1
|
Alemrajabi M, Akbari A, Sohrabi S, Rezazadehkermani M, Moradi M, Agah S, Masoodi M. Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome. Ann Coloproctol 2023; 39:351-356. [PMID: 35570403 PMCID: PMC10475797 DOI: 10.3393/ac.2022.00017.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Hemorrhoids are the most common benign anorectal diseases. Mucopexy strengthens the anal canal mucosa, which can be performed alone or in combination with Doppler-guided hemorrhoidal artery ligation (DG-HAL). In this study, we compared the postoperative complications between simple mucopexy plus HAL with and without a Doppler guide. METHODS This study was performed as a single-blinded randomized clinical trial. Patients referred to a tertiary colorectal referral clinic with grades 3 and 4 hemorrhoids who were candidates for surgical intervention entered the study. Thirty-six patients were randomly divided into 2 groups. Group A including 18 patients underwent mucopexy and DG-HAL and the other 18 patients (group B) underwent standard mucopexy and HAL without a Doppler guide. Postoperative pain score and the duration of oral analgesic consumption were recorded. Additionally, postoperative symptoms and complications were recorded and compared between the 2 methods. RESULTS There was no significant difference between the 2 groups in terms of pain score and the duration of postoperative analgesic consumption as well as the incidence of postoperative complications. Besides, the primary grade of hemorrhoids was not significantly associated with recurrence, but there was a significant association between body mass index and Wexner score (WS) with recurrence. The mean WS of patients showed a significant decrease in both groups postoperatively. However, the rate of WS reduction was not remarkably different between the 2 groups. CONCLUSION Simple mucopexy with blind HAL (without Doppler guide) might be considered for the treatment of grades 3 and 4 hemorrhoids effectively.
Collapse
Affiliation(s)
- Mahdi Alemrajabi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Akbari
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Sohrabi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Moradi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Colorectal Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahram Agah
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Masoodi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Rørvik HD, Davidsen M, Gierløff MC, Brandstrup B, Olaison G. Quality of life in patients with hemorrhoidal disease. Surg Open Sci 2023; 12:22-28. [PMID: 36876020 PMCID: PMC9978033 DOI: 10.1016/j.sopen.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
Background Operation for hemorrhoidal disease is one of the most common operations performed globally. However, we know little about the impact of the disease on health-related quality of life (HRQoL), or the importance of the observed clinical and anatomical changes. Method This was a single-center cross-sectional and cohort study. HRQoL was assessed using the Short Form 12 and 36 (SF12 and SF36), EuroQoL 5-dimensions 5-levels (EQ-5D), and a disease specific questionnaire; Short Health Scale for Hemorrhoidal Disease (SHSHD). SF12 and EQ-5D scores in 257 patients with symptomatic hemorrhoids referred to our proctologic outpatient clinic were compared to a Danish background population adjusting for age, gender, body mass index and educational status.Symptoms were assessed using the Hemorrhoidal Disease Symptom Score. The anatomical pathology was graded using Goligher's classification. The associations between clinical characteristics and HRQoL were tested. The impact of surgical treatment was assessed in 111 patients followed one year postoperatively. Results Patients reporting a high symptom load had lower SF12 physical health scores compared with the background population. The EQ-5D indexes indicated impaired HRQoL in men, women <50 years and patients with higher education. Improvements in all three HRQoL measures were seen after surgery.Symptom burden had a negative association with HRQoL measures, whereas the surgeon's grading of anatomical pathology had no association. Conclusion Hemorrhoidal disease has a negative impact on HRQoL related to the degree of symptoms. Surgical treatment improve the QoL. The surgeon's grading of anal pathology had no association with QoL.
