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De Nardi P, Maggi G, Pagnanelli M, Vlasakov I, Corbetta D. Hemorrhoid laser dearterialization: systematic review and meta-analysis. Lasers Med Sci 2023; 38:54. [PMID: 36695928 DOI: 10.1007/s10103-022-03703-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023]
Abstract
Hemorrhoidal disease is a common and troublesome condition. Excisional hemorrhoidectomy can assure the best chance of cure but it is hampered by postoperative pain and potential long-term morbidity therefore minimally invasive techniques have been developed. Since 2009 a doppler-guided hemorrhoidal dearterialization with laser (the hemorrhoidal laser procedure; HeLP) has been proposed to control symptoms without significant sequelae. The aim of this systematic review is to analyze the benefits and disadvantages of HeLP for symptomatic hemorrhoids. The Medline/PubMed, Embase, and Cochrane library databases were searched from January 2010 to March 2022, language was restricted to English and documents to the full text. Randomized and non-randomized, prospective and retrospective cohort studies were included. Risk of bias assessment was performed using the Risk of bias for non-randomized studies (ROBINS-I) and the RoB2 Tool for randomized clinical trial. Primary outcome was to assess the efficacy of HeLP on symptoms' resolution. Secondary objectives were postoperative pain and complications, comparison with other interventional techniques, and evaluation of long-term recurrence. Whenever possible, a meta-analysis was conducted. The GRADE approach was employed to assess the certainty of evidence. We included six non-randomized and one randomized study. HeLP improved or resolved preoperative symptoms in 83.6 to 100% of patients during follow-up. In the randomized study symptoms resolved in 90% of patients after HeLP and 53.3% after rubber band ligation as comparator. Published data indicate that HeLP is effective, relatively safe, with limited recurrence rate, after a short to medium follow-up. The quality of evidence was however low. There is a paucity of studies assessing the benefits or harms of laser dearterialization for the treatment of hemorrhoids and randomized trials are furthermore rare, therefore trials with adequate power and proper design, assessing the advantages and disadvantages of HeLP versus other minimally invasive techniques, are needed. Furthermore, studies evaluating long-term follow-up are wanted.
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Affiliation(s)
- Paola De Nardi
- Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Giulia Maggi
- Oncologic Surgery, Policlinico Casilino, Rome, Italy
| | | | | | - Davide Corbetta
- Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Wang X, Sheng Y, Wang Z, Wang W, Xia F, Zhao M, Han X. Comparison of different embolic particles for superior rectal arterial embolization of chronic hemorrhoidal bleeding: gelfoam versus microparticle. BMC Gastroenterol 2021; 21:465. [PMID: 34906095 PMCID: PMC8670118 DOI: 10.1186/s12876-021-02046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/30/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Whether different embolic particles with comparable diameter lead to similar beneficial effects in endovascular embolization of hemorrhoidal disease remains to be established. We sought to evaluate the efficacy and safety of different types of agents for superior rectal arterial embolization (SRAE) in patients with bleeding hemorrhoids. METHODS Patients with recurrent episodes of internal hemorrhoidal bleeding and chronic anemia treated by SRAE in three tertiary hospitals between March 2017 and June 2020 were retrospectively evaluated. The patients were divided into two study groups based on the embolic materials: embolization with coils (2-3 mm) + gelfoam particles at 350-560 μm (Group A, n = 23), embolization with coils (2-3 mm) + microparticles at 300-500 μm (Group B, n = 18). The technical success, preliminary clinical efficacy (percentage of patients without hematochezia), postoperative complications and short-term follow-up outcomes were analysed. RESULTS A total of 41 patients (27 males) with symptomatic hemorrhoids were included in the study, mean age was 47 ± 12 years (range 25-72). 39% (16) patients with grade II hemorrhoids while 61% (25) patients with grade III. The technical success rate of the embolization procedure was 100%, and the preliminary clinical efficacy (87.0% vs 88.9%) showed no significant difference between the 2 groups (p = 0.098). No patients reported post-procedural and short-term serious complications, such as infection, intestinal ischemia or massive hemorrhage during the follow-up period (range 6-15 months). CONCLUSIONS Both gelfoam particles and microparticles with comparable diameter in the endovascular treatment of hemorrhoidal bleeding demonstrated similarly good short-term efficacy and safety profile.
