Randomized comparison of stapled haemorrhoidopexy and open haemorrhoidectomy

Background: Surgical management of haemorrhoids is reserved for stage III and IV haemorrhoids. Both Milligan-Morgan technique (CH-Conventional Haemorrhoidectomy) and stapled haemorrhoidopexy technique are used as surgical therapy. Our prospective, comparative study of conventional haemorrhoidectomy versus stapled haemorrhoidectomy was designed in present institution.Methods: This prospective randomised comparative study was carried out in present Surgery Dept from July 2016 to December 2017 with total 60 sample size. All data were analysed according to applicable statistical methods. The results were compared to previous studies so as to arrive at a conclusion.Results: The mean duration of surgery with stapled method was 30.76±3.13 minutes and with conventional method was 49.36±4.08 minutes which was significantly high in conventional method. VAS scores for pain at 12 hours, 24 hours, 72 hours and 7 days for stapled group were 2.63±0.76, 1.66±0.88, 0.90±0.71 and 0.50±0.43 while that for the conventional group were 5.63±0.72, 4.56±1.22, 3.26±1.25 and 2.00±0.69. At all points of time the VAS was significantly lower in stapled group. The mean duration of hospital stay of the patients with stapled method was 3.10±0.75 days and with conventional method was 6.06±0.94 days, which was significantly high in conventional method. The mean time to return to normal activities of the patients with stapled method was 8.16±1.93 days and with conventional method was 12.60±1.67 days, which also significantly high in conventional method.Conclusions: Present study inferred that stapled haemorrhoidopexy is faster, minimally invasive for treatment of haemorrhoids as compared to Conventional haemorrhoidectomy. It is associated less pain and provides a more satisfactory alternative to Conventional surgery because of reduced hospitalisation and earlier return of patient to daily activities, with no significant differences in short term follow up.

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Double versus triple arthrodesis for adult-acquired flatfoot deformity due to stage III posterior tibial tendon insufficiency: a prospective comparative study of two cohorts

International Orthopaedics ◽

10.1007/s00264-021-05041-1 ◽

2021 ◽

Author(s):

Amr A. Fadle ◽

Wael El-Adly ◽

Ahmed Khalil Attia ◽

Mo’men M. Mohamed ◽

Aly Mohamadean ◽

...

Keyword(s):