Collapse
Affiliation(s)
- Håvard D Rørvik
- Department of Surgery, Holbæk Hospital, Denmark.,Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway.,Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Birgitte Brandstrup
- Department of Surgery, Holbæk Hospital, Denmark.,Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | |
Collapse
|
3
|
Marcellier G, Dupont A, Bourgeois-Moine A, Le Tohic A, De Carne-Carnavalet C, Poujade O, Girard G, Benbara A, Mandelbrot L, Abramowitz L. Risk Factors for Anal Continence Impairment Following a Second Delivery after a First Traumatic Delivery: A Prospective Cohort Study. J Clin Med 2023; 12:jcm12041531. [PMID: 36836068 PMCID: PMC9967240 DOI: 10.3390/jcm12041531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Postpartum anal incontinence is common. After a first delivery (D1) with perineal trauma, follow-up is advised to reduce the risk of anal incontinence. Endoanal sonography (EAS) may be considered to evaluate the sphincter and in case of sphincter lesions to discuss cesarean section for the second delivery (D2). Our objective was to study the risk factors for anal continence impairment following D2. Women with a history of traumatic D1 were followed before and 6 months after D2. Continence was measured using the Vaizey score. An increase ≥2 points after D2 defined a significant deterioration. A total of 312 women were followed and 67 (21%) had worse anal continence after D2. The main risk factors for this deterioration were the presence of urinary incontinence and the combined use of instruments and episiotomy during D2 (OR 5.12, 95% CI 1.22-21.5). After D1, 192 women (61.5%) had a sphincter rupture revealed by EAS, whereas it was diagnosed clinically in only 48 (15.7%). However, neither clinically undiagnosed ruptures nor severe ruptures were associated with an increased risk of continence deterioration after D2, and cesarean section did not protect against it. One woman out of five in this population had anal continence impairment after D2. The main risk factor was instrumental delivery. Caesarean section was not protective. Although EAS enabled the diagnosis of clinically-missed sphincter ruptures, these were not associated with continence impairment. Anal incontinence should be systematically screened in patients presenting urinary incontinence after D2 as they are frequently associated.
Collapse
Affiliation(s)
- Gabriel Marcellier
- Proctology and Gastroenterology Department, APHP-Bichat Hospital, 75018 Paris, France
- Correspondence: ; Tel.: +33-6-68-97-79-05
| | - Axelle Dupont
- Biostatistics and Medical IT Department, APHP-Bichat Hospital, 75018 Paris, France
| | | | - Arnaud Le Tohic
- Department of Obstetrics and Gynecology, Versailles Hospital, 78157 Le Chesnay, France
| | | | - Olivier Poujade
- Department of Obstetrics and Gynecology, APHP-Beaujon Hospital, 92110 Clichy, France
| | - Guillaume Girard
- Department of Obstetrics and Gynecology, APHP-Armand Trousseau Hospital, 75012 Paris, France
| | - Amélie Benbara
- Department of Obstetrics and Gynecology, APHP-Jean Verdier Hospital, 93140 Bondy, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, APHP-Louis Mourier Hospital, 92700 Colombes, France
| | - Laurent Abramowitz
- Proctology and Gastroenterology Department, APHP-Bichat Hospital, 75018 Paris, France
- Proctology and Gastroenterology Department, Blomet Clinic (Ramsay GDS Group), 75015 Paris, France
| |
Collapse
|
4
|
Picking Up the Threads: Long-Term Outcomes of the Sutured Haemorrhoidopexy: A Retrospective Single-Centre Cohort Study. J Clin Med 2023; 12:jcm12010391. [PMID: 36615189 PMCID: PMC9821446 DOI: 10.3390/jcm12010391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to assess the short- and long-term safety and efficacy of the sutured haemorrhoidopexy (SH) in patients with haemorrhoidal disease (HD). METHODS A retrospective study was performed, assessing the following treatment characteristics: number of sutures needed; operation time; perioperative complications; postoperative pain; hospital stay. The short- and long-term postoperative complications, HD recurrence and data on current HD symptoms were assessed according to the Core Outcome Set for HD. RESULTS Between January 2009 and December 2021, 149 patients with HD underwent a SH. One-hundred and forty-five patients were included, with a mean age of 61 years (±12.8), of which 70 were women (48.3%). Patients were predominantly diagnosed with grade III (37.2%) HD and the median follow-up was nine years (5-11). Perioperative complications occurred in four cases (2.8%). In two patients (1.4%), short-term postoperative complications were reported, and in seven patients (6.2%), long-term complications were reported. The cumulative efficacy in terms of freedom of recurrence was 88.3% (95% CI, 83.1-93.5) at six months, 80.0% (95% CI, 73.5-86.5) at one year, and 67.7% (95% CI, 59.7-75.7) at five years. CONCLUSIONS Sutured haemorrhoidopexy is a safe treatment for patients with HD and can be proposed as a minimally invasive surgical treatment if basic and outpatient procedures fail.
