A comparative study of open and closed hemorrhoidectomy

Background: Hemorrhoidectomy is the treatment of choice for patients with third-degree or fourth-degree haemorrhoids. This prospective randomized clinical study compared the outcome of surgical haemorrhoidectomy by open and closed techniques in terms of postoperative pain, wound healing, and morbidity.Methods: All consecutive patients with Grade III internal haemorrhoids or Grade IV haemorrhoids were randomly allocated to one of two groups. The entire wound was left open in the open group and completely closed using 2-0 chromic sutures in the closed group. Postoperative pain was assessed by a linear analog scale. Additional consumption of analgesics on the day of surgery and at defecation during the first week was recorded. Patients were followed up 1, 2, and 3 weeks after the procedure.Results: There were 30 patients in each group. No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 78 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 26 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent.Conclusions: Both methods are fairly efficient treatment for third and fourth degree hemorrhoids, without serious drawbacks. The closed method has no advantage in postoperative pain reduction but is more advantageous with respect to faster wound healing.

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A prospective randomized controlled trial comparing the immediate post-operative complications between open and semi-open hemorrhoidectomy

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v22i1.28711 ◽

2019 ◽

Vol 22 (1) ◽

pp. 18-22

Author(s):

Bhuban Rijal ◽

Robin Bahadur Basnet

Keyword(s):

Wound Healing ◽

Pain Score ◽

Treatment Plan ◽

Complication Rates ◽

Open Technique ◽

Narcotic Analgesics ◽

Fourth Degree ◽

Patient Discomfort ◽

Open Hemorrhoidectomy

Introduction: Hemorrhoids are one of the most common anorectal pathologies encountered by general surgeons during their practice. Open technique as described by Milligan and Morgan and closed technique as described by Ferguson are the most widely used. A semi-open technique that has lesser complications than the conventional open hemorrhoidectomy has been described. This study aims to compare the immediate postoperative complications between open and semi-open hemorrhoidectomy. Methods: A prospective randomized study, where patients with third and fourth-degree hemorrhoids undergoing hemorrhoidectomy, were taken for the study. The subjects were randomized into two groups, where they underwent either open or semi-open hemorrhoidectomy. Both groups received standard postoperative care and were evaluated after 24 hours after surgery for pain and urine retention and were then discharged with the same treatment plan for both groups. First, follow up was done in one week and the second was done in two weeks after discharge, where pain score, bleeding, wound healing, use of narcotic analgesics and patient discomfort were recorded. Results: A total of 44 patients were divided into two groups, where the age, sex, and grade of hemorrhoids were matched. The pain score using VAS in the first week was compared and it showed that the pain perceived by the patients in the open hemorrhoidectomy was greater than in the semi-open method ((p=0.06, 95% CI= 0.22 to 1.23). Bleeding rate after the surgeries were not different between the two groups (p=0.43) and the urinary retention between them was also not significant (p=0.47). The use of breakthrough narcotic analgesics was more in the open hemorrhoidectomy group (p=0.01). On the fourteenth day follow up, the wound of those who underwent semi-open hemorrhoidectomy, had significantly healed as compared to those who had undergone the open procedure (p= 0.04, 95% CI=0.23 to 0.76), and the patients who had semi-open hemorrhoidectomy had lesser discomfort as compared to the open technique (p=0.02). Conclusion: Semi-open hemorrhoidectomy has fewer post-operative complication rates as compared to open hemorrhoidectomy with decreased pain, faster wound healing rates, and lesser patient discomfort.

