Procedure for prolapse and hemorrhoids for grade III and IV internal hemorrhoids: A systematic review

ABSTRACT Background and objectives: Bleeding from hemorrhoids is the commonest cause of rectal bleeding in adults. Injection sclerotherapy of internal hemorrhoids is one of the non-surgical treatments, and is simple, safe and feasible. Conventionally sclerotherapy is performed with rigid proctoscope which has limitations of maneuverability, narrower field of vision and documentation compared to flexible videoendoscope. Therefore, we assessed the efficacy and safety of video-colonoscopic sclerotherapy for bleeding internal hemorrhides. Methods: Seventy-nine patients of bleeding internal hemorrhoids were subjected to colonoscopic sclerotherapy using 1.5% polidocanol in retroflexed or forward viewing positions. Success of treatment was defined as cessation of bleeding for six weeks. Patients were observed for complications and were followed up regularly for 3 months. Results: A total of 79 evaluable patients, 61 had grade II and 18 had grade III hemorrhoids. There was no statistically significant differences in achieving excellent or good results for control of bleeding between patients with grade II and grade III hemorrhoids (100% vs 94,5%; p>0.05). The number of sessions of sclerotherapy required were significantly more in grade II than grade III hemorrhoids (1.1 ± 0.3 vs 1.3 ± 0.7; p = 0.04). No significant complications were noted except for bloating in ten patients (12.6 %) and rectal pain in 6 (7.6%) patients. Median time taken for the procedure was 30 minutes. Conclusions: Video-endoscopic sclerotherapy is safe, well-tolerated and effective treatment for bleeding internal hemorrhoids.(J Dig Endosc 2011;2(1):1-5)

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Treatment of Grade III Acromioclavicular Joint Injuries: A Systematic Review

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)79225-3 ◽

2008 ◽

Vol 2008 ◽

pp. 212

Author(s):

B.F. Morrey

Keyword(s):

Systematic Review ◽

Acromioclavicular Joint ◽

Joint Injuries ◽

Grade Iii

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Comparison of Milligan Morgan Hemorrhoidectomy and Stapled Hemorrhoidectomy In Recent Years For Patients With Grade III And IV Hemorrhoids: A Meta-Analysis

QJM ◽

10.1093/qjmed/hcab097.017 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mohamed Kandel Abd-Elfattah ◽

Ibrahim Magid Abd-Elmaksud ◽

Aya Essam Mohamed Abd-Elmoniem

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

Current Evidence ◽

Anal Stenosis ◽

Stapled Hemorrhoidectomy ◽

Eligibility Criteria ◽

Surgical Methods ◽

Internal Hemorrhoids ◽

Ethical Approval ◽

Grade Iii

Abstract Background Hemorrhoids are one of the most common conditions in the world, and grade III and IV internal hemorrhoids are mainly treated with surgery. However, there are many different surgical methods, and many postoperative complications occur. Therefore, we aimed to compare of milligan morgan (MM) hemorrhoidectomy and stapled hemorrhoidectomy (ST) for patients with grade III And IV Hemorrhoids. Objective To compere between Milligan-Morgan hemorrhoidectomy and Stapled hemorrhoidectomy as regards postoperative anal stenosis and fecal incontinence in recent years for treatment grade III and IV hemorrhoids using a meta-analysis approach. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion It is concluded that ST appeared to be the best surgical procedure than MM for grade III and IV hemorrhoids based on the current evidence.

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EVALUATION THE SURGICAL TREATMENT OF HEMORRHOID DISEASE BY TRANSANAL HEMORRHOIDAL DEARTERIALISATION (THD)

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.5.12 ◽

2013 ◽

pp. 76-82

Author(s):

