A Cross Sectional Study on the Outcome of Rubber Band Ligation in third Degree Hemorrhoids

Objective: To determine the outcome of rubber band ligation in third degree hemorrhoids. Methods: - This design of this study was cross sectional study. The study was conducted at Shalamar medical and dental college, Lahore and the duration of this study was from April 2020 to September 2021. 215 patients were seen with complain of hemorrhoids, of which 47 had 3rd degree hemorrhoids. All patients with 3rd degree hemorrhoids underwent for rubber band ligation and were enrolled in the study. Outcome in our study was defined as pain, bleeding, constipation, anal fissure/fistula and infection. Chi- square test (χ2) of all qualitative variables was applied by taking p-value < 0.05 as significant. Results: - Of 47 patients admitted with 3rd degree hemorrhoid, 30 were males and 17 were females. The mean age of males was 38.78±12.71 while mean females age were found to be 22.73± 7.25 respectively. The most common complaint following rubber band ligation (RBL) was pain. 19 out of 47 patients were presented with pain followed by bleeding (14), constipation (13), anal fissure/fistula (10) and infection (8) which constitutes about 22.34 %, 22.78%15.32% and 14.03% respectively. There was significant relationship found between gender and anal fissure/fistula with p-value of <0.05. Conclusion: - Patients with 3rd degree hemorrhoids after RBL procedure showed fewer complications comparable to other surgical procedures in the treatment of hemorrhoids. It is the best possible options in third degree internal hemorrhoids. Moreover, this procedure is simple and cost-effective and requires no hospitalization, no anesthesia and no post-operative care. Keywords: - 3rd degree Hemorrhoids, Outcome, Rubber Band Ligation.

Comparison of Endoscopic Activity before and during the Covid Pandemic at a Tertiary Care Hospital in South Punjab

Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to health-care delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in considerable reduction in all type of endoscopic procedures. Majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection was significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology

Comparison of endoscopic activity before and during the covid pandemic at a tertiary care hospital in South Punjab

Introduction: Coronavirus disease 2019 (COVID-19) has resulted in dramatic changes to healthcare delivery. Endoscopic activity has had frequent disruptions during this pandemic. The objective of the study was to see the influence of pandemic over the endoscopic activity. Methods: This retrospective analysis of endoscopic activity was undertaken at Nishtar Hospital Multan. Procedural analysis was done in the three months immediately after covid lockdown (1st April till 30th June 2020) and was compared to a similar period one year back. Results: Five hundred and fifty-four (68.5%) patients underwent endoscopic procedures during the three months of pre-COVID era, while this number reduced to half (n=255, 31.5%) patients during the covid pandemic. Even though the absolute number of Esophagogastroduodenoscopies (EGDs) reduced during the pandemic, patients were more likely to undergo EGDs during the COVID pandemic in contrast to the era before the pandemic (79% versus 66%, p = 0.002). The most common indication for EGD was upper gastrointestinal bleeding (UGIB). The percentage of EGDs done for UGIB rose from almost 60% to 80% during the covid pandemic (p < 0.001). The most common findings were esophageal varices and portal gastropathy (non-significant difference during and before the pandemic). Percentage of ERCPs done for obstructive jaundice doubled during the COVID pandemic (33% versus 65%, p = 0.002).The most common indication for sigmoidoscopy or colonoscopy was lower gastrointestinal bleeding. However, no significant difference was found before and during the covid pandemic (41.7% and 45.8% respectively, p=0.72). Internal hemorrhoids were the most common endoscopic finding. Colon cancer diagnosis reduced from 10% to undetected during the pandemic period. Conclusion: COVID pandemic resulted in a considerable reduction in all types of endoscopic procedures. The majority of procedures were done for emergency indications like gastrointestinal bleeding. Rates of cancer detection were significantly reduced. MeSH: Endoscopy, COVID-19, Gastroenterology

Comparison of Milligan Morgan Hemorrhoidectomy and Stapled Hemorrhoidectomy In Recent Years For Patients With Grade III And IV Hemorrhoids: A Meta-Analysis

Background Hemorrhoids are one of the most common conditions in the world, and grade III and IV internal hemorrhoids are mainly treated with surgery. However, there are many different surgical methods, and many postoperative complications occur. Therefore, we aimed to compare of milligan morgan (MM) hemorrhoidectomy and stapled hemorrhoidectomy (ST) for patients with grade III And IV Hemorrhoids. Objective To compere between Milligan-Morgan hemorrhoidectomy and Stapled hemorrhoidectomy as regards postoperative anal stenosis and fecal incontinence in recent years for treatment grade III and IV hemorrhoids using a meta-analysis approach. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2020. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion It is concluded that ST appeared to be the best surgical procedure than MM for grade III and IV hemorrhoids based on the current evidence.

Diagnosis and Management of Internal Hemorrhoids: A Brief Review

Hemorrhoidal disease is a pathological condition due to the abnormal engorgement of the arteriovenous plexus beneath the anal mucosa. Anatomically, it can be located under the skin on the outer part of the dentate line, known as external hemorrhoid; or inside the anus on the proximal part of the dentate line, called internal hemorrhoid. Internal hemorrhoid may further develop from a painless anal mass into protruded and painful mass throughout the anal canal, often accompanied by inflammation and more severe symptoms. Various management strategies need to be considered carefully to ensure the success of therapy and improve the quality of life of patients with internal hemorrhoids. Conservative management is the initial stage that can be performed, including the provision of high-fiber nutrition, education related to bathroom habits, and the use of flavonoid regimens. Surgical therapy can be divided into outpatient intervention and conventional surgeries. This review will encompass the comprehensive diagnostic approach and management of internal hemorrhoids to help clinicians understand the appropriate management and provide better clinical benefits for the patients.

Increased Effectiveness of Sclerotherapy as a Treatment Option for Hemorrhoidal Disease in the Elderly and Senile Outpatients

Background. The number of elderly and senile people is about 15% in the population. Together they account for 50% of emergency and 85% of planned hospital admissions to surgical hospitals. One of the most common causes for a patient to see a surgeon is manifestations of hemorrhoids, which affect 10-36% of the population (number increases with age).The aim of the study is to improve results of the outpatient treatment of elderly and senile patients with internal hemorrhoids stages II-III by optimizing the method of sclerotherapy and indications for its application.Material and methods. The results of outpatient treatment of 60 elderly and senile patients for chronic hemorrhoids stages II-III were analyzed. The patients were divided into 2 groups. In the control group (30 patients) standard treatment was performed, including sclerotherapy of internal hemorrhoids with 2-3% solution of aethoxysklerol. One-percent solution of aethoxysklerol was used to perform sclerotherapy in the main group (30 patients). The indication for its administration was low compliance in patients and/or presence of anemia, inability to cancel antiplatelet drugs, continued bleeding. Groups were valid for comparison.Results. There was a decrease in the severity of postoperative pain syndrome by 36.8%, postoperative complications from 20,0% to 6,7%, the average period of temporary disability was from 1.80.4 to 1.00.5 days, the frequency of relapses of the disease in 6 months after sclerotherapy was from 10% to 6.7% in the main group compared to the control one.Conclusion. The proposed method reduces the intensity of postoperative pain, the percentage of postoperative complications and the frequency of relapses of the disease.