scholarly journals Initial experience with stapled hemorrhoidopexy for treatment of hemorrhoids

2006 ◽  
Vol 43 (3) ◽  
pp. 238-242 ◽  
Author(s):  
Carlos Walter Sobrado ◽  
Guilherme Cutait de Castro Cotti ◽  
Fabricio Ferreira Coelho ◽  
Júlio Rafael Mariano da Rocha
Keyword(s):  
Pain Control ◽  
Radical Change ◽  
Stapled Hemorrhoidopexy ◽  
Anal Stenosis ◽  
Initial Experience ◽  
Safe Alternative ◽  
Rescue Analgesia ◽  
Fourth Degree ◽  
Conventional Hemorrhoidectomy ◽  
Anal Bleeding

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.

Stapled Hemorrhoidopexy and Milligan Morgan Hemorrhoidectomy in the Cure of Fourth-Degree Hemorrhoids: Long-Term Evaluation and Clinical Results

2007 ◽  
Vol 50 (11) ◽  
pp. 1770-1775 ◽  
Author(s):  
Claudio Mattana ◽  
Claudio Coco ◽  
Alberto Manno ◽  
Alessandro Verbo ◽  
Gianluca Rizzo ◽  
...  
Keyword(s):  
Clinical Results ◽  
Stapled Hemorrhoidopexy ◽  
Fourth Degree ◽  
Term Evaluation

scholarly journals Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Rodrigo Ayala-Yáñez ◽  
Paulette Bayona-Soriano ◽  
Arturo Hernández-Jimenez ◽  
Alejandra Contreras-Rendón ◽  
Paulina Chabat-Manzanera ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Medical Center ◽  
Prevention Study ◽  
Perineal Tear ◽  
Safe Alternative ◽  
Fourth Degree ◽  
Actual Use ◽  
Life Threatening ◽  
Prophylactic Use ◽  
Threatening Situation

Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country’s high cesarean section incidence.Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p=0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (p=0.016), RR of 3.4 (95% CI: 1.15–10.04).Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications.

scholarly journals Tramadol or Nalbuphine; Which One is Superior for Analgesia in Post-Operative Period after Percutaneous Nephrolithotomy

2021 ◽  
Vol 15 (1) ◽  
pp. 51-54
Author(s):  
Muhammad Sheraz Javed ◽  
◽  
Ghulam Mehboob Subhani ◽  
Muhammad Akmal ◽  
Muhammad Irfan Munir ◽  
...  
Keyword(s):  
Pain Control ◽  
Rating Scale ◽  
Randomized Study ◽  
Rescue Analgesia ◽  
Post Operative Period ◽  
High Prevalence ◽  
Group A ◽  
Group B ◽  
Medical University ◽  
Pain Rating Scale

Background: Kidney stones has got high prevalence worldwide especially in our part of world and per-cutaneous nephrolithotomy (PCNL) is gold standard operative modality for renal stone management. Pain control after PCNL is the most important task for treating surgeon as effective pain control causes smooth patient recovery in post-operative period. For analgesia, many drugs can be used, out of which tramadol and nalbuphine always been in comparison for effective analgesic activity. Objective: To compare efficacy of tramadol and nalbuphine as potent analgesic in patients after PCNL. Study Design: A prospective randomized study. Settings: Department of Urology and Kidney Transplantation, Allied Hospital/Faisalabad Medical University, Faisalabad and Department of Urology, DHQ Hospital/Faisalabad Medical University, Faisalabad Pakistan. Duration: From September 2016 to September 2020 (4 Years). Methodology: 286 patients undergoing PCNL for either gender and sides enrolled in study according to inclusion and exclusion criteria. Patients divided into Group A (Administered with tramadol) and Group B (administered with nalbuphine) and patients evaluated for pain up to 48 hours after surgery using 11-point numerical pain rating scale rating from0-10 where 0 is no pain, 1-3 mild pain, 4-6 moderate pain, 7-9 severe pain and 10 as worst pain and use of rescue analgesia observed in either groups. Data obtained and statistical evaluation done. Results: 286 patients enrolled from age 15-75 years with mean age of 40.2 years. Among 286 patients, 161 were male and 125 were female patients. Both groups A and B having 143 patients each. Analysis showed that tramadol has superiority over nalbuphine and need of analgesia is more in patient given nalbuphine (118 vs 31) as maintenance analgesic agent in post-operative period after PCNL. Conclusion: This study showed that tramadol has superiority over nalbuphine for analgesia after PCNL.

scholarly journals Postoperative recovery; Stapled Hemorrhoidopexy versus Conventional haemorrhoidectomy.

