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 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 Surgical Treatment of Neuroendocrine Liver Metastases

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
Ser Yee Lee ◽  
Peng Chung Cheow ◽  
Jin Yao Teo ◽  
London L. P. J. Ooi
Keyword(s):  
Liver Metastases ◽  
Treatment Options ◽  
Case Series ◽  
Current Evidence ◽  
Progression Rate ◽  
Term Survival ◽  
Management Algorithm ◽  
Pubmed Database ◽  
Neuroendocrine Liver Metastases

Management of Neuroendocrine liver metastases (NELM) is challenging. The presence of NELM worsens survival outcome and almost 10% of all liver metastases are neuroendocrine in origin. There is no firm consensus on the optimal treatment strategy for NELM. A systematic search of the PubMed database was performed from 1995–2010, to collate the current evidence and formulate a sound management algorithm. There are 22 case series with a total of 793 patients who had undergone surgery for NELM. The overall survival ranges from 46–86% at 5 years, 35–79% at 10 years, and the median survival ranges from 52–123 months. After successful cytoreductive surgery, the mean duration of symptom reduction is between 16–26 months, and the 5-year recurrence/progression rate ranges from 59–76%. Five studies evaluated the efficacy of a combination cytoreductive strategy reporting survival rate of ranging from 83% at 3 years to 50% at 10 years. To date, there is no level 1 evidence comparing surgery versus other liver-directed treatment options for NELM. An aggressive surgical approach, including combination with additional liver-directed procedures is recommended as it leads to long-term survival, significant long-term palliation, and a good quality of life. A multidisciplinary approach should be established as the platform for decision making.

scholarly journals Aortic valve surgery: management and outcomes in the paediatric population

2021 ◽  
Author(s):  
Mariam Zaidi ◽  
Ganeshkumar Premkumar ◽  
Rimel Naqvi ◽  
Arwa Khashkhusha ◽  
Zahra Aslam ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Paediatric Population ◽  
Long Term Outcomes ◽  
Mechanical Prosthesis ◽  
Pulmonic Valve ◽  
Replacement Surgery ◽  
Surgical Options

AbstractCongenital anomalies of the aortic valve frequently necessitate intervention in childhood. The most common aortic valve pathologies present in childhood are aortic stenosis and insufficiency. Presentation of aortic valve disease depends on severity and presence of concomitant syndromes and valvular disorders. Treatment options are largely categorised as medical, percutaneous repair or surgical repair and replacement. Surgical techniques have been refined over the last few years making this the mainstay of treatment in paediatric cases. Whilst repair is considered in most instances before replacement, there are substantial limitations which are reflected in the frequency of reintervention and restenosis rate. Replacements are typically undertaken with tissue or mechanical prosthesis. The current gold-standard aortic valve replacement surgery is called the Ross procedure—where replacement is undertaken with a competent pulmonic valve and a simultaneous pulmonary homograft.Conclusion: In this review, we aim to outline the various surgical options and discuss efficacy and complications of various interventions. What is Known: • Congenital aortic valve defects repair options medically and surgically What is New: • Comparisons between surgical options for aortic valve repair including efficacy, risks and long-term outcomes.

scholarly journals Rubber Band Ligation versus Excisional Haemorrhoidectomy A Search for Better Option

1970 ◽  
Vol 20 (2) ◽  
pp. 107-109
Author(s):  
M Nasiruddin ◽  
Mahbubar Rahman ◽  
Haridas Shaha ◽  
Shamima Sultana
Keyword(s):  
Postoperative Complications ◽  
Treatment Options ◽  
Symptom Control ◽  
Rubber Band Ligation ◽  
Rubber Band ◽  
Anal Stenosis ◽  
Band Ligation ◽  
Postoperative Haemorrhage ◽  
Grade Iii

During The period of March-2003 to January-2006 a total of 100 patients with haemorrhoid admitted in Jhenaidah Sadar Hospital and in different private clinics of Jhenaidah and Faridpur town were taken in the study. This study compares the two most popular treatment options for haemorrhoids namely rubber band ligation (R.B.L) and excisional haemorrhoidectomy (E.H). Complete Remission of haemorrhoidal symptoms was better after haemorrhoidectomy than rubber band ligation. Fewer Patients required retreatment after haemorrhoidectomy but anal stenosis, postoperative haemorrhage and incontinence of flatus were more common with this operation. Haemorrhoidectomy produced better long term symptom control in patients with grade III Haemorrhoid but was associated with more postoperative complications than rubber band ligation. doi: 10.3329/taj.v20i2.3069 TAJ 2007; 20(2): 107-109

