Stapled Hemorrhoidopexy: Outcome Assessment

2007 ◽  
Vol 73 (7) ◽  
pp. 733-736 ◽  
Author(s):  
Scott D. Goldstein ◽  
Keith P. Meslin ◽  
Thomas Mazza ◽  
Gerald A. Isenberg ◽  
James Fitzgerald ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Rectal Surgery ◽  
Normal Activity ◽  
Hemorrhoidal Disease ◽  
Stapled Hemorrhoidopexy ◽  
Colon And Rectal Surgery ◽  
Surgery Training ◽  
Operative Control ◽  
Grade Ii ◽  
Hemorrhoidal Prolapse

Since its introduction as a new procedure for the surgical management of hemorrhoidal disease in 1993, stapled hemorrhoidopexy has become increasingly popular. This has been mostly the result of the reported reduction in postoperative pain. This study was designed to review retrospectively 152 patients combined from a 3-year period in a three-surgeon private colorectal practice and a 1-year period from an academic colon and rectal surgery training program. All patients had either grade II or III hemorrhoidal prolapse. There were 78 male (mean age, 52 years) and 74 female patients (mean age, 54 years). A total of 133 patients (87.5%) were treated on an ambulatory basis, with 131 patients (86%) given monitored sedation with local anesthesia. Postoperative complications were seen in 49 patients (32%); 33 were for bleeding, with four requiring operative control. Subsequent associated anorectal procedures were performed on 14 patients (9.2%). Of the original 152 patients, 78 participated in a postoperative survey. Of these patients, 67.9 per cent stated that their postoperative pain was less than expected. Seventy-one patients (91%) stated significant improvement or complete resolution of their symptoms, and 73.1 per cent returned to normal activity in less than 2 weeks. Eighty-nine per cent of patients surveyed stated they would recommend hemorrhoidopexy to others.

Management of Anastomotic Leak: Lessons Learned from a Large Colon and Rectal Surgery Training Program

2013 ◽  
Vol 38 (4) ◽  
pp. 985-991 ◽  
Author(s):  
Jennifer Blumetti ◽  
Vivek Chaudhry ◽  
Jose R. Cintron ◽  
John J. Park ◽  
Slawomir Marecik ◽  
...  
Keyword(s):  
Training Program ◽  
Anastomotic Leak ◽  
Rectal Surgery ◽  
Lessons Learned ◽  
Colon And Rectal Surgery ◽  
Surgery Training

Assessing technical competency during colon and rectal surgery training

2015 ◽  
Vol 26 (3) ◽  
pp. 155-159 ◽  
Author(s):  
Jonathan Hong ◽  
Sandra L. de Montbrun ◽  
Patricia L. Roberts ◽  
Helen MacRae
Keyword(s):  
Rectal Surgery ◽  
Colon And Rectal Surgery ◽  
Surgery Training ◽  
Technical Competency

scholarly journals Selective Hemorrhoidal Dearterialization with High Mucopexy in the Surgical Treatment of Hemorrhoidal Disease

2021 ◽  
Vol 41 (03) ◽  
pp. 234-241
Author(s):  
Carlos Mateus Rotta ◽  
Stephanie Drago ◽  
Afonso Henrique da Silva e Sousa ◽  
Carlos Augusto Real Martinez ◽  
Marjorie Cristina da Cruz Bernardino
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Postoperative Period ◽  
Severe Pain ◽  
Postoperative Bleeding ◽  
Disease Recurrence ◽  
Hemorrhoidal Disease ◽  
Grade Ii ◽  
Surgical Option ◽  
Grade Iii

AbstractThe doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with high mucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence.Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD.

Postoperative Pain After Enhanced Recovery Pathway Robotic Colon and Rectal Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Rebecca F. Brown ◽  
Kara Brockhaus ◽  
Dixy Rajkumar ◽  
Michael A. Battaglia ◽  
Robert K. Cleary
Keyword(s):  
Postoperative Pain ◽  
Enhanced Recovery ◽  
Rectal Surgery ◽  
Colon And Rectal Surgery ◽  
Enhanced Recovery Pathway

scholarly journals Hybrid digitally guided hemorrhoidal artery ligation with laser hemorrhoidoplasty: our experience with a new approach to hemorrhoidal disease

2021 ◽  
Vol 8 (10) ◽  
pp. 2968
Author(s):  
Anushtup De ◽  
Prabal Roy
Keyword(s):  
Postoperative Pain ◽  
Recurrence Rate ◽  
Postoperative Bleeding ◽  
Hemorrhoidal Disease ◽  
Artery Ligation ◽  
Hemorrhoidal Artery Ligation ◽  
Hemorrhoidal Artery ◽  
Grade Ii ◽  
Suspected Recurrence