Comparative Study ◽

Pitch Angle ◽

Functional Outcomes ◽

Operative Time ◽

Deformity Correction ◽

Stage Iii ◽

Triple Arthrodesis ◽

Prospective Comparative Study ◽

The Mean

Abstract Purpose The study aims to prospectively compare double and triple arthrodesis in terms of functional outcomes and deformity correction. To the best of our knowledge, this is the first prospective comparative study in the literature to date. Methods This is a prospective comparative cohort study carried out between May 2017 and May 2019. The study was approved by the IRB at Assiut University and done according to the Helsinki declaration. Patients with AAFD stage III aged between 15 and 40 years old were assigned to double arthrodesis or triple arthrodesis. The groups were prospectively followed for one year. Primary outcomes were union rates, AOFAS scores, and radiological parameters of deformity correction on AP and lateral plain radiographs. Secondary outcomes were operative time, time to union, and complications. The double arthrodesis was done through the medial approach, while the triple arthrodesis was done through dual medial and lateral approaches. The post-operative protocol was standardized for both groups. Results A total of twenty-three patients matched the inclusion criteria and provided their consent to participate in the study. Thirteen (all males) patients underwent double arthrodesis, while ten (nine males and one female) patients underwent triple arthrodesis. The mean age for double and triple arthrodesis was 20.15 ± 5.63 and 25.10 ± 8.36 years, respectively, and the mean follow-up lengths were 12.46 and 12.9 months, respectively. There were no statistically significant differences between both groups in age, gender, laterality, or duration of follow-up. There were no statistically significant differences between both groups in AOFAS hindfoot scores or radiographic parameters. All patients were available for the final follow-up evaluation. All patients in both groups achieved union by four months post-operatively. The mean time to union in the double and triple arthrodesis groups was 3.39 ± 0.65 vs. 3.31 ± 0.6 months, respectively, with no statistically significant differences (p = 0.77). The mean operative time was significantly shorter in the double arthrodesis group than the triple arthrodesis group, 55.77 ± 15.18 vs. 91.6 ± 24.14 min (p < 0.001), respectively. Both double and triple arthrodesis groups had a statistically significant improvement of the mean AOFAS hindfoot score post-operatively (71.46 ± 7.77 vs. 88.38 ± 3.66, p < 0.001) and (66.9 ± 7.69 vs. 85 ± 5.83, p < 0.001), respectively. In the double arthrodesis group, the mean calcaneal pitch angle increased from 11.46° pre-operatively to 19.34° (MD = 8.45°, p < 0.001). The mean Meary’s angle improved from − 4.19 to 2.9° (MD = 7.32°, p < 0.001). Hibbs angle had a mean reduction of 6.45° post-operatively (p = 0.069). In the triple arthrodesis group, the mean calcaneal pitch angle improved from 10.06° pre-operatively to 17.49° post-operatively (MD = 7.12°, p < 0.001). The mean Meary’s angle improved from − 4.72 to 2.29° (MD = 7.09°, p < 0.001). The mean Hibbs angle decreased from 153.07 to 142.32° (MD = 10.54°, p < 0.001). The double vs. triple arthrodesis groups had no statistically significant differences in AOFAS hindfoot score improvement (16.92 vs. 19.1, p = 0.44), respectively. The two groups had no statistically significant differences in the magnitude of correction of all the radiographic parameters. Conclusion Double arthrodesis is an equally reliable surgical option for AAFD stage III for achieving union, improving the functional outcomes, and deformity correction as triple arthrodesis with a significantly shorter operative time in the former. The authors recommend double arthrodesis if the calcaneocuboid joint is unaffected.

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Stapled haemmorhoidopexy versus open haemorrhoidectomy: our initial experience

International Surgery Journal ◽

10.18203/2349-2902.isj20171619 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1672

Author(s):

Mir Mujtaba Ahmad ◽

Raja Nadeem ◽

Musharraf Husain ◽

Irfan Nazir ◽

Manzoor Ahmad

Keyword(s):

Hospital Stay ◽

Operating Time ◽

P Value ◽

Stapled Haemorrhoidopexy ◽

Mean Values ◽

Post Surgery ◽

Stapled Haemorrhoidectomy ◽

Significant Difference ◽

Vas Scores ◽

The Mean

Background: Haemorrhoids or ‘Piles’ is a frequently observed disease in surgical practice. Various non-surgical and surgical treatments are available. Open haemorrhoidectomy (Milligan-Morgan) is a widely-used procedure. A recent novel technique called ‘Stapled haemorrhoidopexy’, first described and performed by Italian surgeon Antonio Longo is gaining worldwide recognition for its benefits.Methods: A total of 155 patients between the age group of 20 and 65 years, diagnosed to have grade III or IV haemorrhoids were included in the study, divided into 2 groups, Group 1 undergoing Open haemorrhoidectomy (30 patients) and Group 2 undergoing Stapled haemorrhoidectomy (25 patients). Post operatively patients of both groups were reviewed at the time of discharge, at 7 days after discharge, at 1 month and 3 months post-surgery. The significant difference of the percentages between the two groups was tested using the Chi Square test. The significant difference in the mean values between the 2 groups was tested using the Student’s t- independent test. For all the tests, level of significance was taken as 0.05.Results: In present study, the mean operating time for stapled haemorrhoidopexy was 34.96±7.38 minutes with an average of 20-50 minutes, while with open haemorrhoidectomy, the mean operating time was 44.67±11.83 minutes (p<0.001). The mean VAS scores at 6, 12 and 24 hours with stapled haemorrhoidopexy were 1.79±0.76; 1.83±0.61 and 1.47±0.66, respectively, and with open haemorrhoidectomy, the mean VAS scores at 6, 12 and 24 hours were 2.88±0.88; 2.13±0.82 and 1.91±0.83, respectively. The mean hospital stay for patients with stapled haemorrhoidopexy was 1.96±0.55 days in comparison to the open group where the mean hospital stay was 3.51±0.72 days (P-value<0.001). The time for resumption to routine work was shorter in stapled group 8.61±2.76 as compared to 15.34± 2.12 which was statistically significant (P value <0.001). The mean amount of blood loss during stapled hemorrhoidectomy was statistically less than in open surgery.Conclusions:Stapled Haemorrhoidectomy is less painful with shorter duration of hospital stay and resumption of daily activity is faster than the open haemorrhoidectomy. However, long term follow-up is required to know the recurrence rate in stapled haemorrhoidectomy.