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Comparative study of ultrasonography-guided percutaneous A1 pulley release versus blinded percutaneous A1 pulley release

Journal of Orthopaedic Surgery ◽

10.1177/2309499018772368 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901877236 ◽

Cited By ~ 4

Author(s):

Sung Hyun Lee ◽

Young Chae Choi ◽

Hong Je Kang

Keyword(s):

Patient Satisfaction ◽

Postoperative Pain ◽

Prospective Study ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Trigger Finger ◽

Analog Scale ◽

Vas Score ◽

A1 Pulley

Purpose: The purpose of this study was to compare the results of blind versus ultrasonography-guided percutaneous A1 pulley release for treatment of trigger finger. Methods: This prospective study included 21 patients (25 fingers) who underwent blind release and 20 patients (23 fingers) who underwent ultrasonography-guided release. The visual analog scale (VAS) score, proximal interphalangeal joint contracture, complications, and patient satisfaction were compared between the groups. Results: At the final follow-up, triggering had disappeared in all patients who underwent ultrasonography-guided release, whereas three patients who underwent blind release required revision surgery for postoperative triggering. No complications were observed. VAS score was significantly different between groups at 2 and 4 weeks postoperatively. All patients who underwent ultrasonography-guided release were satisfied, whereas three patients who underwent blind release were not satisfied. Conclusion: Ultrasonography-guided percutaneous A1 pulley release for treatment of trigger finger reduces postoperative pain and complications, such as incomplete release, compared with a blind procedure.

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Knee Disarticulation: Survival, Wound Healing and Ambulation. A Historic Cohort Study

Prosthetics and Orthotics International ◽

10.1080/03093640802557020 ◽

2009 ◽

Vol 33 (1) ◽

pp. 52-60 ◽

Cited By ~ 13

Author(s):

K. Ten Duis ◽

J. C. Bosmans ◽

H. G. J. Voesten ◽

J. H. B. Geertzen ◽

P. U. Dijkstra

Keyword(s):

Wound Healing ◽

Cohort Study ◽

Medical Records ◽

Arterial Disease ◽

Concomitant Disease ◽

Delayed Wound Healing ◽

Peripheral Arterial ◽

Knee Disarticulation ◽

Historic Cohort

The aim of this study was to analyze survival, wound healing and ambulation after knee disarticulation (KD). A historic cohort study using medical records and nursing home records was performed. Data included demographics, reason for amputation, concomitant diseases, survival, wound healing, re-amputation and ambulation. Data of 80 patients (71 unilateral and nine bilateral amputees) were available for evaluation. Median follow-up was 9.9 years (IQR: 4.1; 14.3 years). Mean age of amputation was 76.9 (± 9.6) years. Reason for amputation was gangrene in 72 patients. Most common concomitant (96%) disease was peripheral arterial disease (PAD). Survival after 1, 6 and 12 months was 87%, 65% and 52%, respectively. Delayed wound healing occurred in 42% ( n = 16) of the patients with two or three concomitant diseases and in 15% ( n = 6) of the patients with no or one concomitant disease. Trans-femoral re-amputation was performed in nine (12%) patients. Of the 61 discharged KD amputees, 36 (59%) were provided with a prosthesis. Eventually 21 (34%) patients became household walkers.

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Open and closed haemorrhoidectomy for fourth degree haemorrhoids - comparative one center study

Acta chirurgica iugoslavica ◽

10.2298/aci0803119m ◽

2008 ◽

Vol 55 (3) ◽

pp. 119-125 ◽

Cited By ~ 6

Author(s):

M. Mik ◽

T. Rzetecki ◽

A. Sygut ◽

R. Trzcinski ◽

A. Dziki

Keyword(s):

