scholarly journals Surgical treatment of hemorrhoids: a critical appraisal of the current options

2014 ◽  
Vol 27 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Marlise Mello CERATO ◽  
Nilo Luiz CERATO ◽  
Patrícia PASSOS ◽  
Alberto TREIGUE ◽  
Daniel C. DAMIN
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Postoperative Recurrence ◽  
Long Term Results ◽  
Published Data ◽  
Complication Rates ◽  
Recurrence Rates

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

scholarly journals COMPARATIVE STUDY OF POSTOPERATIVE PAIN BETWEEN THE LICHTENSTEIN AND LAPAROSCOPY SURGICAL TECHNIQUES FOR THE TREATMENT OF UNILATERAL PRIMARY INGUINAL HERNIA

2017 ◽  
Vol 30 (3) ◽  
pp. 173-176 ◽  
Author(s):  
Leandro Mendonça PEDROSO ◽  
Renato Miranda DE-MELO ◽  
Nelson Jorge DA-SILVA-JR
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Data Analysis ◽  
Surgical Treatment ◽  
Postoperative Pain ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Lichtenstein Technique ◽  
Primary Inguinal Hernia ◽  
Lichtenstein Procedure

ABSTRACT Background: There are several surgical treatment options for inguinal hernia; however, there is no consensus on the literature identifying which surgical technique promotes less postoperative pain. Aim: To compare the intensity of postoperative pain between the surgical techniques Lichtenstein and transabdominal pre-peritoneal laparoscopy for the treatment of unilateral primary inguinal hernia. Methods: Were included 60 patients, of which 30 were operated through the Lichtenstein technique and 30 patients through the transabdominal pre-peritoneal laparoscopy. The pain levels were evaluated through the analogue visual scale for 2, 10 and 30 days after the surgery. Additionally, the recurrence rate and the presence of chronic pain and paresthesia were evaluated 12 months after the surgery. Results: Overall, the data analysis showed significant differences on pain levels between the surgical techniques. There were no significant differences between the pain levels for day 2. However, for 10 and 30 days after the surgery, the pain levels were significantly lower for the patients operated through the transabdominal pre-peritoneal laparoscopy technique compared to the Lichtenstein technique. Furthermore, despite no recurrent hernias for both surgical techniques, 32 % of patients operated through the Lichtenstein technique reported chronic pain and paresthesia 12 months after the surgery, compared with 3,6% of patients operated through the transabdominal pre-peritoneal laparoscopy technique. Conclusion: There are differences between the surgical techniques, with the transabdominal pre-peritoneal laparoscopy procedure promoting significantly lower postoperative pain (10 and 30 days) and chronic pain (12 months) compared to the Lichtenstein procedure.

Clinical Outcome at Ten Years after Laparoscopic Fundoplication: Nissen versus Toupet

2010 ◽  
Vol 76 (12) ◽  
pp. 1408-1411 ◽  
Author(s):  
Jaime Ruiz-Tovar ◽  
Maria Diez-Tabernilla ◽  
Alejandro Chames ◽  
Vicente Morales ◽  
Alfonso Sanjuanbenito ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Laparoscopic Fundoplication ◽  
Surgical Techniques ◽  
Outcome Data ◽  
Long Term Results ◽  
Toupet Fundoplication

Laparoscopic surgery has become the elective approach for the surgical treatment of gastroesophageal reflux disease in the last decade. Outcome data beyond 10 years are available for open fundoplication, with good-to-excellent results, but few studies report long-term follow-up after laparoscopic fundoplication. We performed a retrospective study of all the patients that underwent laparoscopic Nissen and Toupet fundoplications as antireflux surgery between 1995 and 1998 in our institution. To evaluate the long-term results, a face-to-face interview was performed in 2009. One hundred and six patients were included in the study. Surgical techniques performed were Nissen fundoplication (NF) in 56 patients and Toupet (TF) in 50. Complication rate was 4 per cent in both groups (nonsignificant [NS]). Two patients (4%) of NF required reoperation because of dysphagia. After 10 years, 10 per cent of the patients remain symptomatic in both groups. Fifteen per cent of NF take daily inhibitors of the proton pump versus 14 per cent of TF (NS). Twenty per cent of NF refer dysphagia, all of them without evidence of stenosis at endoscopy or contrasted studies. The satisfaction rate of the patients was 96 per cent in NF and 98 per cent in TF. Laparoscopic Toupet fundoplication seems to be as safe and long-term effective as Nissen, but with a lower incidence of postoperative dysphagia. In our experience Toupet fundoplication should be the elective approach for the surgical treatment of gastroesophageal reflux disease.

scholarly journals A Systematic Literature Review to Compare Clinical Outcomes of Different Surgical Techniques for Second Branchial Cyst Removal