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Effect of preservation of the C-6 spinous process and its paraspinal muscular attachment on the prevention of postoperative axial neck pain in C3–6 laminoplasty

Journal of Neurosurgery Spine ◽

10.3171/2014.11.spine131153 ◽

2015 ◽

Vol 22 (3) ◽

pp. 221-229 ◽

Cited By ~ 5

Author(s):

Eiji Mori ◽

Takayoshi Ueta ◽

Takeshi Maeda ◽

Itaru Yugué ◽

Osamu Kawano ◽

...

Keyword(s):

Neck Pain ◽

Spinous Process ◽

Posterior Longitudinal Ligament ◽

Paraspinal Muscle ◽

Vas Scores ◽

The Mean ◽

Axial Neck Pain ◽

Process Length ◽

Preservation Technique

OBJECT Axial neck pain after C3–6 laminoplasty has been reported to be significantly lesser than that after C3–7 laminoplasty because of the preservation of the C-7 spinous process and the attachment of nuchal muscles such as the trapezius and rhomboideus minor, which are connected to the scapula. The C-6 spinous process is the second longest spinous process after that of C-7, and it serves as an attachment point for these muscles. The effect of preserving the C-6 spinous process and its muscular attachment, in addition to preservation of the C-7 spinous process, on the prevention of axial neck pain is not well understood. The purpose of the current study was to clarify whether preservation of the paraspinal muscles of the C-6 spinous process reduces postoperative axial neck pain compared to that after using nonpreservation techniques. METHODS The authors studied 60 patients who underwent C3–6 double-door laminoplasty for the treatment of cervical spondylotic myelopathy or cervical ossification of the posterior longitudinal ligament; the minimum follow-up period was 1 year. Twenty-five patients underwent a C-6 paraspinal muscle preservation technique, and 35 underwent a C-6 nonpreservation technique. A visual analog scale (VAS) and VAS grading (Grades I–IV) were used to assess axial neck pain 1–3 months after surgery and at the final follow-up examination. Axial neck pain was classified as being 1 of 5 types, and its location was divided into 5 areas. The potential correlation between the C-6/C-7 spinous process length ratio and axial neck pain was examined. RESULTS The mean VAS scores (± SD) for axial neck pain were comparable between the C6-preservation group and the C6-nonpreservation group in both the early and late postoperative stages (4.1 ± 3.1 vs 4.0 ± 3.2 and 3.8 ± 2.9 vs 3.6 ± 3.0, respectively). The distribution of VAS grades was comparable in the 2 groups in both postoperative stages. Stiffness was the most prevalent complaint in both groups (64.0% and 54.5%, respectively), and the suprascapular region was the most common site in both groups (60.0% and 57.1%, respectively). The types and locations of axial neck pain were also similar between the groups. The C-6/C-7 spinous process length ratios were similar in the groups, and they did not correlate with axial neck pain. The reductions of range of motion and changes in sagittal alignment after surgery were also similar. CONCLUSIONS The C-6 paraspinal muscle preservation technique was not superior to the C6-nonpreservation technique for preventing postoperative axial neck pain.