Wound Healing ◽

Recovery Time ◽

Healing Time ◽

Urine Retention ◽

Fourth Degree ◽

Follow Up Study ◽

Wound Healing Time ◽

Length Of Hospitalization ◽

Closed Haemorrhoidectomy

AIM: We compared results of two techniques of haemorrhoidectomy: open Milligan-Morgan (MM) and closed Ferguson (CF) techniques. Length of hospitalization, pain complaints, return to full activity, wound healing time were considered. METHODS: We included the group of 63 patients: 29 patients (16 women) were randomly allocated to MM operation and 34 patients (15 women) to CF operation. Follow-up study was performed after 2, 4, 24 weeks and six and eighteen months postoperatively. RESULTS: We did not note any statistically significant differences in relation to hospitalization time 30.9 days (MM) and 30.8 days (CF). Postoperative urine retention was similar: 5 (17,2 %) patients (MM) and 7 (20,6 %) patients (CF). No differences in the intensity of postoperative pain was observed. Patients returned to work after 293 days (MM) and 342 days (CF) (p=0,059). We observed no infection of the wound in MM group but in four patients from CF group (11,8%); (p=0,053). However overall wound healing time was shorter after CF method than after MM method: 233 vs. 274 days, respectively (p=0,053). CONCLUSIONS: Our study confirms that the results after MM and CF haemorrhoidectomy are similar. We found a trend towards faster wound healing after CF procedure, however there was a trend towards higher wound infection in that group. There was also a trend towards shorter recovery time in patients after MM operation.

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Complications of Silastic Implant Arthroplasty in the Hallux

Foot & Ankle ◽

10.1177/107110078000100210 ◽

1980 ◽

Vol 1 (2) ◽

pp. 95-101 ◽

Cited By ~ 54

Author(s):

Michael J. Shereff ◽

Melvin H. Jahss

Keyword(s):

Wound Healing ◽

Skin Necrosis ◽

Metatarsophalangeal Joint ◽

Superficial Infection ◽

Delayed Wound Healing ◽

Long Term Follow Up ◽

Silastic Implant ◽

Articulating Surface

A long-term follow-up was evaluated on silastic implant arthroplasty performed on five patients (seven feet) for pathology of the metatarsophalangeal joint of the hallux. Four patients (five feet) displayed an inflammatory reaction in the immediate postoperative period with considerable swelling about the operative site. Subsequently, these patients developed either delayed wound healing of mild skin necrosis with secondary superficial infection. Three patients (five feet) ultimately developed implant failure via fracture of the prosthesis and/or erosion through the articulating surface of the prosthesis. All patients had late roentgenographic findings of resorption of bone around the implants. These complications necessitated removal of implants in three patients (five feet). Implant removal was recommended but refused in two patients (two feet).

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Effect of A-PRF Application on Palatal Wound Healing after Free Gingival Graft Harvesting: A Prospective Randomized Study

10.20944/preprints201902.0131.v1 ◽

2019 ◽

Author(s):

Filipa Sousa ◽

Vanessa Machado ◽

João Botelho ◽

Luís Proença ◽

José João Mendes ◽

...

Keyword(s):

Wound Healing ◽

Soft Tissue Augmentation ◽

Gelatin Sponge ◽

Control Group ◽

Pain Experience ◽

Free Gingival Graft ◽

Randomized Clinical Study ◽

Significant Difference ◽

Gingival Graft

This study aimed to investigate the healing effect of advanced platelet-rich fibrin (A-PRF) clot membranes in the reduction of palatal wounds resulting from free gingival graft (FGG) harvesting, in the re-epithelization rate and in the pain experience after surgery. Twenty-five patients requiring soft tissue augmentation (gingival recession coverage or keratinized gingiva augmentation) participated in this prospective randomized clinical study. After FGG harvesting, the test group (n=14) received A-PRF clot membranes at the palatal wound and the control group (n=11) a gelatin sponge. Epithelialization rate of the palatal wound, wound healing area, correspondent percentage of reduction and post-surgical pain experience were assessed. The follow-up period was 90 days. There was a significantly higher reduction of the palatal wound area in the A-PRF group vs. the control group, at 7 (p<0.001), 14 (p=0.009) and 30 days (p<0.001) follow-up. The maximum difference between groups was attained at 30 days (91.5% for A-PRF vs. 59.0% for the control group). At 14 days a significant difference in the proportion of patients showing total epithelization was found: 64.3% for A-PRF vs. 9.1% for the control group (p=0.012). At 90 days, both groups showed total recovery. Overall, the control group experienced a higher level of pain and discomfort until the 14th day, being significantly higher on the second day (p=0.013). The results suggest that A-PRF membranes haste the healing process by promoting a greater reduction along the recovery period and an apparent less painful postoperative period.