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Affiliation(s)
- Xuemin Wang
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, Shandong, People's Republic of China, 256603
| | - Yuguo Sheng
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong Province, People's Republic of China
| | - Zhu Wang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong Province, People's Republic of China
| | - Wenming Wang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong Province, People's Republic of China
| | - Fengfei Xia
- Department of Interventional Medicine and Vascular, Binzhou Peoples Hospital, Binzhou, Shandong, People's Republic of China, 256600
| | - Mengpeng Zhao
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong Province, People's Republic of China
| | - Xinqiang Han
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong Province, People's Republic of China.
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Wu CW, Pu TW, Kang JC, Hsiao CW, Chen CY, Hu JM, Lin KH, Lin TC. Preservation of superior rectal artery in laparoscopically assisted subtotal colectomy with ileorectal anastomosis for slow transit constipation. World J Gastroenterol 2021; 27:3121-3129. [PMID: 34168413 PMCID: PMC8192293 DOI: 10.3748/wjg.v27.i22.3121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/08/2020] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Slow transit constipation (STC) has traditionally been considered as a functional disorder. However, evidence is accumulating that suggests that most of the motility alterations in STC might be of a neuropathic etiology. If the patient does not meet the diagnosis of pelvic outlet obstruction and poorly response to conservative treatment, surgical intervention with subtotal colectomy may be effective. The most unwanted complication of the procedure is anastomotic leakage, however, preservation of the superior rectal artery (SRA) may reduce its incidence.
AIM To evaluate the preservation of the SRA in laparoscopically assisted subtotal colectomy with ileorectal anastomosis in STC patients.
METHODS This was a single-center retrospective observational study. STC was diagnosed after a series of examinations which included a colonic transit test, anal manometry, a balloon expulsion test, and a barium enema. Eligible patients underwent laparoscopically assisted total colectomy with ileorectal anastomosis and were examined between January 2016 and January 2018. The operation time, blood loss, time to first flatus, length of hospital days, and incidence of minor or major complications were recorded.
RESULTS A total of 32 patients (mean age, 42.6 years) who had received laparoscopic assisted subtotal colectomy with ileorectal artery anastomosis and preservation of the SRA. All patients were diagnosed with STC after a series of examinations. The mean operative time was 151 min and the mean blood loss was 119 mL. The mean day of first time to flatus was 3.0 d, and the mean hospital stay was 10.6 d. There were no any patients conversions to laparotomy. Post-operative minor complications including 1 wound infection and 1 case of ileus. There was no surgical mortality. No anastomosis leakage was noted in any of the patients.
CONCLUSION Laparoscopically assisted subtotal colectomy with ileorectal anastomosis and preservation of the SRA can significantly improve bowel function with careful patient selection. Sparing the SRA may protect against anastomosis leakage.