Van Lieu Nguyen ◽

Doan Van Phu Nguyen ◽

Thanh Phuc Nguyen

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Hospital Stay ◽

Mucosal Prolapse ◽

Safe Procedure ◽

Average Hospital ◽

Rectal Mucosal Prolapse ◽

Internal Hemorrhoids ◽

Grade Iii

Introduction: Since 2006 Transanal hemorrhoidal dearterialization (THD), as a Doppler - guided Minimally Invasive Therapeutic Approach to Hemorrhoids, has been widely applied in European countries, America owing to its remarkable advantages over other surgical procedures such as less postoperative pain, shorter length of hospital stay, absence of serious complications, sooner recovery after surgery. Therefore, it has been widely indicated and accepted by surgeons. In Hue, THD has been implemented since April 2013. So far, this procedure has been in more or less common use to treat grade III and IV internal hemorrhoids with or without rectal mucosal prolapse. Method: From April 2013 through September 2013, 79 patients with grade III and IV hemorrhoids with or without rectal mucosal prolapse were treated by means of THD. During the study, postoperative complications, pains, hospital stay and patient’s satisfaction were monitored. Systematic follow-up of patients after surgery were carried out regularly 1 month and 3 months after surgery. Results: With 79 patients with grade III and IV hemorrhoids with or without rectal mucosal prolapse treated with THD, the following results were obtained: (i) THD was performed on 48 (60.8%) male patients, 31 (39.2%) female patients, mean age of 48.7±22.5 years; the youngest 18 and oldest 81 years old; (ii) Average hospital stay was 2.12 ± 1.25 days, the shortest stay 1 day and the longest 5 days. No surgical complications was reported. No serious postoperative complications was reported; (iii) Postoperative pains were found mild in 65 patients (82.2%), moderate in 13 patients (16.5%), and severe in 1 patient (1.3%). No case of postoperative urinary retention was recorded; (iv) Follow-up 1 month after surgery: good results in 71 patients (94.6%) patients, satisfactory results in 4 patients (5.4%) patients; (v) Follow-up 3 months after surgery: good results in 40 (95.2%) patients, satisfactory results in 2 patients (4.8%). Conclusion: Our research shows that surgical treatment of hemorrhoids with THD proves to be a safe procedure, causing less postoperative pains, shorter hospital stay and sooner resumption of work. Key words: Hemorrhoid disease, transanal hemorrhoidal dearterialisation (THD).

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PTU-198 Systematic review of the assessment and management of anal intraepithelial neoplasia grade iii

Gut ◽

10.1136/gutjnl-2015-309861.313 ◽

2015 ◽

Vol 64 (Suppl 1) ◽

pp. A150.2-A150

Author(s):

NN Alam ◽

D White ◽

SK Narang ◽

IR Daniels ◽

NJ Smart

Keyword(s):

Systematic Review ◽

Intraepithelial Neoplasia ◽

Anal Intraepithelial Neoplasia ◽

Grade Iii

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Grade III Acromioclavicular Separations Treated With Suspensory Fixation Techniques: A Systematic Review of Level I Through IV Studies

Arthroscopy, Sports Medicine, and Rehabilitation ◽

10.1016/j.asmr.2021.04.003 ◽

2021 ◽

Author(s):

Joseph J. Ruzbarsky ◽

Bryant P. Elrick ◽

Philip-C. Nolte ◽

Justin W. Arner ◽

Peter J. Millett

Keyword(s):

Systematic Review ◽

Fixation Techniques ◽

Suspensory Fixation ◽

Level I ◽

Grade Iii

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Infection risks in multiple myeloma: a systematic review and meta-analysis of randomized trials from 2015 to 2019

BMC Cancer ◽

10.1186/s12885-021-08451-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nicole Balmaceda ◽

Muhammad Aziz ◽

Viveksandeep Thoguluva Chandrasekar ◽

Brian McClune ◽

Suman Kambhampati ◽

...

Keyword(s):

Systematic Review ◽

Multiple Myeloma ◽

Patient Population ◽

Randomized Clinical Trials ◽

Significant Risk ◽

Disease Process ◽

Severe Infection ◽

Increased Risk ◽

Drug Regimens ◽

Grade Iii

Abstract Background Patients with multiple myeloma (MM) remain at an increased risk of infection due to the disease process, as well as the ensuing treatments. Methods We performed a systematic review to evaluate the monthly risk of grade III/IV infection, pneumonia, and neutropenia in patients with myeloma enrolled in randomized clinical trials (RCTs). Results The risk of grade III or higher infection, pneumonia, and neutropenia persists among all phases of treatment. There was no statistical difference in grade III or higher infection, pneumonia, and neutropenia between frontline and relapsed/refractory setting. In the maintenance setting, the complications of infection, pneumonia, and neutropenia were low, but not negligible. Three-drug regimens were no more likely than two-drug regimens to have an increased risk of Grade III or higher infection. Conclusions This is the first study to quantify the monthly risk of grade III or higher infection, pneumonia, and neutropenia across different treatment regimens in the frontline, maintenance, and relapsed/refractory settings. The results of our systematic review demonstrate a significant risk for severe infection, pneumonia, and neutropenia in patients with MM. Further studies are needed to determine the value of antibiotic prophylaxis in a broader myeloma patient population, as well as other approaches that will further mitigate the morbidity and mortality related to infection in this vulnerable patient population.

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