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Outcomes of endoscopic suturectomy with postoperative helmet therapy in bilateral coronal craniosynostosis

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.2.peds15693 ◽

2016 ◽

Vol 18 (3) ◽

pp. 281-286 ◽

Cited By ~ 14

Author(s):

S. Alex Rottgers ◽

Subash Lohani ◽

Mark R. Proctor

Keyword(s):

Hospital Stay ◽

Head Circumference ◽

Major Complication ◽

Csf Leak ◽

Perioperative Morbidity ◽

Syndromic Craniosynostosis ◽

Duration Of Surgery ◽

Coronal Synostosis ◽

The Mean

OBJECTIVE Historically, bilateral frontoorbital advancement (FOA) has been the keystone for treatment of turribrachycephaly caused by bilateral coronal synostosis. Early endoscopic suturectomy has become a popular technique for treatment of single-suture synostosis, with acceptable results and minimal perioperative morbidity. Boston Children's Hospital has adopted this method of treating early-presenting cases of bilateral coronal synostosis. METHODS A retrospective review of patients with bilateral coronal craniosynostosis who were treated with endoscopic suturectomy between 2005 and 2012 was completed. Patients were operated on between 1 and 4 months of age. Hospital records were reviewed for perioperative morbidity, length of stay, head circumference and cephalic indices, and the need for further surgery. RESULTS Eighteen patients were identified, 8 males and 10 females, with a mean age at surgery of 2.6 months (range 1–4 months). Nine patients had syndromic craniosynostosis. The mean duration of surgery was 73.3 minutes (range 50–93 minutes). The mean blood loss was 40 ml (range 20–100 ml), and 2 patients needed a blood transfusion. The mean duration of hospital stay was 1.2 days (range 1–2 days). There was 1 major complication in the form of a CSF leak. The mean follow-up was 37 months (range 6–102 months). Eleven percent of nonsyndromic patients required a subsequent FOA; 55.6% of syndromic patients underwent FOA. The head circumference percentiles and cephalic indices improved significantly. CONCLUSIONS Early endoscopic suturectomy successfully treats the majority of patients with bilateral coronal synostosis, and affords a short procedure time, a brief hospital stay, and an expedited recovery. Close follow-up is needed to detect patients who will require a secondary FOA due to progressive suture fusion or resynostosis of the released coronal sutures.

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A Comparative Study of Endoscopic Coblation Adenoidectomy and Regular Curettage Adenoidectomy in a Tertiary Care Hospital in Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/645 ◽

2021 ◽

Vol 8 (41) ◽

pp. 3559-3566

Author(s):

Abdul Salam R. T. ◽

Shahul Hameed A. ◽

Meera Rajan

Keyword(s):

Blood Loss ◽

Comparative Study ◽

Tertiary Care ◽

Operation Time ◽

Care Hospital ◽

Adenoid Tissue ◽

Significant Difference ◽

Tube Function ◽

Prospective Comparative Study ◽

The Mean

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

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A prospective comparative study to compare orthobiological PRP platelet rich plasma intra lesional injectional therapy compare to steroid injection in treatment of Achilles tendonitis and intractable plantar fasciitis a clinical follow up study for 2 Years

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2018.v4.i2i.81 ◽

2018 ◽

Vol 4 (2i) ◽

pp. 549-554

Author(s):

Ahmed Alkhuzai

Keyword(s):

Comparative Study ◽

Plantar Fasciitis ◽

Steroid Injection ◽

Platelet Rich Plasma ◽

Follow Up Study ◽

Prospective Comparative Study ◽

Achilles Tendonitis

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Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures

Asian Spine Journal ◽

10.31616/asj.2019.0189 ◽

2020 ◽

Vol 14 (4) ◽

pp. 466-474

Author(s):