Collapse
|
5
|
Langenbach MR, Florescu RV, Köhler A, Barkus J, Ritz JP, Quemalli E, Siegel R, Zirngibl H, Lefering R, Bönicke L. OUP accepted manuscript. BJS Open 2022; 6:6594076. [PMID: 35639947 PMCID: PMC9154318 DOI: 10.1093/bjsopen/zrac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Symptomatic haemorrhoids are a common anorectal disorder. The aim of the study was to investigate whether the omission of tamponade dressings after haemorrhoidectomy reduces postoperative pain without increasing the risk of severe bleeding. Method This was an open-label, randomized clinical trial conducted at 14 German hospitals. All patients with third- or fourth-degree haemorrhoids undergoing haemorrhoidectomy were considered eligible for selection in the intervention (no dressing) or control group (tamponade applied). Two co-primary outcomes were analysed by testing hierarchically ordered hypotheses. First, maximum pain intensity within 48 h after surgery was compared between the groups (superiority). This was followed by an analysis of severe bleeding complications, defined as any bleeding requiring surgical re-intervention within 7 days (non-inferiority). Secondary outcomes included health-related quality of life, patient satisfaction, haemoglobin levels, and adverse events. Results Out of 950 patients screened, 754 were randomized and 725 received intervention (366 patients in the intervention and 359 patients in the control group). In the group with tamponade dressings, median pain intensity on the 0 to 10 scale was 6 (interquartile range (i.q.r.) 4–7). Patients without tamponade dressings reported significantly less pain (median 5 (i.q.r. 3–7), P < 0.001). In each group, five patients (1.4 per cent) experienced severe bleeding. The absolute difference for the severe bleeding rate was −0.03 per cent with the 90 per cent confidence interval ranging from −1.47 per cent to +1.41 per cent, in line with the non-inferiority aim. No significant between-group difference was found for secondary outcomes. Conclusions The practice of inserting tamponade dressings after haemorrhoidectomy correlates with increased postoperative pain and does not provide benefits in terms of reduced postoperative bleeding. Registration number DRKS00011590
Collapse
Affiliation(s)
- Mike Ralf Langenbach
- Correspondence to: Mike Ralf Langenbach, Ev. Krankenhaus Lippstadt, Department of Surgery II, University of Witten-Herdecke, Wiedenbrücker Straße 33, 59555 Lippstadt, Germany (e-mail: )
| | - Razvan-Valentin Florescu
- Helios St. Elisabeth Klinik Oberhausen, Department of Surgery II, University of Witten/Herdecke, Oberhausen, Germany
| | | | - Jörg Barkus
- Helios Klinikum Niederberg, Velbert, Germany
| | | | | | | | - Hubert Zirngibl
- Helios Klinikum Wuppertal, Department of Surgery II, University of Witten/Herdecke, Wuppertal, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | | |
Collapse
|
6
|
Systematic review and meta-analysis of postoperative pain and symptoms control following laser haemorrhoidoplasty versus Milligan-Morgan haemorrhoidectomy for symptomatic haemorrhoids: a new standard. Int J Colorectal Dis 2022; 37:1759-1771. [PMID: 35906356 PMCID: PMC9388431 DOI: 10.1007/s00384-022-04225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Haemorrhoidal disease (HD) plagues one in every ten people, with a plethora of surgical treatment modalities, of which laser haemorrhoidoplasty (LHP) is a relatively novel option. This systematic review and meta-analysis objectively evaluated the efficacy, safety, and tolerability of LHP compared against conventional (Milligan-Morgan) open haemorrhoidectomy (CoH). METHOD A comprehensive search of MEDLINE, EMBASE, CENTRAL, and Google Scholar was conducted. Randomised controlled trials (RCTs) and comparative cohort studies (CCSs) which compared LHP against CoH were included, with postoperative pain as the primary outcome. Secondary outcomes included intraoperative characteristics, short- and moderate-term outcome, and complications. RESULTS A total of 12 studies (6 RCTs and 6 CCSs), with a total of 1824 patients, were analysed. LHP resulted in reduced postoperative pain for the first day (mean difference of 2.07 visual analogue scale units), week, and month. The mean dosage and duration of postoperative analgesia use was similarly lower, with a mean difference of 4.88 mg (morphine) and 2.25 days, respectively. Crucially, recurrence was equivocal (HR: 0.72, CI: 0.21-2.40) at a mean follow-up duration of 8.58 ± 9.55 months. LHP resulted in lower blood loss and was 12.74 min shorter on average. LHP's postoperative recovery time was 9.03 days less with equivalent or decreased risk of most short- and moderate-term complications except anal thrombosis. CONCLUSION Our study suggests that LHP is more tolerable than CoH, providing patients with superior postoperative quality of life at equivalent moderate-term efficacy. These findings contribute to improved understanding of LHP and its potential at enhancing the quality of HD care.