2020 ◽  
Vol 27 (01) ◽  
pp. 166-171
Author(s):  
Ashar Ahmad Khan ◽  
Tania Mahar ◽  
Muhammad Kashif Adnan ◽  
Abdul Rasheed Surahio ◽  
Abdul Manan ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Postoperative Recovery ◽  
Stapled Hemorrhoidopexy ◽  
Anal Stenosis ◽  
P Value ◽  
Group A ◽  
Conventional Haemorrhoidectomy ◽  
Group B

Conventional haemorrhoidectomy, a usual procedure for hemorrhoids in our set up have many short and long term complications. Some patients complained pain many weeks after surgery and are unable to do their routine work. Anal stenosis and recurrence are long term issues. There is need for some other procedure which can decrease postoperative pain and hospital stay. Objectives: To compare the postoperative recovery between stapled hemorrhoidopexy and conventional hemorrhoidectomy. Study Design: Randomized Clinical trial. Setting: Surgery Department of Nishtar Medical University Multan. Period: from 01-01-2018 to 31-12-2018. Material & Methods: Randomly 02 equal groups of the patients, A and B were made. Stapled hemorrhoidopexy (SH) and conventional haemorrhoidectomy was done in group A and B respectively. SPSS version 20 used for data analysis. Mean and standard deviation were used for quantitative variables including postoperative pain, age and hospital stay. Independent Student t test used for comparison of hospital stay and postoperative pain. Effect modifier including gender, age, duration and grade of hemorrhoids were controlled by stratification and Chi square test was applied. P value less than 0.05 was taken as significant. Results: Out of 60 patients, 32 were males and 28 females. In Group A (Stapled Hemorrhoidopexy), mean age was 37.37 + 6.36 years and 39.17 + 5.53 years in Group-B. Postoperative pain in Group A was 3.60 + 1.27 and 6.03 + 1.73 in Group B. Postoperative pain was significantly high in Group B (CH) and P value =0.000. Mean hospital stay was 0.90 + 0.48 days in Group A and 1.87 + 0.57 days in Group B with P value= 0.000. Conclusion: Stapled hemorrhoidopexy is associated with shorter hospital stay and decrease postoperative pain irrespective of age, sex and grade of the hemorrhoids.

scholarly journals A Comparative Study of Open (Milligan-Morgan) Versus Closed (Ferguson) Hemorrhoidectomy

2016 ◽  
Vol 3 (1) ◽  
pp. 7 ◽  
Author(s):  
Hemant Borse ◽  
Swapnil Dhake
Keyword(s):  
Randomized Study ◽  
Open Group ◽  
Anal Stenosis ◽  
Fissure In Ano ◽  
College Hospital ◽  
Fourth Degree ◽  
Closed Group ◽  
Open Hemorrhoidectomy ◽  
Post Operative Pain ◽  
Bowel Diseases

<strong>Introduction</strong>: Hemorrhoidectomy is an operation for third and fourth degree haemorrhoids. There are two methods by which hemorrhoidectomy can be done -open (Milligan-Morgan) in which the wound is left open and allowed to heal by secondary intension and closed (Ferguson) methods in which the wound is closed with absorbale sutures. <strong>Aim:</strong> To compare post operative pain and recovery in open (Milligan-Morgan) and closed (Ferguson) methods and evaluate optimum choice of the procedure for third or fourth degree hemorrhoids. Study Design: Prospective randomized study. <strong>Settings:</strong> Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Center. <strong>Duration:</strong> Two year (August 2010 to August 2012). Sample Size: 70 cases (35 cases in each group). Inclusion Criteria: Patients with third/four degree hemorrhoids. Exclusion Criteria: Patients with associated anal and perianal conditions like fissure in ano, inflammatory bowel diseases and rectal malignancy, portal hypertension were excluded from the study. <strong>Results:</strong> Mean hospital stay for open group was 5 days and closed group was 3 days. Post operative pain was seen in 77% in open group and 48 % in closed group. Pain was relieved earlier in closed group. 71% patients had completely healed wounds at 3 weeks in closed group in comparision to only 42% in open group. Anal stenosis was seen in 2 patients of open hemorrhoidectomy. <strong>Conclusion:</strong> Closed hemorrhoidectomy is the procedure of choice for three/four degree hemorrhoids.