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Affiliation(s)
- Chien-Wei Wu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 10581, Taiwan
| | - Jung-Cheng Kang
- Division of Colon and Rectal Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei 10556, Taiwan
| | - Cheng-Wen Hsiao
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chao-Yang Chen
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Je-Ming Hu
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Kuan-Hsun Lin
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Tzu-Chiao Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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Zhang C, Wei HT, Hu W, Sun Y, Zhang Q, Abe M, Du Z, Xu Y, Zong L, Hu X. The feasibility of laparoscopic TSME preserving the left colic artery and superior rectal artery for upper rectal cancer. World J Surg Oncol 2020; 18:212. [PMID: 32811501 PMCID: PMC7436988 DOI: 10.1186/s12957-020-01986-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background Laparoscopic tumor-specific mesorectal excision (TSME) preserving the left colic artery and superior rectal artery is still a technically challenging procedure. We conducted this study to demonstrate the feasibility of this procedure for upper rectal cancer. Methods A total of 184 patients with upper rectal cancer were retrospectively analyzed in our cancer center between April 2010 and April 2017. These patients were treated with either laparoscopic TSME (n = 46) or laparoscopic total mesorectal excision (TME) (n = 138). In the TSME group, the left colonic artery and superior rectal artery were preserved while they were not in the TME group. Results The operation time in the TSME group was longer than that in the TME group (218.56 ± 35.85 min vs. 201.13 ± 42.65 min, P = 0.004). Furthermore, the number of resected lymph nodes in the TSME group was greater than that in the TME group (19.43 ± 9.46 vs. 18.03 ± 7.43, P = 0.024). The blood loss between the TSME and TME groups was not significant. No mortality occurred in either the TSME or TME groups. One patient in the TME group underwent conversion to laparotomy. The total postoperative complication rates in the TSME and TME groups were 8.7% and 17.4%, respectively. There was no difference in severe complications between the two groups (anastomotic leakage and stenosis). Conclusions Laparoscopic TSME preserving the left colic artery and superior rectal artery can be safely conducted for upper rectal cancer.
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Affiliation(s)
- Chi Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Hao-Tang Wei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China
| | - Wenqing Hu
- Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Yueming Sun
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qinyuan Zhang
- Department of Gastrointestinal Surgery, The First People's Hospital of Dali City, Dali, Yunnan Province, China
| | - Masanobu Abe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Zhuoran Du
- Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Yingying Xu
- Department of General Surgery, Yizhen People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu Province, China.
| | - Liang Zong
- Department of Gastrointestinal Surgery, Changzhi People's Hospital, The Affiliated Hospital of Changzhi Medical College, Changzhi, Shanxi Province, China.
| | - Xiang Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
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Han X, Xia F, Chen G, Sheng Y, Wang W, Wang Z, Zhao M, Wang X. Superior rectal artery embolization for bleeding internal hemorrhoids. Tech Coloproctol 2020; 25:75-80. [PMID: 32712932 DOI: 10.1007/s10151-020-02312-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate clinical efficacy and safety of superselective embolization of the superior rectal artery (SRA) for the treatment of internal hemorrhoidal bleeding. METHODS Patients with stage II and stage III internal hemorrhoids, treated by interventional embolization of the SRA in our department between January 2017 and June 2019 were retrospectively evaluated. All patients suffering from disabling chronic hematochezia and some with relative contraindications for operation (n = 17) or rejection of conventional hemorrhoidectomy (n = 15). Superselective SRA branch embolization was performed using gelatin sponge particles (350-560 μm) and metallic coils (2-3 mm). This treatment process was planned by a multidisciplinary team consisting of proctologist, gastroenterologist and radiologist. The surgical efficacy, postoperative complications and follow-up outcomes were observed. RESULTS There were 32 patients (18 males, mean age 52 ± 12 years, range: 22-78 years), 12 (37%) with stage II hemorrhoids and 20 (63%) with stage III hemorrhoids. Embolization was successful in all patients, and bleeding symptoms resolved in 27 (84.4%) patients. The remaining 5 (15.6%) patients underwent either stapled hemorrhoidopexy (n = 4) or sclerotherapy (n = 1). Some patients experienced different degrees of pain (n = 4;12.5%), low fever (n = 11;34.4%), and tenesmus (n = 17;53.1%), which all spontaneously regressed without further treatment. All patients were followed up for at least 1 year. There were no serious complications, such as infection, intestinal ischemia or massive hemorrhage. Four patients (14.8%) had rebleeding during the first months of follow-up. All patients with re-bleeding were successfully treated with internal iliac arteriography and branch embolization and did not experience further bleeds after a minimum follow up 3 months follow-up. CONCLUSIONS The short-term efficacy of superselective SRA embolization for grade II-III internal hemorrhoids is good, and this method is safe and feasible.
