Laser hemorrhoidoplasty versus Milligan-Morgan hemorrhoidectomy - short term outcome

Background/Aim. According to the ?vascular? theory, arterial inflow into the upper hemorrhoidal artery leads to venous dilatation of the hemorrhoidal plexus. Laser hemorrhoidoplasty (LHP) is a new treatment applied to outpatients in whom the hemorrhoid arterial blood flow is coagulated (nourishes by hemorrhoidal plexus) by laser. The aim of this study was to compare two groups of patients treated by two different methods: by laser (LHP) and with open surgical procedure ? the Milligan Morgan (MM) method. Methods. This study included 200 patients with grade 3 hemorrhoidal disease older than 18 years, divided into two groups: 100 patients treated with the LHP, while the other 100 patients with the MM hemorrhoidectomy. Parameters used to compare two applied surgical methods were: duration of hospitalization, postoperative pain, the presence of bleeding and time needed to return to normal life. Results. The results reveal a statistically significant difference between these two methods. The level of postoperative pain was lower in the group of patients treated with the LHP compared to the group of patients treated with the MM method (p < 0.0001). The group treated with the LHP manifested less bleeding in comparison with the group treated with the open surgical method (MM). Length of hospitalization and duration of surgery were significantly shorter in the group treated with the LHP method than in the group treated by the MM method. Conclusion. According to our results, it is clear that the LHP method has many advantages over the MM hemorrhoidectomy in patients with grade 3 hemorrhoidal disease.

Download Full-text

The Effect of Perianal Tramadol Infiltration on Postoperative Pain Following Hemorrhoidectomy

The American Surgeon ◽

10.1177/0003134820981683 ◽

2020 ◽

pp. 000313482098168

Author(s):

Maryam Hatami ◽

Mohammad Talebi ◽

Naimeh Heiranizadeh ◽

Sedighe Vaziribozorg

Keyword(s):

Postoperative Pain ◽

Pain Score ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Topical Anesthetic ◽

Double Blind ◽

Double Blind Clinical Trial ◽

Significant Difference ◽

Duration Of Surgery ◽

Grade 3

Introduction The present study was attempted to evaluate the effect of perianal infiltration of tramadol on postoperative pain in patients undergoing hemorrhoidectomy. Method This double-blind clinical trial study was carried out on 90 patients with grade 3 and 4 hemorrhoids undergoing hemorrhoidectomy. Patients were randomly assigned into 3 groups of control or bupivacaine or tramadol. Before the surgery, perianal infiltration of .25% bupivacaine or tramadol or normal saline was prescribed to each group, respectively. Data on pain severity (based on the visual analog scale (VAS), the duration of surgery, sedation score, pain at the first defecation, first request time for additional analgesia, nausea and vomiting, and analgesic intakes) were evaluated and analyzed. Results Duration of surgery was almost similar in all 3 groups ( P = .974). The results showed a significant difference in pain score between 3 groups ( P ≤.05) at all times after the surgery. In addition, the means of sedation scores ( P = .03), pain score at the first defecation ( P = .001), the time to first analgesic request ( P = .001), and ketorolac administration times ( P = .01) were significantly different between 3 groups. Finally, no complication was reported regarding postoperative nausea and vomiting. Conclusion Given the notable efficacy of tramadol in reducing pain after hemorrhoidectomy and its minor side effects, this medication is suggested as an effective topical anesthetic to decrease pain after hemorrhoidectomy.

Download Full-text

Application of platysma muscle suture after thyroidectomy

Journal of Surgery and Trauma ◽

10.32592/jsurgery.2020.8.4.103 ◽

2020 ◽

pp. 147-150

Keyword(s):

Postoperative Pain ◽

Wound Infection ◽

Intervention Group ◽

Control Group ◽

P Value ◽

Platysma Muscle ◽

Significant Difference ◽

Duration Of Surgery ◽

The Mean ◽

Length Of Hospitalization

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.