Collapse
|
7
|
Xianqing S, Wei S, Yintong B, Jinjin T, Tongcheng Z. Outcome of a modified Park's submucosal hemorrhoidectomy versus Milligan-Morgan for grade III-IV circumferential prolapsed hemorrhoids. Asian J Surg 2021; 45:2208-2213. [PMID: 34840045 DOI: 10.1016/j.asjsur.2021.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND This prospective randomized controlled study compared the short- and long-term efficacy and advantages of modified Park's submucosal over Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of grade III and IV circumferential prolapsed hemorrhoids (CPH). METHODS A total of 186 consecutive patients with grade III or IV CPH were enrolled. The patients were randomized to MPSH (n = 93) or MMH (n = 93) treatment groups. Patient data included demographics, clinical characteristics, surgical parameters, underlying or arising complications, and CPH recurrence. The patients were closely followed up for at least 24 months. RESULTS The patient demographic data and clinical parameters were comparable in the two groups (P > 0.05). MPSH took significantly longer operative time (P < 0.05). Although there was no significant difference in mean postoperative pain between the two groups at days 3 and 14, pain at day 7 was significantly more frequent and severe in the MMH group (P < 0.05). There were no significant group differences in postoperative bleeding, intraoperative blood loss, or development of anal stenosis (P > 0.05). However, the cumulative relapse-free rate was substantially higher in the MPSH group (P < 0.05). CONCLUSION MPSH and MMH are both practical and safe techniques for treating grade III and IV CPH disease. However, MPSH is safer, easier, and faster to perform and is associated with fewer recurrences within 24 months of surgery. Additional clinical studies are needed to validate these conclusions.
Collapse
Affiliation(s)
- Song Xianqing
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China.
| | - Sun Wei
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China
| | - Bao Yintong
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China
| | - Tu Jinjin
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China
| | - Zhang Tongcheng
- General Surgery Department, Ningbo Fourth Hospital, No. 291 Donggu Road, Dandong Street, Xiangshan County, Ningbo, Zhejiang, 315000, PR China
| |
Collapse
|
8
|
Boukris Toledano A, Blanchard P, Zaleski A, Benfredj P, Fathallah N, Sultan S, Pommaret E, de Parades V. Lessons from the first 70 patients operated by doppler-guided haemorrhoidal artery ligation with mucopexy in a French team specialising in surgical proctology. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2017.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Doppler-guided haemorrhoidal artery ligation with mucopexy is a minimal-invasive surgical technique. It is both effective and less painful than conventional haemorrhoidectomy.
Methods We gathered records on all patients operated on between November 2012 and June 2014. Pre- and postoperative scores were calculated during consultation and then by phone. Unsuccessful surgical treatment was defined by persistent haemorrhoid symptoms within three months following the procedure and relapse defined by recurrent symptoms after the third postoperative month.
Results During the period analysed, 70 patients underwent consecutive surgical procedures for haemorrhoid prolapse (52%), bleeding (29%), or both (17%). Hospitalisation was outpatient or overnight for 87% of patients. There were no complications in 92.7% of cases. The average period away from work was 11 days (± 6.5). The time between the procedure and last postoperative consultation, followed by telephone contact, was respectively 2.7 months (± 5.8) and 16.5 months (± 4.9). At the time of the postoperative telephone call, the Thaha et al. score decreased by 5.6 (p < 0.001), while the quality of life score decreased by 2 (p < 0.001). The Wexner score remained the same or improved for all patients except one. Treatment was unsuccessful for 6/67 patients (9%) and 10/61 patients (16.4%) experienced a subsequent recurrence in haemorrhoid symptoms. Only those over 51 years old were statistically associated with more frequent recurrences (p = 0.044).
Conclusion Doppler-guided haemorrhoidal artery ligation with mucopexy is an effective technique in the medium-term. Good tolerance in makes this treatment an attractive alternative to conventional haemorrhoidectomy.