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Affiliation(s)
- X Han
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - F Xia
- Department of Interventional Medicine and Vascular, Binzhou Peoples Hospital, Binzhou, 256600, Shandong, People's Republic of China
| | - G Chen
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - Y Sheng
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - W Wang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - Z Wang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - M Zhao
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, Binzhou, 256603, Shandong, People's Republic of China
| | - X Wang
- Department of Gastroenterology, Binzhou Medical University Hospital, No.661 Huanghe 2nd Road, Binzhou, 256603, Shandong, People's Republic of China.
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Taira T, Murono K, Nozawa H, Hojo D, Kawai K, Hata K, Tanaka T, Ishihara S. A cross sectional study to investigate internal hernia post left-sided colectomy preserving superior rectal artery. Ann Med Surg (Lond) 2019; 48:124-128. [PMID: 31763040 PMCID: PMC6864359 DOI: 10.1016/j.amsu.2019.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/26/2019] [Accepted: 10/28/2019] [Indexed: 01/18/2023] Open
Abstract
Background and Purpose: Intestinal obstruction caused by an internal hernia projecting through a mesenteric defect is a rare sequela of laparoscopic colectomy, as surgeons usually leave such defects open. In this study, we investigated cases of internal hernia after laparoscopic left-sided colectomy. Methods Data of 308 patients who underwent laparoscopic left hemicolectomy or sigmoidectomy at our institute between 2013 and 2018 were retrospectively reviewed. Patient characteristics and surgical variables were analyzed. The distance between the superior rectal artery (SRA) and abdominal aorta at the level of aortic bifurcation was measured using postoperative computed tomography in patients who underwent SRA-preserving colectomy. Results In all, 3 patients (0.97%), all of whom had undergone colostomy without anastomosis and with SRA preservation, developed internal hernia passing between the SRA and the aorta. The distance between the SRA and abdominal aorta in patients who underwent ostomy was significantly more than that in patients who underwent non-ostomy (10.6 mm vs. 4.7 mm, respectively, p < 0.001). Conclusions SRA preservation and stoma construction are potential risk factors for internal hernia after laparoscopic left-sided colectomy. Lifting of the SRA due to stoma construction possibly enlarges the space between the SRA and aorta. When colostomy is created, it is important to evaluate the space behind the SRA.
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Affiliation(s)
- Tetsuro Taira
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daisuke Hojo
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Tseng WK, Yu YL, Fan CW. Colonoscopy-induced right superior rectal artery tear: A case report. Int J Surg Case Rep 2017; 41:47-49. [PMID: 29032279 PMCID: PMC5645518 DOI: 10.1016/j.ijscr.2017.07.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/28/2017] [Accepted: 07/30/2017] [Indexed: 02/05/2023] Open
Abstract
Colonoscopy examination induced mesentery injury and subsequent massive hemoperitoneum is rare. Angiography and computer tomography study help to identify bleeder and control the bleeder with highly selective embolization. Non surgical intervention of mesentery artery injury is feasible under superselective angiography embolization.
Introduction Colonoscopy is a well-accepted procedure applied worldwide in diagnosis and management of colon lesions. The incidence of reported complications is not rare. Presentation A 79-year-old man with postcolonoscopy intraperitoneal bleeding secondary to superior rectal artery injury. He received computer tomogram and angiogram study to confirmed bleeder from right superior rectal artery and subsequently managed with embolization and operation. Discussion This is the second case report in the literatures of mesentery tear and the first case with massive hemoperitoneum. Conclusion Identification and careful evaluation are crucial for successful diagnosis and treatment in cases such as this after colonoscopy.
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Affiliation(s)
- Wen-Ko Tseng
- Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle District, KeeLung, Taiwan, ROC.
| | - Yen-Lin Yu
- Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle District, KeeLung, Taiwan, ROC.
| | - Chung-Wei Fan
- Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle District, KeeLung, Taiwan, ROC.