Download Full-text

P1315PREDICTABILITY OF SONOGRAPHICALLY DETERMINED IMMEDIATE POST-OPERATIVE BLOODFLOW AND VEIN DIAMETER ON PRIMARY RADIOCEPHALIC FISTULA SHORT AND LONGTERM OUTCOMES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa143.p1315 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Claude Renaud ◽

Desmond Ooi ◽

Chuo Ren Leong

Keyword(s):

Predictive Value ◽

Cox Regression ◽

Area Under The Curve ◽

Primary Patency ◽

Arterial Blood Flow ◽

Secondary Patency ◽

Arterial Blood ◽

Linear Probe ◽

Significant Difference ◽

Esrd Patients

Abstract Background and Aims Vascular access (VA) guidelines recommend radio-cephalic (RC) over upper arm autogenous arteriovenous fistulas (AVF) as first line VA for hemodialysis in end stage renal disease (ESRD) patients. RCAVFs generally have inferior maturation and patency rates predicated on a lower feeding arterial blood flow (BF) and outflow vein calibre (VC). However studies on postoperative BF and VC as predictors of AVF outcomes, so far are confounded by their focus on early outcomes only, heterogeneity of AVFs studied, variable timing of assessment and use of non-standardised outcome definitions. Our aim was therefore to assess the accuracy and influence of immediate post-operative BF and VC on both early and longterm outcomes in a homogenous cohort of primary RCAVFs using standardised definitions and outcome measures as mandated by VA guidelines. Method This was a prospective study conducted in multi-ethnic Asian ESRD patients who had their primary RCAVFs created between October 2013 and October 2014 under regional anesthesia at Khoo Teck Puat hospital Singapore. All AVFs were assessed immediately after surgery for brachial artery BF and outflow VC using doppler ultrasound. A 10MHz linear probe and GE Logic e R7 machine were used exclusively by a single operator. Receiver operating characteristic (ROC) curves were generated to determine the optimal BF and VC cut-off for AVF maturation. Maturation was defined as BF>600mL/min, VC>6mm and vein depth <6mm at 6 weeks post-op. An area under the curve (AUC)> 0.7 was considered clinically significant. Kaplan–Meier analysis was used to evaluate the AVF primary and secondary patency based on best BF and VC cut-offs. Cox regression statistics was used to determine AVF hazard factors. Results Fifty-seven primary RCAVFs were created and included in the study. The baseline characteristics are shown in Table 1. Sonography- based non-assisted maturation at 6 weeks was 56%. ROC identified 410 mL/min and 42mm as the best BF and VC cut-off respectively to most accurately predict 6-week maturation. The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 61%, 44% and 86% for BF at 410 mL/min and 69%, 61%, 41% and 83% for VC at 42mm respectively. Survival analysis (Fig. 1 and 2) showed that AVFs with VC≥42 mm compared to <42mm had significantly greater 6 months, 1-year, 2-year and 4-year primary and secondary patency rates. There was no significant difference in patency rates between AVFs with BF≥410 and <410mL/min. Cox proportional regression hazard analysis showed that diabetes (HR 2.26, CI 1.02-4.99, p= 0.04) and maturation (HR 0.47, 95% CJ 0.24-0.89, p=0.02) as significant contributed to the variability of primary patency. Only VC (HR 0.28, 95% CI 0.13-0.063, p=0.002) impacted significantly towards secondary patency. Conclusion An immediate post-op BF≥410mL/min and VC≥42mm can predict early RCAVF outcome in the form of nonassisted maturation, but only VC accurately impact on longterm AVF survival. VA surveillance efforts should therefore target RCAVFs with post-op VC <42mm for timely intervention and maintenance of longterm patency.

Download Full-text

Laparoscopic Versus Open Appendectomy for the Treatment of Complicated Acute Appendicitis

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.8n.1p.15 ◽

2020 ◽

Vol 8 (1) ◽

pp. 15

Author(s):

Alireza Barband ◽

Amir Mangouri ◽

Changiz Gholipouri ◽

Abasad Gharedaghi

Keyword(s):

Laparoscopic Surgery ◽

Surgical Treatment ◽

Postoperative Pain ◽

Acute Appendicitis ◽

Open Surgery ◽

Surgery Group ◽

Significant Difference ◽

Duration Of Surgery ◽

Duration Of Hospitalization ◽

Complicated Acute Appendicitis

Background and Objective: Acute appendicitis is one of the most common and at the same time lethal if not treated promptly. Failure to treat this medical condition in a timely manner then it can lead to major complications that endanger the patient’s health. In these cases, surgical treatment can be done in an open or laparoscopic method. Despite some limited studies comparing the results of these two therapies, there is still insufficient information in patients with this complicated situation. The aim of this study was to evaluate the results of these two therapies in patients with complicated acute appendicitis. Materials and Methods: In this randomized controlled clinical trial, 52 patients with complicated acute appendicitis in the laparoscopic surgery group and 56 patients in the open surgery group were studied. Primary outcomes in this study were duration of surgery and secondary outcomes including wound infection, intra-abdominal abscess, postoperative pain, miscarriage, hospitalization, and need for re-surgery that were compared between the two groups. Results: Both groups were matched for age (mean 31.0 years in laparoscopic surgery group, 30.5 years in open surgery group, p = 0.81) and gender (28 men in laparoscopic surgery group, 32 men in surgical group, p = 0.73). The mean duration of surgery in the laparoscopic group was significantly longer (mean 66.8 vs. 55.1 min, p <0.001). In contrast, mean duration of hospitalization (85.2 vs 98.6 hours, p <0.001) and mean postoperative pain severity (6.3 vs 7.2, p <0.001) was more significant high in open surgery group. In other cases there was no significant difference between the two groups. Conclusion: Although in surgical treatment of complicated acute appendicitis the duration of laparoscopic surgery is longer than the open method, but the duration of hospitalization and pain intensity in laparoscopic method is significantly reduced.