Shanmuganathan Rajasekaran ◽

Dilip Chand Raja Soundararajan ◽

Ajoy Prasad Shetty ◽

Rishi Mugesh Kanna

Keyword(s):

Neck Disability Index ◽

Optimal Placement ◽

Range Of Movement ◽

Ct Guided ◽

Duration Of Surgery ◽

The Mean ◽

The Right ◽

Neck Disability ◽

Displaced Fracture

Study Design: Prospective observational study.Purpose: To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation.Overview of Literature: The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion and function. Monosegmental C1 osteosynthesis negates these drawbacks and provides excellent functional outcomes.Methods: The patients were positioned in a prone position, and cranial traction was applied using Mayfield tongs to restore the C0–C2 height and obtain a reduction in the displaced fracture fragments. An intraoperative, CT-based navigation system was used to enable the optimal placement of C1 screws. A transverse rod was then placed connecting the two screws, and controlled compression was applied across the fixation. The patients were prospectively evaluated in terms of their clinical, functional, and radiological outcomes, with a minimal follow-up of 2 years.Results: A total of 10 screws were placed in five patients, with a mean follow-up of 40.8 months. The mean duration of surgery was 77±13.96 minutes, and the average blood loss was 84.4±8.04 mL. The mean combined lateral mass dislocation at presentation was 14.6±1.34 mm and following surgery, it was 5.2±1.64 mm, with a correction of 9.4±2.3 mm (p <0.001). The follow-up CT showed excellent placement of screws and sound healing. There were no complications and instances of AA instability. The clinical range of movement at 2 years in degrees was as follows: rotation to the right (73.6°±9.09°), rotation to the left (71.6°±5.59°), flexion (35.4°±4.5°), extension (43.8°±8.19°), and lateral bending on the right (28.4°±10.45°) and left (24.8°±11.77°). Significant improvement was observed in the functional Neck Disability Index from 78±4.4 to 1.6±1.6. All patients returned to their occupation within 3 months.Conclusions: Successful C1 reduction and fixation allows a motion-preserving option in unstable atlas fractures. CT navigation permits accurate and adequate monosegmental fixation with excellent clinical and radiological outcomes, and all patients in this study returned to their preoperative functional status.

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Evaluation of outcome in open and stapler haemorrhoidectomy in grade III/IV haemorrhoids

International Surgery Journal ◽

10.18203/2349-2902.isj20204125 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3294

Author(s):

Manju Singh ◽

Amit Agarwal ◽

Kush Pandey

Keyword(s):

Postoperative Bleeding ◽

Treatment Modalities ◽

Stapled Haemorrhoidopexy ◽

College Hospital ◽

Duration Of Surgery ◽

Operative Complications ◽

Hospital Stays ◽

Grade Iii ◽

Post Operative Complications

Background: Haemorrhoids are one of most common benign anorectal malformation worldwide. There are various surgical treatment modalities for 3rd and 4th degree haemorrhoids. Open haemorrhoidectomy was the most widely practiced and is considered the current gold standard. In search of a newer surgical technique, stapler has been introduced for haemorrhoidectomy and has revolutionised operative procedures over the last decade world-wide due to its ease and simplicity and lesser post-operative complications. The following study was done to evaluate the outcome of open versus stapled haemorrhoidectomy in terms of post-operative pain, postoperative bleeding, duration of surgery, duration of hospital stays in a medical college hospital at Raipur, Chhattisgarh.Methods: This was a prospective follow-up study, in patients undergoing surgery for grade III/IV haemorrhoids conducted in the Department of Surgery, Dr BRAM Hospital, Raipur, from August 2017 to July 2018. Fourteen patients underwent stapled haemorrhoidopexy and eighteen underwent open haemorrhoidectomy. All patients were reviewed immediately after surgery, at discharge and at 1, 3 and 10 weeks post-operatively. The two groups were compared for post-operative outcomes and complications.Results: The majority of patients in the study were males and had grade 4 haemorrhoids. Stapled haemorrhoidopexy group had shorter duration of surgery, less postoperative pain, shorter duration of hospital stays as compared with open haemorrhoidectomy group. There were no major post-operative complications in the follow up period of 10 weeks in the stapled group.Conclusions: Stapled haemorrhoidopexy is a safer alternative to open haemorrhoidectomy with many short-term benefits.