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Luo CS, Jia YP, Mao AW, Yang W. [Preliminavy clinical study of the treatment of hemorrhoids by superselective embolization of superior rectal artery]. Zhonghua Yi Xue Za Zhi 2017; 97:1960-1963. [PMID: 28693075 DOI: 10.3760/cma.j.issn.0376-2491.2017.25.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the safety and feasibility of the treatment of hemorrhoids by superselective arterial embolization. Methods: The clinical data of 15 patients with grade Ⅱ to Ⅳ hemorrhoids were collected who were treated by superselective SRA embolization.According to the number and shape of SRA in the vicinity of the dentate line, chosed coils, PVA particles and gelfoam particles, ethanol and bletilla mixture of gelfoam particles for embolization.And intraoperative operations, postoperative complications, follow-up treatment results were observed. Results: The interventional procedures were successfully accomplished in all 15 cases.The operation time was (30±14) min, and the hospital stay was 1-7 (2.0±1.8) days after operation, and the patients recovered to normal life in 12 hours after the operation.Tenesmus (14/15), pain (5/15) and low fever (11/15) can alleviate without special treatment. All patients were follow up (19.0±2.6) months, bleeding symptoms were cured, there's no serious complications. Conclusion: The treatment of hemorrhoids by transcatheter superselective embolization of superior rectal artery is technically safe and feasible.
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Affiliation(s)
- C S Luo
- Department of Colorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Sohn M, Schlitt HJ, Hornung M, Zülke C, Hochrein A, Moser C, Agha A. Preservation of the superior rectal artery: influence of surgical technique on anastomotic healing and postoperative morbidity in laparoscopic sigmoidectomy for diverticular disease. Int J Colorectal Dis 2017; 32:955-60. [PMID: 28378155 DOI: 10.1007/s00384-017-2792-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the impact of superior rectal artery (SRA) sparing technique on anastomotic leakage in laparoscopic sigmoidectomy for diverticular disease. MATERIAL AND METHODS A retrospective multicenter analysis of all patients undergoing laparoscopic sigmoid resection for diverticular disease between 2002 and 2015 was conducted. Data were recorded in three hospitals: University Hospital Regensburg, Marienhospital Gelsenkirchen, and Städtisches Klinikum München Bogenhausen. The SRA was resected between 2002 and 2005. Since 2005, the artery was preserved in most cases. RESULTS Two hundred sixty-seven patients were included. One hundred sixty patients presented with complicated diverticulitis (60%). The SRA was resected in 102 patients (group 1) and preserved in 157 patients (group 2, no data in eight cases). Anastomotic leakage occurred in 7% of patients in group 1 and 1.9% of patients in group 2 (p = 0.053). Duration of surgery was significantly shorter (157 vs. 183 min, p < 0.001) in group 2 patients. Length of hospital stay was without significant difference (group 1 8.2 days; group 2 8.3 days; p = 0.83). The conversion rate was higher in group 2 patients; however, the difference was not statistically significant (9 vs. 3%, p = 0.07). There was no significant difference between both groups regarding intraoperative complications and overall complication rate. The length of the resected specimen (19 vs. 21 cm, p = 0.001) was significantly shorter in group 2 patients. CONCLUSION Preservation of the SRA seems to be associated with favorable outcome in patients undergoing laparoscopic sigmoid resection for diverticular disease.