Collapse
Affiliation(s)
- Alexia Boukris Toledano
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Pierre Blanchard
- Institut Gustave Roussy, Epidemiology and Biostatistics, Villejuif, France
| | | | - Paul Benfredj
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
- Clinique du Louvre, Paris, France
| | - Nadia Fathallah
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Samy Sultan
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Elise Pommaret
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| | - Vincent de Parades
- Institut Léopold Bellan, Groupe hospitalier Paris Saint-Joseph, Department of Medical and Surgical Proctology, Paris, France
| |
Collapse
|
9
|
Koh FH, Foo FJ, Ho L, Sivarajah SS, Tan WJ, Chew MH. Study Protocol for the Use of Conventional Open Haemorrhoidectomy versus Laser Haemorrhoidoplasty in the Treatment of Symptomatic Haemorrhoids: A Randomized Controlled Trial. Eur Surg Res 2021; 61:201-208. [PMID: 33631763 DOI: 10.1159/000513844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Haemorrhoids result in a variety of symptoms that cause significant patient anxiety. Treatment has long been associated with post-operative complications, which cause significant symptoms and may result in readmissions. The open conventional haemorrhoidectomy (COH) is still regarded as the gold standard treatment for non-circumferential grade II-IV haemorrhoids. Laser haemorrhoidoplasty (LAH) has recently been studied and the initial results appear promising. This study aims to compare these 2 techniques in the treatment of symptomatic haemorrhoids. We hypothesize that LAH has significantly less pain and bleeding and better quality of life (QoL) scores 1, 3 and 12 months post-operatively. METHODS A prospective, randomized, double-blind, single-centre clinical trial will be conducted. All patients aged between 21 and 90 years who present with symptomatic grade II-IV haemorrhoids will be recruited. Exclusion criteria include those who have had previous operations for haemorrhoids and those with an increased risk of bleeding. Data collected will include patient demographics, pre- and intra-operative characteristics of the haemorrhoids, operative details and post-operative pain Visual Analogue Scale (VAS) score, complications, readmissions, and haemorrhoid-specific QoL surveys. Primary outcome will be median post-operative pain VAS score on post-operative days (POD) 1-10. Secondary outcomes include operative duration, bleeding on the first 10 days post-operatively, readmissions, procedure-related complications (fistulation, incontinence, stenosis), QoL scores, and recurrence of symptoms up to 12 months. DISCUSSION Results from this trial may demonstrate the superiority of LAH over COH in terms of post-operative pain and recovery. This would likely increase the adoption of LAH for the treatment of symptomatic haemorrhoids. TRIAL REGISTRATION This trial was registered on 1/4/2020 at ClinicalTrials.gov. URL: https://www.clinicaltrials.gov/ct2/show/NCT04329364?term=NCT04329364&draw=2&rank=1.
Collapse
Affiliation(s)
- Frederick H Koh
- Colorectal Service, Division of Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore,
| | - Fung Joon Foo
- Colorectal Service, Division of Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Leonard Ho
- Colorectal Service, Division of Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Sharmini S Sivarajah
- Colorectal Service, Division of Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Winson J Tan
- Colorectal Service, Division of Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| | - Min-Hoe Chew
- Colorectal Service, Division of Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
| |
Collapse
|
10
|
Abbas ST, Raza A, Muhammad Ch I, Hameed T, Hasham N, Arshad N. Comparison of mean pain score using topical and oral metronidazole in post milligan morgan hemorrhoidectomy patient; A randomized controlled trial. Pak J Med Sci 2020; 36:867-871. [PMID: 32704254 PMCID: PMC7372682 DOI: 10.12669/pjms.36.5.1796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives: Milligan Morgan Hemorrhoidectomy is one of the most commonly performed surgeries. Post-operative pain is the major cause of morbidity in post hemorrhoidectomy patients. Metronidazole has an established role in relieving post hemorrhoidectomy pain. The objective was to evaluate the pain score by using topical and oral metronidazole in post Milligan Morgan hemorrhoidectomy patients. Methods: A prospective randomized controlled trail was done in surgical departments of Akbar Niazi Teaching Hospital, Islamabad. A total of 166 consecutive patients with 3rd and 4th degree hemorrhoids were presenting in surgical OPD and who underwent Milligan Morgan hemorrhoidectomy between July 2018 and December 2018 were included in the study. Patients allocated in two groups, Group-A received topical metronidazole 10% post hemorrhoidectomy for seven days and Group-B were given oral metronidazole 400mg for 07 days. Analgesics were given on patient’s requirement. Patients post hemorrhoidectomy pain was recorded by using VSA scale at baseline (1st day) and on 7th post-operative day. Data analysis was done by using SPSS 21. Pain calculated by compared in terms of mean, standard deviation between groups and independent sample T test was used. Association between demographic details like gender and ages of the patients with pain scale on 7th day was measured and chi-square distribution was used. Results: Total 166 patients were included in this study. The mean ages of the patients were 44.07±10.62 years with minimum 20 and maximum 60 years. Out of 166 patients, female were 55 (33.1%) and male were 111 (66.9%). Results showed significantly lower pain in patients using topical metronidazole as compared to oral metronidazole (p=0.001). Association of pain with respect to ages was insignificant (p=0.202) whereas between genders inside the groups showed significant difference (p=0.028). Conclusion: These results showed that topical metronidazole significantly reduces pain in post hemorrhoidectomy patients as compared to oral metronidazole overall and even when data stratified among age, gender and type of hemorrhoids.