Download Full-text

STAPLED HEMORRHOIDOPEXY A BETTER AND SAFER ALTERNATIVE TO OPEN HEMORRHOIDECTOMY IN THE MANAGEMENT OF GRADE III & IV HEMORRHOIDS- A HOSPITAL BASED STUDY

10.36106/ijar/7311143 ◽

2021 ◽

pp. 39-42

Author(s):

G.D. Yadav ◽

Ramendra Kumar Jauhari ◽

Nishant Saxena ◽

Firoj Khan ◽

Sunil Kumar Gupta

Keyword(s):

Statistical Analysis ◽

Postoperative Pain ◽

Hospital Stay ◽

Stapled Hemorrhoidopexy ◽

Short Term ◽

Open Hemorrhoidectomy ◽

Continuous Scale ◽

Duration Of Surgery ◽

Grade 3 ◽

Grade Iii

Background: Surgical hemorrhoidectomy is usual method for management in hemorrhoid grade III and IV. It is generally associated with postoperative pain, long hospital stay and a longer convalescence. Stapled hemorrhoidopexy is a newer minimally invasive alternative for the treatment of hemorrhoids. Aims: In this study, the above two methods were compared with respect to short term outcomes. Settings and Design: This was a prospective and randomized study. Methods: 60 patients having grade 3 or 4 hemorrhoids and who fullled the criteria were included in the study. Thirty patients underwent stapled hemorrhoidopexy and other thirty underwent open hemorrhoidectomy. All patients were reviewed immediately after surgery and at 1, 3 and6 weeks post-operatively. The two groups were compared in terms of duration of surgery, hospital stay, return to work and post-operative level of satisfaction . Statistical Analysis: The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software. Signicance was assessed at 5% level of signicance. Student t-test was used to nd the signicance of study parameters on continuous scale in parametric condition between two groups (inter group analysis) and Mann Whitney U test was used to nd the signicance of study parameters on continuous scale in non-parametric condition within each group. Chi-square/ Fisher Exact test were used to nd the signicance of study parameters on categorical scale between two groups. Results: The overall mean age of patients in our study was 41.35 ± 12.80. The majority of patients in the study were males (78.3%) and had grade 3 haemorrhoids (93.3%). Stapled hemorrhoidopexy group had shorter duration of surgery, less postoperative pain and need for analgesia, shorter duration of hospital stay and earlier return to work and a high patient satisfaction as compared with open hemorrhoidectomy group. Conclusions: Stapled hemorrhoidopexy is a minimally invasive, better and safer alternative to open hemorrhoidectomy with many short-term benets.

Download Full-text

The Effect of Dexmedetomidine on Emergence Agitation in Children After Desflurane Anesthesia

Acta Medica ◽

10.32552/2018.actamedica.294 ◽

2018 ◽

Vol 49 (2) ◽

pp. 1

Author(s):