Background: Minimally invasive surgeries are currently advocated in hemorrhoidal disease for better patient satisfaction. The aim of our study is to assess the feasibility, efficacy and safety of a hybrid hemorrhoidal artery ligation under digital guidance with laser hemorrhoidoplasty (Hybrid HAL-LHP) in patients with grade II to III hemorrhoids.Methods: In a prospective clinical study, hybrid HAL-LHP was performed in 75 consecutive patients between May 2018 to February 2020 with grade II to III hemorrhoids. Hemorrhoidal artery ligation was done by digital palpation followed by laser hemorrhoidoplasty using a 1470 nm diode laser. Postoperative pain and bleeding, return to work, resolution of symptoms, recurrence and reoperation was assessed on a follow up upto 1 year.Results: Postoperative pain assessed on Visual analog score (VAS) was 2.82 on 3rd day, 1.28 on 7th day and till 14th day was extremely low. None of the patients had significant intraoperative or spontaneous postoperative bleeding. Most of the patients had some degree of post defecation bleeding till 7th to 14 days which resolved after 2 weeks. After a mean follow up of 16.6 months, we reported a suspected recurrence rate of 5.33%.Conclusions: Postoperative pain assessed on Visual analog score (VAS) was 2.82 on 3rd day, 1.28 on 7th day and till 14th day was extremely low. None of the patients had significant intraoperative or spontaneous postoperative bleeding. Most of the patients had some degree of post defecation bleeding till 7 to 14 days which resolved after 2 weeks. After a mean follow up of 16.6 months we reported a suspected recurrence rate of 5.33%.

The role of simulation in colon and rectal surgery training

2015 ◽  
Vol 26 (3) ◽  
pp. 134-139 ◽  
Author(s):  
Victoria Valinluck Lao ◽  
Scott R. Steele
Keyword(s):  
Rectal Surgery ◽  
Colon And Rectal Surgery ◽  
Surgery Training

Neutrophil/lymphocyte Ratio after Flow Citometry Periferic Blood Cell Detection - Predictive Marker of Anastomotic Fistula in Colorectal Cancer Surgery

2020 ◽  
Vol 71 (6) ◽  
pp. 295-306
Author(s):  
Dumitru Radulescu ◽  
Vlad Dumitru Baleanu ◽  
Andrei Nicolaescu ◽  
Marius Lazar ◽  
Marius Bica ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Patients ◽  
Rectal Surgery ◽  
Predictive Marker ◽  
Fistula Formation ◽  
Cell Detection ◽  
Colon And Rectal Surgery ◽  
Optimal Value ◽  
Anastomotic Fistula ◽  
Colorectal Cancer Patients

Anastomotic fistula is a dreadful complication of colon and rectal surgery that can put life into danger, being common after colorectal surgery. The preoperative lymphocyte neutrophil ratio (NLR) is known as a prognostic marker for colorectal cancer patients. The existence of a predictive marker of anastomotic fistula in colorectal cancer patients is not fully undestood, so we proposed to investigate the utility of preoperative NLR as a predictor of anastomotic fistula formation. This study the Neutrophils and lymphocytes were detected from periferic blood using flow citometry. We retrospectively evaluated 161 patients with colorectal cancer, who were treated curatively, in which at least one anastomosis was performed, comparing NLR values between patients who had fistula and those with normal healing, then comparing the group with low NLR, with the group with increased NLR, after finding the optimal value of NLR using the ROC curve.The optimal value of the NLR after establishing the cutoff value was 3.07. Between the low NLR group (n=134) and the high NLR group (n=27), were observed statistically significant differences in fistula (p [0.001) and death (p=0.001). The odds ratio for failure in the group with increased NLR was 10.37, which means that patients with NLR]3.54 have a chance of developing anastomotic fistula greater than 10.37 comparable to patients with lower NLR. We suggest the preoperative use of NLR can be used as a predictive marker of anastomotic fistula than can increase the quality of preoperative preparation and therefore the establishment of the optimal surgical technique that can lead to anastomotic fistula risk decrease.

Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to the Modern Times

2020 ◽  
Vol 15 ◽  
Author(s):  
Alessandro Sturiale ◽  
Bernardina Fabiani ◽  
Claudia Menconi ◽  
Danilo Cafaro ◽  
Felipe Celedon Porzio ◽  
...  
Keyword(s):  
Postoperative Bleeding ◽  
Invasive Procedure ◽  
High Volume ◽  
Normal Mucosa ◽  
Stapled Hemorrhoidopexy ◽  
Wound Complications ◽  
Rectal Intussusception ◽  
Stapler Technique ◽  
History Of ◽  
Hemorrhoidal Prolapse

Introduction: Hemorrhoidal disease is the most common proctologic condition in adults. Among the different surgical procedures, one of the greatest innovations is represented by the stapled hemorrhoidopexy. The history of this technique started with a single stapler use passing thorough a double stapler technique to resect the adequate amount of prolapse, finally arriving to the use of high volume devices. Methods: Nevertheless each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with a forcep, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery the Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left. Results: Several studies have reported that SH is a safe and effective procedure to treat the hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to a less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rate with better anatomical and symptomatic results. Conclusions: Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may to offer to the patients a safe, effective treatment with less pain and fast recovery.

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