Collapse
Affiliation(s)
- Syed Tatheer Abbas
- Syed Tatheer Abbas, FCPS. Department of Surgery, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Ahmad Raza
- Ahmad Raza, MRCS, FCPS. Department of Surgery, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Ihtasham Muhammad Ch
- Ihtasham Muhammad Ch, FCPS. Associate Professor Department of Surgery, Al-Nafees Medical College, Islamabad, Pakistan
| | - Tahira Hameed
- Tahira Hameed, MBBS, MRCS. Registrar, Department of Surgery, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Nausheen Hasham
- Nausheen Hasham, MBBS. Registrar, Department of Surgery, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Naveed Arshad
- Naveed Arshad M.Phil. Assistant Professor, Rehabilitation Department, Islamabad Medical and Dental College, Islamabad, Pakistan
| |
Collapse
|
11
|
Longchamp G, Liot É, Meyer J, Longchamp A, Toso C, Buchs NC, Ris F. Scoring systems as outcomes assessment of the treatments for haemorrhoidal disease: a systematic review of the literature. Int J Colorectal Dis 2020; 35:1015-1024. [PMID: 32382836 DOI: 10.1007/s00384-020-03603-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The comparison between haemorrhoidal treatments is still unclear. Attempts have been made to adopt a unifying postoperative scoring system and thus ensure adequate comparison between clinical trials. We aimed to systematically review the available outcome scores of haemorrhoidal treatment. METHODS MEDLINE/Pubmed, Web of science, Embase and Cochrane were searched from database implementation until the December 6th 2019. All studies describing or referencing a score to assess haemorrhoidal disease treatment were included. Likert scale alone, incontinence score alone, general assessment of quality of life or scores developed for other proctologic disorders were excluded. The main outcome measures were validation of the scores and correlation of the score items to the core outcome set for haemorrhoidal disease developed by the European Society of Coloproctology. RESULTS From the 633 records initially screened, 22 studies were included: 8 original articles describing a scoring system and 14 referencing a previously described scoring system. Only 1 score was validated by an external prospective cohort. All the scores evaluated the symptoms of haemorrhoidal disease. No score integrated the disease recurrences or patient's satisfaction. Scores values tended to decrease postoperatively. CONCLUSIONS The scores described by Gerjy et al. and by Shanmugan et al. are available questionnaires, which have been validated and used in various studies. These scores might help researchers for comparative studies between treatment modalities and optimize haemorrhoids treatment.
Collapse
Affiliation(s)
- Gregoire Longchamp
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Émilie Liot
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Jérémy Meyer
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Alban Longchamp
- Department of Vascular Surgery, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Nicolas C Buchs
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Frédéric Ris
- Division of Digestive Surgery, Geneva University Hospitals and Medical School, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
| |
Collapse
|
12
|
Prevalence of Anal Fistulas in Europe: Systematic Literature Reviews and Population-Based Database Analysis. Adv Ther 2019; 36:3503-3518. [PMID: 31656013 PMCID: PMC6860471 DOI: 10.1007/s12325-019-01117-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 12/12/2022]
Abstract
Introduction Despite the fact that perianal fistulas are associated with significant morbidity and impaired quality of life, their prevalence in Europe is unknown. The aim of this study was to estimate the prevalence of perianal fistulas in Europe, overall and according to etiology. Methods Two independent literature reviews were performed using different search strategies to maximize the identification of potentially relevant studies. Data from relevant articles were used to estimate the prevalence of perianal fistulas in Europe. The robustness of the estimate was evaluated using data from a large population-based database from the UK. Results A total of 26 studies provided epidemiological data on perianal fistulas, of which 16 provided suitable data to estimate the prevalence. Estimations using these data yielded a total prevalence of 1.69 per 10,000 population. Cryptoglandular infection and Crohn’s disease (CD) were the predominant etiologies, with prevalence rates at 0.86 and 0.76 per 10,000 population, respectively. Comparison of prevalence data from the UK population-based database with the European population resulted in a standardized prevalence estimate of all perianal fistulas of 1.83 per 10,000 population, confirming the robustness of the literature-based estimate. Conclusion Although in terms of incidence cryptoglandular fistulas were clearly predominant, the prevalence of fistulas in CD and cryptoglandular infection appeared more balanced. This is due to the longer duration and higher frequency of relapses of fistulas in CD. The estimated prevalence implies that perianal fistulas meet the criteria to be considered as a rare condition in Europe (prevalence less than 5 per 10,000 population). Funding This study was funded by Takeda Pharmaceutical U.S.A., Inc. and TiGenix SAU. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01117-y) contains supplementary material, which is available to authorized users.