2021 ◽  
pp. 000348942110240
Author(s):  
Sebastiaan Meijers ◽  
Rutger Meijers ◽  
Erwin van der Veen ◽  
Maaike van den Aardweg ◽  
Hanneke Bruijnzeel
Keyword(s):  
Surgical Techniques ◽  
Postoperative Recurrence ◽  
Branchial Arch ◽  
Conventional Technique ◽  
Surgical Removal ◽  
Complication Rates ◽  
Recurrence Rates ◽  
New Treatment ◽  
Meta Analyses

Objective: During the last 2 decades, new treatment methods have been developed for the surgical removal of second branchial cysts which result in less visible scars. The aim of this systematic review is to assess which surgical technique for second branchial arch cyst removal results in the lowest complication and recurrence rates with the highest scar satisfaction. Methods: Two authors systematically reviewed the literature in the Cochrane, PubMed, and EMBASE databases (search date: 1975 to December 2nd, 2020) to identify studies comparing surgical outcomes of second branchial arch cyst removal. Authors appraised selected studies on directness of evidence and risk of bias. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Out of the 2442 retrieved articles, 4 articles were included in the current review including a total of 140 operated cysts. Only 2 studies included pre-operatively infected cysts. Follow up ranged from 3 to 24 months. Complication rates ranged from 0 to 27.3% (conventional: [0–10.4%]; endoscopic/retro-auricular: [0–27.3%]). None of the patients presented with postoperative recurrence. Significantly higher scar satisfaction was found in adult patients who underwent endoscopic or retro-auricular hairline incision cyst removal. Conclusion: No recurrence of disease occurred during (at least) 3 months of follow up using either conventional surgery or endoscopic/retro-auricular techniques. Although more (temporary) complications occur using endoscopic and retro-auricular techniques, patients report a significantly higher scar satisfaction 3 to 6 months after surgery in comparison to the conventional technique. Future studies are needed to support these findings.

scholarly journals Prognostic Model of Surgical Treatment of Severe Mitral Regurgitation at Mitral Valve Prolapse

2019 ◽  
pp. 28-35
Author(s):  
S. I. Mokhnatyi ◽  
O. M. Dovgan
Keyword(s):  
Surgical Treatment ◽  
Mitral Valve ◽  
Postoperative Period ◽  
Prognostic Model ◽  
Surgical Techniques ◽  
Long Term Results ◽  
Mitral Leaflet ◽  
Anatomical Variant ◽  
Posterior Mitral Leaflet

The article presents a single-center experience of surgical treatment of patients with severe mitral regurgitation(MR) caused by mitral valve prolapse (MVP). The study is based on long-term results of reconstructive interventions on the mitral valve (MV) of the UCCC of the Ministry of Health of Ukraine. The purpose of this work is to determine the factors that influence the long-term results of surgical treatment of MR in prolapse of the mitral valve leaflets. Material and methods.From January 1, 2011, to January 1, 2018, 146 patients with severe MR were operated on the basis of the UCCC, which was conditioned by the prolapse of mitral valve leaflets. Results.Long-term results were analyzed in 95.2% of patients. The average postoperative follow-up period was 39.7 ± 19.8 months. The overall mortality rate was 1.4%. Freedom from moderate and severe MR in the remote postoperative period decreased to 94.2%, compared to the early postoperative period. Residual MR was absent in 17 (12.4%) patients. In 76 (55.5%) patients trivial MR was detected, in 36 (26.3%) there was a mild MR, in 3 (2.2%) a moderate MR. In 5 (3.6%) patients, a severe MR was detected during the observation. Using statistical methods, it was found that the anatomical variant of MVP influences the prognosis of treatment results in the long postoperative period with worse results in the group with isolated prolapse of the anterior leaflet. Also, the dependence of the results on the applied surgical techniques with better results in annuloplication using the annuloplasty rings and in the application of resection of the posterior mitral leaflet. On the basis of statistics, a prognostic model for the evaluation of MV repair results in the distant period was developed. The height of coaptation of mitral leaflets was determined as one of the indicators for predicting the results of surgical treatment of MR with MVP. Conclusions: 1. In most cases, a successful mitral valve repair is possible with the MVP. 2. A good immediate result does not mean keeping it in the long term. 3. The long-term results of MV reconstruction depend on the anatomical variant of the MVP, with worse results in patients with isolated prolapse of the anterior mitral leaflet. 4. The result of MV repair depends on the surgical techniques used, with better results when using the annuloplasty rings and resection of the posterior mitral leaflet. 5. The height of the coaptation of the MV leaflets is an indicator that allows predicting the outcome of surgical treatment in the long postoperative period.

scholarly journals Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

2020 ◽  
Vol 36 (3) ◽  
pp. 133-147 ◽  
Author(s):  
Kheng-Seong Ng ◽  
Melanie Holzgang ◽  
Christopher Young
Keyword(s):  
English Literature ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Rubber Band Ligation ◽  
Current Evidence ◽  
Injection Sclerotherapy ◽  
Recurrence Rates ◽  
Management Options ◽  
Fourth Degree