Filiz Banu Ethemoglu ◽

Aysun Ankay Yilbas ◽

Basak Akca ◽

Hemra Cil ◽

Ozgur Canbay

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Pediatric Anesthesia ◽

Saline Group ◽

Pain Scale ◽

Control Group ◽

Emergence Agitation ◽

Emergence Delirium ◽

Significant Difference ◽

Duration Of Surgery

Objective: To evaluate the effect of dexmedetomidine on the emergence agitation in children after desflurane anesthesia. Materials-Methods: In this prospective randomized comparative study, 50 children between the age group 2-10 years of American Society of Anesthesiologists physical status I or II, who were scheduled for infrainguinal urologic surgery were enrolled and randomly divided into two groups. Group dexmedetomidine (Group B) (n=25) received 0.2 μg/kg dexmedetomidine in 10 ml saline intravenously over 10 minutes after induction and group control (Group A) (n=25) received only 10 ml saline infusion after induction. The emergence agitation levels of the children were evaluated according to the Pediatric Anesthesia Emergence Delirium Scale in the recovery room and postoperative pain scores were evaluated using Children’s and Infants’ Postoperative Pain Scale at the 10th and 30th minutes after extubation. Age, gender, weight, hemodynamic parameters, duration of anesthesia, duration of surgery and side effects were recorded. Results: There was no significant difference in Pediatric Anesthesia Emergence Delirium scores at the 10th and 30th minutes after extubation between dexmedetomidine and saline groups. The decrease in emergence agitation at the 30th minute compared to the 10th minute was independent from sex, age and anesthesia duration in both groups. Incidence of hypotension and bradycardia was higher in the dexmedetomidine group compared to the saline group. Conclusion: In children aged from two to 10 who undergo surgery with desflurane anesthesia, dexmedetomidine administration was not effective in preventing postoperative emergence agitation and caused increased side effects, such as hypotension and bradycardia.

Download Full-text

Nonclosure of the Peritoneum during Appendectomy May Cause Less Postoperative Pain: A Randomized, Double-Blind Study

Pain Research and Management ◽

10.1155/2019/9392780 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Huseyin Kazim Bektasoglu ◽

Mustafa Hasbahceci ◽

Samet Yigman ◽

Erkan Yardimci ◽

Enver Kunduz ◽

...

Keyword(s):

Postoperative Pain ◽

Demographic Data ◽

Open Appendectomy ◽

Life Quality ◽

Life Assessment ◽

Mortality Data ◽

Complication Rates ◽

Significant Difference ◽

Duration Of Surgery ◽

Euroqol 5D

Objective. We aim to evaluate the effect of peritoneal closure on postoperative pain and life quality associated with open appendectomy operations. Methods. This is a single-center, prospective, randomized, and double-blinded study. Here, 18–65-year-old patients who underwent open appendectomy for acute appendicitis were included. Demographic data of the patients, operation time, length of hospital stay, pain scores using a 10 cm visual analogue scale (VAS) on the first postoperative day, quality of life assessment using the EuroQol-5D-5L questionnaire on postoperative 10th day, deep wound dehiscence, bowel obstruction, and mortality data were recorded. Results. In total, 112 patients were included in the study. The demographic data showed no significant difference between the groups. The median VAS score was lower in the group with open peritoneum, but this difference was not statistically significant (3 vs. 4, p=0.134). The duration of surgery was significantly shorter in the peritoneal nonclosure group (31.0 ± 15.1 vs. 38.5 ± 17.5 minutes, p=0.016). Overall complication rates and life quality test (EuroQol-5D-5L) results were similar between groups. Conclusion. Nonclosure of the peritoneum seems to shorten the duration of surgery without increasing complications during open appendectomy. Postoperative pain and life quality measures were not affected by nonclosure of the peritoneum. This trial is registered with NCT02803463.

Download Full-text

Cerebral arterial blood flow and aneurysm surgery

Journal of Neurosurgery ◽

10.3171/jns.1977.47.6.0819 ◽

1977 ◽

Vol 47 (6) ◽

pp. 819-827 ◽

Cited By ~ 69

Author(s):

Helge Nornes ◽

Hanna Berit Knutzen ◽

Per Wikeby

Keyword(s):

Blood Flow ◽

Systematic Investigation ◽

Arterial Blood Flow ◽

Surprising Result ◽

Induced Hypotension ◽

Content Type ◽

Intracranial Surgery ◽

Arterial Blood ◽

Upper Limit ◽

Significant Difference

✓ A study of 21 patients was conducted to clarify the autoregulatory capacity in patients subjected to induced hypotension during intracranial surgery for saccular aneurysms. Trimethaphan camsylate (Arfonad) was used for induced hypotension and arterial blood flow was measured with an electromagnetic flow probe on the internal carotid artery or one of its main intracranial branches. In Grade I and II patients the control arterial blood pressure (ABP) ranged from a mean of 90 to 135 mm Hg (average 110 mm Hg), with a lower level of autoregulation (LLAR) from 35 to 85 mm Hg (average 62 mm Hg). Grade III patients had a control ABP of between 105 and 145 mm Hg (average 124 mm Hg) and the LLAR was found to be between 60 and 95 mm Hg (average 76 mm Hg). There was a significant difference between the two groups with regard to both the control ABP and the LLAR. A surprising result obtained from these data was that the average lower autoregulatory range (the difference between control ABP and LLAR) is practically the same in the two groups. A systematic investigation of the upper limit of autoregulation was not possible for ethical reasons. In those few patients in whom spontaneous increase in the ABP made such observations possible, upper limits up to 150 mm Hg with a total autoregulatory capacity of about 75 mm Hg were observed. In some patients, however, lower limits and corresponding “breakthroughs” of cerebral blood flow were seen, demonstrating that the upper limit of autoregulation is markedly influenced by several factors.