Collapse
|
13
|
Adegboyega T, Rivadeneira D. Lower GI Bleeding: An Update on Incidences and Causes. Clin Colon Rectal Surg 2019; 33:28-34. [PMID: 31915423 DOI: 10.1055/s-0039-1695035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bleeding from the lower gastrointestinal tract represents a significant source of morbidity and mortality. The colon represents the vast majority of the location of bleeding with only a much smaller incidence occurring in the small intestine. The major causes of lower gastrointestinal bleeding (LGIB) are from diverticulosis, vascular malformations, and cancer. We discuss the incidence and causes of LGIB.
Collapse
Affiliation(s)
- Titilayo Adegboyega
- Department of Surgery, Donald and Barbara Zucker School of Medicine Hofstra University, Northwell Health System, New York
| | - David Rivadeneira
- Department of Surgery, Donald and Barbara Zucker School of Medicine Hofstra University, Northwell Health System, New York
| |
Collapse
|
14
|
Langenbach MR, Seidel D. Tamponade dressings versus no tamponade after hemorrhoidectomy: study protocol for a randomized controlled trial. Trials 2019; 20:188. [PMID: 30940201 PMCID: PMC6444871 DOI: 10.1186/s13063-019-3280-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/06/2019] [Indexed: 12/21/2022] Open
Abstract
Background Symptomatic hemorrhoids are one of the most common anorectal disorders. Many surgeons use tamponades after open hemorrhoidectomy to manage postoperative bleeding. The question of whether a tamponade is necessary and beneficial after hemorrhoidectomy has not yet been conclusively answered. A previously conducted single-center pilot trial included 100 patients after Milligan–Morgan hemorrhoidectomy. The data indicated that insertion of an anal tamponade after hemorrhoidectomy does not reduce postoperative bleeding but causes significantly more pain. The findings of this pilot trial are now to be verified by means of a multicenter randomized clinical study called NoTamp. Methods We plan to include 953 patients after Milligan-Morgan or Parks hemorrhoidectomy in the NoTamp study. The aim is to demonstrate that using no tamponade dressing after open hemorrhoidectomy is not inferior to using tamponades with respect to postoperative bleeding, and that the patients report less pain. Primary endpoints of the trial are the maximum postoperative pain within 48 h and the incidence of severe postoperative bleeding that requires surgical revision within 7 days after the surgical procedure. Secondary endpoints of the study are the use of analgesics in the postoperative course, the lowest hemoglobin documented within 7 days, quality of life and patient satisfaction. Safety analysis includes all adverse and serious adverse events in relation to the study treatment. Further information can be found in the registration at the German Registry of Clinical Studies (DRKS00011590) and on the study webpage (https://notamp.de/en-GB/trial/main/setLocale/en_GB/). The study is financed by the HELIOS research funding. Discussion The study received full ethics committee approval. The first patient was enrolled on 3 May 2017. This trial will finally answer the question whether the insertion of a tamponade after open hemorrhoidectomy is necessary and beneficial. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien (DRKS), DRKS00011590. Registered on 12 April 2017.
Collapse
Affiliation(s)
- Mike Ralf Langenbach
- Klinik für Allgemein-/Viszeralchirurgie und Koloproktologie, Helios St. Elisabeth Klinik, Josefstr. 3, 46045, Oberhausen, Germany
| | - Dörthe Seidel
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Ostmerheimerstraße 200 Haus 38, 51109, Köln, Germany.