The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR “Hemorrhoid”[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel “walk-in-walk-out” techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.

scholarly journals Treatment of traumatic rupture of the thoracic aorta

2008 ◽  
Vol 136 (9-10) ◽  
pp. 498-504 ◽  
Author(s):  
Lazar Davidovic ◽  
Miroslav Markovic ◽  
Momcilo Colic ◽  
Nikola Ilic ◽  
Igor Koncar ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Endovascular Treatment ◽  
Thoracic Aorta ◽  
Good Condition ◽  
Long Term Results ◽  
Traumatic Rupture ◽  
Published Data ◽  
Aorta Rupture

INTRODUCTION Interest for traumatic thoracic aorta rupture stems from the fact that its number continually increases, and it can be rapidly lethal. OBJECTIVE The aim of this study is to present early and long term results as well as experiences of our team in surgical treatment of traumatic thoracic aorta rupture. METHOD Our retrospective study includes 12 patients with traumatic thoracic aorta rupture treated between 1985 and 2007. There were 10 male and two female patients of average age 30.75 years (18-74). RESULTS In six cases, primary diagnosis was established during the first seven days days after trauma, while in 6 more than one month later. In 11 cases, classical open surgical procedure was performed, while endovascular treatment was used in one patient. Three (25%) patients died, while two (16.6%) had paraplegia. Nine patients (75%) were treated without complications, and are in good condition after a mean follow-up period of 9.7 years (from one month to 22 years). CONCLUSION Surgical treatment requires spinal cord protection to prevent paraplegia, using cardiopulmonary by-pass (three of our cases) or external heparin-bonded shunts (five of our cases). Cardiopulmonary by-pass is followed with lower incidence of paraplegia, however it is not such a good solution for patients with polytrauma because of hemorrhage. The endovascular repair is a safe and feasible procedure in the acute phase, especially because of traumatic shock and polytrauma which contributes to higher mortality rate after open surgery. On the other hand, in chronic postrauamatic aortic rupture, open surgical treatment is connected with a lower mortality rate and good long-term results. There have been no published data about long-term results of endovascular treatment in the chronic phase.

Temporary “liquid” Implant for Congenital Glaucoma (long-term results)

2020 ◽  
pp. 49-65
Author(s):  
N Bobrova ◽  
N Trofimova
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Hypotensive Effect ◽  
Congenital Glaucoma ◽  
Long Term Results ◽  
General Will ◽  
Visual Functions ◽  
Advanced Stages ◽  
Intraocular Fluid

The aim of the work was to analyze the long-term results of using a temporary “liquid” implant in the surgery of congenital glaucoma in children. The basis of the developed method of filtrative antiglaucomatous surgery (Patent of Ukraine No. 45099 of 2009) – viscosinusotrabeculotomy – has been set the task of reducing the risk of developing intra- and postoperative complications, reducing the scarring rate and maintaining the newly created ways of the intraocular fluid outflow, which in general will increase the effectiveness of surgical treatment of congenital glaucoma in children. 54 children (91 eyes) with simple congenital glaucoma at the age of 1 to 36 months were operated on average (8.7 ± 8.2) months. The persistent and long-lasting hypotensive effect achieved due to viscosinusotrabeculotomy in children with developed and far-advanced stages of congenital glaucoma stops the processes of stretching of the membranes of the eye and stabilizes their size, which in general allows preserving and visual functions improving, in infancy – creating conditions for their formation.

SIMULTANEOUS ESOPHAGO-GASTRECTOMY WITH COLONIC INTERPOSITION AS A METHOD OF SURGICAL TREATMENT OF GASTROESOPHAGEAL CANCER WITH HIGH INVOLVEMENT OF THE ESOPHAGUS

2017 ◽  
Vol 63 (1) ◽  
pp. 146-152
Author(s):  
Mikhail Ter-ovanesov ◽  
Aleksandr Levitskiy ◽  
E. Lesnidze ◽  
Aram Gaboyan ◽  
Mariya Kukosh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Long Term Results ◽  
Esophageal Reconstruction ◽  
Gastroesophageal Cancer ◽  
Colonic Interposition ◽  
Simultaneous Application ◽  
High Involvement ◽  
Surgical Access ◽  
Critical Overview

In the current oncological practice surgical treatment of gastroesophageal cancer with high involvement of the esophagus can extend to total esophago-gastrectomy with colonic interposition as the main method of radical treatment. However the technical complexity and high risk of the intervention are factors in determining the divergent views on the operation itself, testimony for the criteria of patient’s selection, choice of surgical access and the formation of a colonic graft in conjunction with method of esophageal reconstruction. The long-term results of operative intervention depend primarily on the extent of tumor process but obviously higher than after conservative treatment. This article presents a brief critical overview of the main aspects of the simultaneous application of esophago-gastrectomy in surgery of gastroesophageal cancer with high esophageal involvement and our clinical case of successful surgical treatment of a woman with pregnancy-associated gastroesophageal cancer.

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