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Clinical Outcomes Associated With Preoperative Opioid Use in Various Shoulder Surgical Procedures: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121997601 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712199760

Author(s):

Dan Michael J. Devano ◽

John-Rudolph Smith ◽

Darby A. Houck ◽

Eric C. McCarty ◽

Adam J. Seidl ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Surgical Procedures ◽

Total Shoulder Arthroplasty ◽

Shoulder Surgery ◽

Opioid Use ◽

Analog Scale ◽

Constant Murley Score ◽

Coleman Methodology Score

Background: The impact of preoperative opioid use on outcomes after shoulder surgery is unknown. Purpose/Hypothesis: To examine the role of preoperative opioid use on outcomes in patients after shoulder surgery. We hypothesized that preoperative opioid use in shoulder surgery will result in increased postoperative pain and functional deficits when compared with nonuse. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were all English-language studies comparing clinical outcomes of shoulder surgery in patients who used opioids preoperatively (opioid group) as well as patients who did not (nonopioid group) with a minimum follow-up of 1 year. Outcomes included range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and visual analog scale for pain. Study quality was evaluated with the Modified Coleman Methodology Score and the MINORS score (Methodological Index for Non-randomized Studies). Results: Included were 5 studies (level 2, n = 1; level 3, n = 4): Two studies were on total shoulder arthroplasty, 2 on reverse total shoulder arthroplasty, 1 on both, and 1 on arthroscopic rotator cuff repair. There were 827 patients overall: 290 in the opioid group (age, 63.2 ± 4.0 years [mean ± SD]; follow-up, 38.9 ± 7.5 months) and 537 in the nonopioid group (age, 66.0 ± 4.7 years; follow-up, 39.5 ± 8.1 months). The opioid group demonstrated significantly worse pre- and postoperative visual analog scale and Constant-Murley score pain scores as compared with the nonopioid group. Mean American Shoulder and Elbow Surgeons scores were significantly lower in the opioid group at pre- and postoperative time points as compared with the nonopioid group ( P < .05 for all). However, both groups experienced similar improvement in outcomes pre- to postoperatively. One study showed that the opioid group consumed significantly more opioids postoperatively than the nonopioid group and for a longer duration ( P < .05). The overall mean Modified Coleman Methodology Score and MINORS score were 64.2 ± 14 and 15.8 ± 1.0, respectively. Conclusion: Opioid use prior to various shoulder surgical procedures negatively affected postoperative pain and functionality. Although the opioid group showed significantly worse scores postoperatively, the groups experienced similar improvements.

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Comparative Analysis for the Treatment of Hemorrhoids Using Harmonic Scalpel versus Conventional Hemorrhoidectomy: A Single-Center Experience

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i2330729 ◽

2020 ◽

pp. 164-170

Author(s):

Fatma Al- Thoubaity

Keyword(s):