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Borchert DH, Schachtebeck M, Schoepe J, Federlein M, Bunse J, Gellert K, Burghardt J. Observational study on preservation of the superior rectal artery in sigmoid resection for diverticular disease. Int J Surg 2015; 21:45-50. [PMID: 26192969 DOI: 10.1016/j.ijsu.2015.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 07/13/2015] [Indexed: 11/18/2022]
Abstract
AIM Recent investigations have shown improved patient reported outcome after preservation of the inferior mesenteric artery in sigmoid resection for diverticular disease. We report on our experience with preservation of the superior rectal artery (SRA). METHODS This is an observational single center study in a high-volume, level II inner city hospital from 2006 to 2008. Inclusion criteria were all patients with diverticular disease. Exclusion criteria were stoma formation, cancer, and iatrogenic perforation. Patients were investigated in group A with preservation of the SRA, and group B ligation of the SRA. Outcomes assessed, included incidence of anastomotic breakdown, intraoperative complications, hospital stay, and risk factors. RESULTS The patient population included 259 patients, 46 patients were excluded, leaving 100 patients in group A and 113 patients in group B. Patients in both groups were comparable regarding age, gender, co-morbidities and stage of disease. Anastomotic breakdown occurred in one patient in group A and in eight patients in group B (p = 0.038). Incidence of intraoperative bleeding, wound dehiscence, and length of stay was increased in group B (p < 0.03; p < 0.04; p = 0.05). Obesity was an independent risk factor for anastomotic dehiscence in group B (p < 0.04). CONCLUSION Our data comprise the largest patient population reported so far on vascular preservation in surgery for diverticular disease. The results of this study support the establishment of evidence based recommendations on the level of dissection in diverticular disease. Specifically obese patients are at risk of anastomotic breakdown with ligation of the SRA.
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Affiliation(s)
- D H Borchert
- Department of General, Visceral, Vascular and Pediatric Surgery, and Institute of Biometry, Epidemiology and Medical Informatics, Saarland University Hospitals, Kirrberger Straße 100, 66421 Homburg, Saarland, Germany.
| | - M Schachtebeck
- Department of Medicine Werner-Forßmann Hospitals, Rudolf-Breitscheid-Straße 100, 16225 Eberswalde, Germany
| | - J Schoepe
- Department of General, Visceral, Vascular and Pediatric Surgery, and Institute of Biometry, Epidemiology and Medical Informatics, Saarland University Hospitals, Kirrberger Straße 100, 66421 Homburg, Saarland, Germany
| | - M Federlein
- Department of General and Visceral Surgery, Sana Hospital Lichtenberg, Sana Hospitals Berlin-Brandenburg, Affiliated Teaching Hospital to the Charité, Fanningerstraße 32, 10365 Berlin, Germany
| | - J Bunse
- Department of General and Visceral Surgery, Sana Hospital Lichtenberg, Sana Hospitals Berlin-Brandenburg, Affiliated Teaching Hospital to the Charité, Fanningerstraße 32, 10365 Berlin, Germany
| | - K Gellert
- Department of General and Visceral Surgery, Sana Hospital Lichtenberg, Sana Hospitals Berlin-Brandenburg, Affiliated Teaching Hospital to the Charité, Fanningerstraße 32, 10365 Berlin, Germany
| | - J Burghardt
- Department of Surgery, Immanuel Hospital Rüdersdorf, Seebad 82, 15562 Rüdersdorf, Germany
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Iqbal J, Kaman L, Parkash M. Traumatic Pseudoaneurysm of Superior Rectal Artery - an Unusual Cause of Massive Lower Gastrointestinal Bleed: A Case Report. Gastroenterology Res 2011; 4:36-38. [PMID: 27957012 PMCID: PMC5139800 DOI: 10.4021/gr274w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2011] [Indexed: 12/22/2022] Open
Abstract
Traumatic pseudoaneurysm of superior rectal artery is an unusual cause of massive lower gastrointestinal bleed. We are reporting the first case as we could not come across any similar report in the literature. Patient underwent exploratory laparotomy, diversion sigmoid loop colostomy, perineal wound debridement and antiseptic dressing for traumatic perineal wound. Patient had repeated episode of massive lower gastrointestinal bleeding and was diagnosed as a case of bleeding from superior rectal artery pseudoaneurysm which was managed by selective superior rectal artery embolization after failure of surgical treatment.
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Affiliation(s)
- Javid Iqbal
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Mahesh Parkash
- Department of Radio Diagnosis, PGIMER, Chandigarh, India
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