Download Full-text

A comparative study of coblation assissted adenotonsillectomy and cold dissection adenotonsillectomy in children

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20164814 ◽

2016 ◽

Vol 3 (1) ◽

pp. 122 ◽

Cited By ~ 1

Author(s):

Nithya V. ◽

Angshuman Dutta ◽

Sabarigirish K.

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Postoperative Period ◽

P Value ◽

Intraoperative Blood Loss ◽

Pain Scores ◽

Significant Difference ◽

Duration Of Surgery ◽

The Mean ◽

Cold Dissection

Background: The aim of the present study was to compare intraoperative blood loss, operative duration and postoperative pain between coblation-assisted adenotonsillectomy and cold dissection adenotonsillectomy in children.Methods: A prospective, randomized, single-blind trial of pediatric patients aged 7 to 13 years undergoing adenotonsillectomy was conducted. Patients were randomized to undergo either cold dissection or coblation-assisted adenotonsillectomy. Measured intraoperative parameters included surgical duration and intraoperative blood loss. Measured postoperative parameters included a daily pain rating using the visual analog scale on the postoperative evening, postoperative day 1 and day 7. Intraoperative and postoperative measures were statistically compared between the two groups. Results: Sixty children were randomized and included in the study. 30 patients underwent cold dissection adenotonsillectomy and 30 coblation-assisted adenotonsillectomy. Mean age was 8.7 years in the coblation group and 9.1 years in the cold dissection group. Intraoperative blood loss was lower for the coblation assisted adenotonsillectomy group versus the cold dissection adenotonsillectomy group which was proved statistically (mean bleeding was 16.67 in coblation group and 58.67 in cold dissection group and p value <0.0001).There was statistically no significant difference in the mean pain scores in the 2 groups in the postoperative evening and on postoperative day 1. The mean pain scores on postoperative day 7 were found to be 3.4 in the coblation group and 2.47 in the cold dissection group with a significant p value of 0.0087. The average duration of surgery in the coblation group was 55.6 minutes as against 34.1 minutes in the cold dissection group. The p- value was found to be less than 0.0001 which makes the difference statistically significant. Conclusions: This study found that the intraoperative blood loss was significantly less in Coblation adenotonsillectomy than in cold dissection adenotonsillectomy. The duration of surgery in Coblation assisted adenotonsillectomy is significantly greater than the duration of surgery in cold dissectionadenotonsillectomy. While the postoperative pain scores are similar with coblation and cold dissection adenotonsillectomy in the early postoperative period, it is significantly more with coblation in the late postoperative period.

Download Full-text

Effect of Cryotherapy On Pain Scores and Satisfaction Levels of Patients in Cataract Surgery Under Topical Anesthesia

10.21203/rs.3.rs-966789/v1 ◽

2021 ◽

Author(s):

Marzieh Beigom Khezri ◽

Abbas Akrami ◽

Matina Majdi ◽

Bijan Gahandideh ◽

Navid mohammadi

Keyword(s):

Postoperative Pain ◽

Cataract Surgery ◽

Study Groups ◽

Opioid Consumption ◽

Operating Conditions ◽

Topical Anesthesia ◽

Pain Scores ◽

Arterial Blood ◽

Significant Difference

Abstract Background To evaluate the effects of cryotherapy on pain scores and satisfaction levels of patients during cataract surgery under topical anesthesia. Methods Eighty patients aged between 55 and 75 years scheduled for cataract surgery were randomly allocated to two study groups to receive topical anesthesia with cryotherapy (TC) or topical anesthesia alone (T) groups. Visual analog pain scores, patient satisfaction level, hemodynamic parameters, and quality of operating conditions were recorded. Results Cryotherapy significantly reduced VAS pain scores during surgery (P=0.014). Although no significant difference in postoperative pain scores, opioid consumption, heart rate, and mean arterial blood pressure was seen in the postoperative period. The surgeon reported better quality of operating conditions in the TC group (P = 0.018). Conclusion Cryotherapy as a complementary method with topical anesthesia reduced pain scores of patients during surgery. It also produced a better quality of operating conditions for surgeons. There was no significant difference in either postoperative pain scores or opioid consumption.

Download Full-text