Novel Therapeutic Approaches and Targets for Treatment of Vulvar Lichen Sclerosus

2020 ◽  
Vol 22 (1) ◽  
pp. 99-114
Author(s):  
Alessandro Borghi ◽  
Monica Corazza
Keyword(s):  
Maintenance Treatment ◽  
English Literature ◽  
Lichen Sclerosus ◽  
Treatment Phase ◽  
Current Evidence ◽  
Systemic Treatments ◽  
Pubmed Database ◽  
Term Maintenance ◽  
Vulvar Lichen Sclerosus

Background: Vulvar Lichen Sclerosus (VLS) is a chronic inflammatory disease with a huge impact on a person’s quality of life. A correct therapy is required for relieving symptoms, reversing signs and preventing further anatomical changes. Objective: The main objective of the present paper is to provide suggestions for the best treatment approach, based on the available evidence. Treatment strategies are divided on the basis of the treatment phase, distinguishing options for initial, acute or attack treatment and those for long-term, maintenance treatment. Methods: An electronic search was performed using the National Library of Medicine PubMed database. All the studies evaluating treatment of vulvar lichen sclerosus published in the English literature were analyzed, including controlled studies, case series, guidelines and reviews. Results: Current evidence identifies ultra-potent and potent corticosteroids, administered for 12 weeks, as the first-line recommended treatment for active VLS. Topical calcineurin inhibitors, tacrolimus and pimecrolimus, are effective and safe alternatives. Long-term maintenance strategies aimed at preventing recurrences are required, after the initial treatment phase. Maintenance treatment mostly consists in topical corticosteroids, administered i) on an “as needed” basis (“reactive” scheme), ii) on a continuative regimen, iii) on a low-dose, intermittent regimen (“proactive” scheme). Further investigations are needed for better defining the placement of other options within the VLS therapeutic algorithm, including retinoids, physical and systemic treatments. Conclusion: The available evidence provides useful indications for the management of VLS. Both the identification of new therapeutic targets and the optimization of the available options represent the main objectives of future research.

scholarly journals Degenerative lumbar stenosis: update

2009 ◽  
Vol 67 (2b) ◽  
pp. 553-558 ◽  
Author(s):  
Andrei F. Joaquim ◽  
Charles A. Sansur ◽  
David K. Hamilton ◽  
Christopher I. Shaffrey
Keyword(s):  
Clinical Symptoms ◽  
Treatment Options ◽  
Cauda Equina ◽  
Surgical Techniques ◽  
Neurogenic Claudication ◽  
New Techniques ◽  
Recent Developments ◽  
Surgical Options ◽  
Lumbar Spinal

We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. However, the variety of surgical options is vast. New techniques have been developed with the goal of increasing long term functional outcomes. In this article we review lumbar decompression and fusion as treatment options for LS but also present other recent developments. Prospective long term studies are necessary to know which procedures would result in optimal patient outcome.

scholarly journals New Agents, Emerging Late Effects, and the Development of Precision Survivorship

2018 ◽  
Vol 36 (21) ◽  
pp. 2231-2240 ◽  
Author(s):  
Eric J. Chow ◽  
Zoltan Antal ◽  
Louis S. Constine ◽  
Rebecca Gardner ◽  
W. Hamish Wallace ◽  
...  
Keyword(s):  
Late Effects ◽  
Treatment Options ◽  
Survival Rates ◽  
Surgical Techniques ◽  
Adaptive Immune System ◽  
Host Susceptibility ◽  
Cell Surface Antigens ◽  
New Agents

Incremental improvements in the treatment of children and adolescents with cancer have led to 5-year survival rates reaching nearly 85%. In the past decade, impressive progress has been made in understanding the biology of many pediatric cancers. With that understanding, multiple new agents have become available that offer the promise of more-effective and less-toxic treatment. These include agents that target various cell surface antigens and engage the adaptive immune system, as well as those that interfere with key signaling pathways involved in tumor development and growth. For local control, surgery and radiation techniques also have evolved, becoming less invasive or featuring new techniques and particles that more precisely target the tumor and limit the dose to normal tissue. Nevertheless, targeted agents, like conventional chemotherapy, radiotherapy, and surgery, may have off-target effects and deserve long-term follow-up of their safety and efficacy. These include injury to the endocrine, cardiovascular, and immunologic systems. New radiation and surgical techniques that theoretically reduce morbidity and improve long-term quality of life must also be validated with actual patient outcomes. Finally, with advances in genomics, information on host susceptibility to late effects is beginning to emerge. Such knowledge, coupled with improved metrics that better describe the spectrum of potential late effects across the entire lifespan, can lead to the development of decision models that project the potential long-term health outcomes associated with various treatment and follow-up strategies. These developments will help extend the current focus on precision medicine to precision survivorship, where clinicians, patients, and families will have a better grasp of the potential risks, benefits, and tradeoffs associated with the growing number of cancer treatment options.