Evaluation of post-operative complications after Milligan- Morgan haemorrhoidectomy versus Stapled Haemorrhoidopexy techniques

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Adel Darweish ◽  
Dr.Ibrahim Maged Abed El Maksod ◽  
Atef Abed El Tawab Nafea
Keyword(s):  
Surgical Intervention ◽  
Anal Stenosis ◽  
Stapled Haemorrhoidopexy ◽  
Success Rates ◽  
University Hospitals ◽  
Haemorrhoidal Disease ◽  
Post Operative Pain ◽  
Conventional Hemorrhoidectomy ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background Haemorrhoidal disease is one of the oldest illnesses known to mankind. It leads to significant pain, discomfort and poor quality of life. It is one of the common diseases which affect mankind but it is difficult to give an accurate figure of the prevalence because although many patients present with symptoms, many do not and some never bring it to notice of clinicians. The word hemorrhoids means flow of blood, the word pile means a ball, indicating two cardinal symptoms of this disease; bleeding per rectum and mass per anus. Aim of the work Aim of the work is to detect and compare the post-operative complications (Pain, Bleeding and anal stenosis) after 2 of the most commonly used techniques for management of the clinically diagnosed third and fourth stage hemorrhoids: Milligan-Morgan hemorrhoidectomy and stapler hemorrhoidopexy. Patient and Methods After obtaining approval from The College Ethical Committee, the study entitled "Evaluation of Postoperative Complications after Open MM Hemorrhidectomy versus Stapled Hemorrhoidopexy" was conducted on a total of 30 patients with hemorrhoids undergoing either conventional hemorrhoidectomy by Milligan Morgan (MM) technique or stapler hemorrhoidopexy. The patients were selected randomly after fulfilling the inclusion criteria in the department of general surgery, Ain Shams University hospitals over a period of 4 months starting from 1 August 2019 to 1 December 2019. Patients were admitted via surgical outpatient clinic. Patients were randomly distributed to 2 groups (A & B), each group containing 15 patients. Results A total of 30 patients who underwent either conventional hemorrhoidectomy (CH) or stapler hemorrhoidopexy (SH) in The Department of Surgery, Faculty of Medicine, Ain Shams University included in this study for 4 months started from 1/8/2019 and ended in 1/12/2019 and the following results are obtained. Conclusion Haemorrhoidal disease is considered as one of the commonest ano-rectal diseases. Non-surgical measures whatever drug therapy or office procedures, can be presented to the patients with stage 1 and stage 2 haemorrhoids. However, when these measures fail, surgical intervention must be thought for the patients with stage 3 and stage 4 haemorrhoids. Surgical intervention should be tailored to each patient in accordance to the seriousness of symptoms, the magnitude of the external anorectal element and the presence of any concurrent ano-rectal morbidity. At present, there are many surgical interventions obtainable for treatment of prolapsing piles disease and most of them yielding acceptable success rates. Conventional Haemorrhoidectomy (CH) whatever open (Milligan Morgan) or closed (Ferguson) is considered the gold standard for surgical intervention of piles but due to the severe associated post-operative pain, especially with defecation, Stapled Haemorrhoidopexy (SH) seems to present shorter operative time, less post-operative pain, less bleeding and anal stricture and also less time off work in comparison with CH. Although rare but horrible complications have been noted with SH, which dictate that SH should be performed only by experienced surgeons. Eventually we strongly recommend the use of stapler devices for haemorrhoidectomy when and where possible especially for high grade and prolapsing haemorrhoids although more research and study should be made in this concern for more confirmation of our results due to decreased specimen size and short post-operative follow up period in our study.

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