Wound Healing ◽

Patient Satisfaction ◽

Postoperative Pain ◽

Pain Relief ◽

Postoperative Complications ◽

Blood Loss ◽

Patient Group ◽

Harmonic Scalpel ◽

Conventional Hemorrhoidectomy ◽

Grade Iii

Background: Hemorrhoidectomy is one of the most effective treatments for Grade III/IV hemorrhoids. This study was aimed to compare the outcomes and postoperative complications arising from the harmonic scalpel hemorrhoidectomy with conventional hemorrhoidectomy. Methods: In this retrospective study, 1120 patients were operated on for symptomatic Grade III/IV hemorrhoids during April 2004-April 2020. In the conventional hemorrhoidectomy patient group, the operation was performed by Ferguson closed method using monopolar electrocautery, while the other patient group was operated using a harmonic scalpel. Patient demographic data and common patient complaints were recorded. Operation duration and blood loss during the procedure were noted. Regular follow up of the patients was done for 4 weeks, and postoperative pain relief was recorded using the Visual Analog Scale. Finally, patient satisfaction and complete wound healing were analyzed along with postoperative complications like incontinence, secondary hemorrhage, recurrence, and anal stenosis. Results: The patient demographic characteristics and preoperative complaints were similar for both groups. Harmonic scalpel procedure resulted in shorter operation time and less blood loss. Postoperative pain relief was substantially better in the patient group who underwent harmonic scalpel hemorrhoidectomy. Harmonic hemorrhoidectomy procedure also resulted in higher patient satisfaction and wound healing. Minimal postoperative complications were observed for both groups. Conclusion: Harmonic scalpel hemorrhoidectomy is a safe and effective procedure that achieves simultaneous tissue and vessel sealing. It reduces the duration of the operation, blood loss, postoperative pain, and complications compared to a conventional hemorrhoidectomy procedure.

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Comparison of Postoperative complications between Conventional Ferguson’s Hemorrhoidectomy and LigaSureTM Hemorrhoidectomy

QJM ◽

10.1093/qjmed/hcab097.003 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Sherif Abd El-Halim ◽

Mohab Gamal El-Den ◽

Ahmad Magdy Muhammad Husayn

Keyword(s):

Postoperative Pain ◽

Postoperative Complications ◽

Anal Fistula ◽

Perianal Fistula ◽

Comprehensive Overview ◽

Post Operative Pain ◽

Surgical Device ◽

Closed Hemorrhoidectomy ◽

A Prospective Study ◽

Grade Iii

Abstract Background For symptomatic grade III and IV haemorrhoids, some form of hemorrhoidectomy remains the accepted modality of treatment. The traditional methods like the Milligan-Morgan method and the Ferguson‘s method have been in practice for more than half a century. Recently we acquired the LigaSureTM device. It is an electro-surgical device, which is an improved version of bipolar diathermy, now widely used for hemorrhoidectomy. This study will give a comprehensive overview on differences between conventional Ferguson‘s haemorrhoidectomy and LigaSureTM haemorrhoidectomy focusing on post-operative complications mainly postoperative pain, bleeding and peri-anal fistulae occurrence Objective To compere between closed hemorrhoidectomy, Ferguson‘s method, and LigaSureTM hemorrhoidectomy as regards post-operative pain, bleeding and peri-anal fistula occurrence. Patients and Methods It is a prospective study conducted over 40 patients with grade III and IV hemorrhoids, randomly divided into two groups to compare between closed hemorrhoidectomy, Ferguson‘s method, and LigaSure™ hemorrhoidectomy as regards post-operative pain, bleeding and peri-anal fistula occurrence. Results An overall favorable trend exists toward LigaSureTM hemorrhoidectomy in all parameters of the current study, in another word, the postoperative complications mainly pain, bleeding and peri-anal fistula occurrence was much lesser in the LigaSureTM group. Conclusion LigaSureTM hemorrhoidectomy is a sutureless, hemorrhoidectomy technique dependent on a modified electro- surgical unit to achieve vessel and tissue sealing. It is safe and effective, has less blood loss, postoperative pain, bleeding and perianal fistula occurrence compared to conventional Ferguson‘s hemorrhoidectomy.

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Deficiencies in micronutrients are common in Trauma patients but not related with delayed wound healing

Aktuelle Ernährungsmedizin ◽

10.1055/s-0029-1223898 ◽

2009 ◽

Vol 34 (03) ◽

Author(s):

SC Blass ◽

C Reimann ◽

S Ellinger ◽

H Goost ◽

C Burger ◽

...

Keyword(s):

Wound Healing ◽

Trauma Patients ◽

Delayed Wound Healing

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