scholarly journals Closed Limb Fractures With Compromised Vascularization: A Narrative Review

2019 ◽  
Vol 12 ◽  
pp. 117954411983674
Author(s):  
Christopher Vannabouathong ◽  
Emil Schemitsch ◽  
Bradley Petrisor ◽  
Mohit Bhandari
Keyword(s):  
Femoral Neck ◽  
Bone Quality ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Delayed Union ◽  
Nonoperative Treatment ◽  
High Rate ◽  
Current Evidence ◽  
Post Injury ◽  
Common Procedure

Vascular compromised fractures typically result in a high rate of healing complications, such as avascular necrosis, nonunion, delayed union, and arthritis, which severely affect a patient’s function and quality of life. The purpose of this review was to identify and describe the epidemiology and available treatment options for the most well-known vascular compromised closed fractures. The injuries discussed in detail in this review were scaphoid, lunate, femoral neck, and talar fractures. Current evidence suggests that optimal treatment for vascular compromised fractures is dependent on the degree of fracture displacement and comminution, and the patient’s post-injury functional demands, age, and bone quality. Conservative efforts generally include casting or splinting with a period of immobilization. Surgery is indicated for substantially displaced fractures, patients who require higher functional demands and an earlier return to activity, or if complications occur following nonoperative treatment; however, operative intervention is typically performed for femoral neck fractures regardless of the amount of displacement. Various surgical techniques exist, though internal fixation with screws is a common procedure among these injuries and can be used in combination with other implants, such as plating or Kirschner wires (k-wires), when needed. Severe fracture comminution, poor bone quality, or arthritis can contraindicate the use of screws and more invasive intervention will be required. Bone grafting is done in some cases to enhance vascularity. Salvage procedures exist for patients who develop severe complications, but these will permanently alter the anatomy of the injured area and should be considered a last resort.

scholarly journals Which treatment for anal fistula? Cut or cover, plug or paste, loop or lift

2012 ◽  
Vol 59 (2) ◽  
pp. 15-20 ◽  
Author(s):  
Pravin Gupta ◽  
Gupta Shalini ◽  
P.S. Heda
Keyword(s):  
Fecal Incontinence ◽  
Treatment Options ◽  
Fistula Tract ◽  
Management Options ◽  
Perianal Fistulas ◽  
Different Types ◽  
Attractive Option ◽  
Advancement Flaps ◽  
Initial Results

Anorectal fistulas are common maladies. The challenge in therapy of perianal fistulas balances between the best possible cure and the preservation of continence. Complex fistulous disease challenges even the most experienced surgical specialists. The management options in these groups of patients are inadequate, with treatment often requiring multiple procedures, causing a risk for continued symptoms and fecal incontinence. This has lead to a serious search for newer and safer treatment options. Use of different types of setons and advancement flaps have their own advantages and pitfalls. Invasive methods with high rates of incontinence have given way to sphincter-sparing methods that have a much lower associated morbidity. Treatment with fibrin glue is an attractive option whenever continence might be endangered by operative procedures. Initial results with fistula plugs are promising but need further critical observations. Recently, the ligation of fistula tract had shown few promising results though it will be too early to comment on its long-term efficacy.

Nonsurgical Management Options for Pelvic Organ Prolapse: Review of the Current Evidence

2018 ◽  
Author(s):  
Nathan Kow
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Uterine Prolapse ◽  
Pelvic Floor Muscle ◽  
Treatment Options ◽  
Pelvic Organ ◽  
Current Evidence ◽  
Management Options ◽  
Nonsurgical Management ◽  
First Line Therapy

Pelvic organ prolapse (POP) is a common disorder that impacts a woman’s quality of life and has been projected to increase in the near future. Although many different treatments are currently available, healthcare practioners should be familiar with the common nonsurgical options that are considered the first-line therapy. Advances in nonsurgical interventions have traditionally included pessaries and pelvic floor muscle therapy.  These optiosn have not changed much over time, however there have been recent trials providing more evidence with regards to their efficacy.  The objective of this article is to review the current evidence for nonsurgical treatment options for POP.  This review contains 2 tables and 19 references Key Words: pelvic floor muscle training, pelvic floor physical therapy, pelvic organ prolapse, pessary, kegel excercises, uterine prolapse, cystocele, rectocele

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