regular group (8.11% vs. 41.86%, P < 0.05). CONCLUSION Hiao's double-C nursing model combined with pain care can effectively improve postoperative degrees of pain, satisfaction with pain control and complications, and duration of pain.
Collapse
Affiliation(s)
- Shuhua Xu
- Hospital Infection-Control Department, The Third Affiliated Hospital of Gannan Medical UniversityGanzhou 341000, Jiangxi Province, China
| | - Jianwen Qiu
- Department of Surgery, Ganzhou Maternal and Child Health Care HospitalGanzhou 341000, Jiangxi Province, China
| | - Hongwei Zhang
- Endoscopic Room, The Third Affiliated Hospital of Gannan Medical UniversityGanzhou 341000, Jiangxi Province, China
| | - Jing Lu
- Department of Surgery, The Third Affiliated Hospital of Gannan Medical UniversityGanzhou 341000, Jiangxi Province, China
| | - Weixin Huang
- Department of Colorectal Surgery, The Third Affiliated Hospital of Gannan Medical UniversityGanzhou 341000, Jiangxi Province, China
| |
Collapse
|
8
|
Vijayaraghavalu S, Prasad R G, Rajkumar S. The Role of Lateral Internal Sphincterotomy in Haemorrhoidectomy: A Study in a Tertiary Care Center. Cureus 2021; 13:e15630. [PMID: 34306842 PMCID: PMC8277982 DOI: 10.7759/cureus.15630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hemorrhoids are a common condition that presents with bleeding per rectum, pain at rest and defecation, mucosal discharge, and prolapse. Surgical hemorrhoidectomy is the treatment method of choice for Grade 3 and Grade 4 hemorrhoids. Hemorrhoidectomy is associated with postoperative pain and no single surgical technique has been proved to significantly reduce the pain. We analyzed in our study the effect of lateral internal sphincterotomy with hemorrhoidectomy on postoperative pain, anorectal function, and retention of urine after the Milligan and Morgan technique. Methods This randomized, prospective, and comparative study included 200 Grade 3 and Grade 4 hemorrhoids patients who were scheduled for surgical management. The patients were classified randomly into two groups with an equal number of participants: Group A underwent Milligan & Morgan open hemorrhoidectomy and Group B underwent lateral internal sphincterotomy (LIS) in addition to Milligan and Morgan open hemorrhoidectomy. Postoperative pain was recorded using the Visual Analog Scale (VAS) score for up to 48 hours. Postoperative bleeding, urinary retention, and bowel and gas incontinence were noted. Long-term follow-up at six and 24 months for anal stenosis, anal fissure, incontinence, and recurrence was also noted. Results Patients who underwent LIS showed a significant reduction in postoperative pain at 12 hours (p=0.0008*), 24 hours (p=0.000*), and 48 hours (p=0.003*); the time taken to request rescue analgesia was similar between the two groups (p=0.07). Side effects, such as postoperative bleeding and urinary retention, were significantly lower after LIS (p=0.001* and p=0.01*, respectively), and gas incontinence was significantly higher after LIS (p=0.002*). The long-term outcomes of anal fissure were significantly higher without LIS at six months (p=0.02*) and 24 months (p=0.04*) and those of anal stenosis were significantly higher without LIS at six months (p=0.04*). Conclusions From our study, we conclude that postoperative pain, bleeding, and urinary retention were significantly lower after LIS, and gas incontinence was transient. The long-term outcomes, which included anal stenosis and anal fissure, were significantly lower after LIS. However, bowel and gas incontinence and recurrence were not altered. Therefore, we conclude that the addition of LIS to hemorrhoidectomy improves patient outcomes in terms of postoperative pain and anorectal function.
Collapse
Affiliation(s)
| | - Guru Prasad R
- General Surgery/Surgical Oncology, ACS Medical College Hospital, Chennai, IND
| | | |
Collapse
|
9
|
The Sub-Saharan Experience of Excisional Haemorrhoidectomy with Simultaneous Lateral Internal Sphincterotomy. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
10
|
Laubert T, Jongen J. Supportive Therapie nach proktologischen Eingriffen. COLOPROCTOLOGY 2019. [DOI: 10.1007/s00053-019-0349-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|