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Calcifying tendinitis of the shoulder: arthroscopic needling versus complete calcium removal and rotator cuff repair. A prospective comparative study

Joints ◽

10.11138/jts/2015.3.4.166 ◽

2015 ◽

Vol 03 (04) ◽

pp. 166-172 ◽

Cited By ~ 2

Author(s):

Alessandro Castagna ◽

Silvana De Giorgi ◽

Raffaele Garofalo ◽

Marco Conti ◽

Silvio Tafuri ◽

...

Keyword(s):

Rotator Cuff ◽

Comparative Study ◽

Clinical Outcomes ◽

Tendon Repair ◽

Complete Removal ◽

Calcium Deposit ◽

Calcifying Tendinitis ◽

Clinical Scores ◽

Prospective Comparative Study

Purpose: the aim of the present study was to verify the differences in the clinical outcomes of two arthroscopic techniques used to treat calcifying tendinitis of the shoulder: needling versus complete removal of the calcium deposit and tendon repair. Methods: from September 2010 to September 2012, 40 patients with calcifying tendinitis of the rotator cuff were arthroscopically treated by the same surgeon using one of the two following techniques: needling (Group 1) and complete removal of the calcium deposit and tendon repair with suture anchors (Group 2). Both groups followed the same rehabilitation program. The two groups were compared at 6 and 12 months of follow-up for the presence of residual calcifications and for the following clinical outcomes: Constant score, American Shoulder and Elbow Surgeons Evaluation Form (ASES) shoulder score, University of California Los Angeles (UCLA) shoulder rating scale, Simple Shoulder Test (SST) and Visual Analogue Scale (VAS). Results: all the clinical scores (Constant, ASES, UCLA, SST and VAS scores) improved significantly between baseline and postoperative follow-up, both at 6 and at 12 months. no differences at final follow-up were found between the two groups. Conclusions: both the techniques were effective in solving the symptoms of calcifying tendinitis of the shoulder. Clinical scores improved in both groups. Residual calcifications were found in only a few cases and were always less than 10 mm. Level of evidence:Level II, prospective comparative study.

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Comparative study between endoscopic cartilage myringoplasty and endoscopic temporalis fascia myringoplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185116 ◽

2018 ◽

Vol 5 (1) ◽

pp. 24 ◽

Cited By ~ 1

Author(s):

P. Chozhan ◽

M. Sankara Subramanian ◽

D. Kannathal ◽

R. Malarvizhi

Keyword(s):

Comparative Study ◽

Prospective Study ◽

Temporalis Fascia ◽

Ear Surgery ◽

Medical College ◽

The World ◽

Prospective Comparative Study ◽

Patient Series ◽

A Prospective Study

Background: Myringoplasty is a common ear surgery performed all over the world. This study is focused on prospective comparative study using two different graft materials.Methods: This was a prospective study done in the Department of ENT Stanley Medical College, Chennai during the period from March 2013 to September 2013. Sample size was 60 patients. Follow up was done till 6 months. Results: Graft acceptance was achieved in 28 patients (93%) who underwent palisade cartilage myringoplasty, whereas it was achieved in 24 patients (80%) in the temporalis fascia myringoplasty group.Conclusions: The outcomes in our patient series indicate that cartilage myringoplasty achieves good results. Cartilage, a very effective material for the reconstruction of the TM and grafts can provide an excellent anatomical result, perfect stability and good functional outcome.

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