| |
Collapse
|
15
|
Previnaire JG, De Bont N, Bordi H, Senal N, Mortier PE. Open surgery for haemorrhoids in persons with spinal cord injury. Spinal Cord Ser Cases 2018; 4:35. [PMID: 29707238 DOI: 10.1038/s41394-018-0070-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 12/19/2022] Open
Abstract
Study design Pilot retrospective study on the outcome of open surgery for grade III and IV haemorrhoids in patients with SCI. Objective Haemorrhoids and anal fissures are common in patients with spinal cord injury (SCI). Grade I to III haemorrhoids are usually managed medically or by surgical ligation. Grade III and IV haemorrhoids are treated with surgical haemorrhoidectomy in the general population, but not in patients with SCI, most probably due to fear of complications. Setting Fondation Hopale, Berck-sur Mer, France. Methods The surgical database was searched for open haemorrhoidectomies performed between 2007 and 2016. Seventeen patients were included. There were mostly males with complete paraplegia, mean age: 50 years and mean time since injury: 15.9 years. Open haemorrhoidectomy (Milligan and Morgan) was performed for isolated haemorrhoids (n = 4), and combined with Leopold Bellan procedure (posterior anoplasty and internal sphincterotomy) for associated anal fissures (n = 13). Short-term follow-up was performed by the surgeon (post-operative weeks 2 and 6), long-term follow-up by telephone interview (mean 5.7 years, SD 1.9). Results At 6-weeks post-operative, no significant complications had occurred and all wounds had healed, however 1 patient had recurrence of anal fissure. At long-term follow-up, 75% of patients reported a significant improvement in anorectal symptoms. Recurrences were reported by 5 patients: 3 haemorrhoids (18%) and 2 anal fissures (25%). Anal incontinence occurred in 1 patient who required an anal plug. All patients maintained the same bowel programs as pre-operative. Conclusions Open surgery procedures were well tolerated and should be considered in persons with SCI.
Collapse
Affiliation(s)
- J G Previnaire
- 1Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
| | - N De Bont
- 1Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
| | - H Bordi
- 1Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
| | - N Senal
- 1Spinal Department, Centre Calvé, Fondation Hopale, Berck-sur-Mer, France
| | - P E Mortier
- Department of Gastroenterology, Institut Calot, Fondation Hopale, Berck-sur-Mer, France.,3Department of Gastroenterology, Centre Hospitalo-Universitaire de Lille, Lille, France
| |
Collapse
|
16
|
van Tol RR, Bruijnen MPA, Melenhorst J, van Kuijk SMJ, Stassen LPS, Breukink SO. A national evaluation of the management practices of hemorrhoidal disease in the Netherlands. Int J Colorectal Dis 2018; 33:577-588. [PMID: 29546558 PMCID: PMC5899108 DOI: 10.1007/s00384-018-3019-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE In this study, we describe current practices in the management of hemorrhoidal disease in the Netherlands. METHODS A validated online survey was performed among Dutch surgeons and residents treating hemorrhoidal disease. Contact details were retrieved from the Dutch Association for Surgery resulting in 619 contacts. Only doctors who were treating hemorrhoidal disease regularly were asked to complete the questionnaire. The following items were assessed: initial treatment, recurrence, complications, and follow-up. RESULTS In total, 133 respondents completed the survey. Ninety percent of the respondents started with rubber band ligation (RBL) as the first treatment in low-grade hemorrhoidal disease. In case of recurrence, 64% of the respondents repeated RBL three times before switching to a more invasive treatment modality. In grade III hemorrhoidal disease, the respondents preferred more invasive techniques: a sutured hemorrhoidopexy was performed in 24%, Doppler-guided hemorrhoidal artery ligation (DG-HAL) in 9%, stapled hemorrhoidopexy in 19%, and the traditional hemorrhoidectomy in 31% of the patients, respectively. The majority of the respondents (39%) reported a mild complication in 5-10% of the patients. The most reported complication was pain. Nearly all the respondents (98%) reported a major complication in less than 5% of the patients. The majority of the patients (57%) were seen in outpatient clinics 6 weeks post-treatment. CONCLUSION This Dutch survey showed areas of common practice for primary treatment of hemorrhoidal disease. However, it also demonstrated varying practices regarding recurrent hemorrhoidal disease. Practical guidelines are required to support colorectal surgeons in the Netherlands.
Collapse
Affiliation(s)
- Robin R. van Tol
- 0000 0004 0480 1382grid.412966.eDepartment of Surgery and Colorectal Surgery, Academic Hospital Maastricht, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Marieke P. A. Bruijnen
- 0000 0004 0480 1382grid.412966.eDepartment of Surgery and Colorectal Surgery, Academic Hospital Maastricht, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Jarno Melenhorst
- 0000 0004 0480 1382grid.412966.eDepartment of Surgery and Colorectal Surgery, Academic Hospital Maastricht, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Sander M. J. van Kuijk
- 0000 0004 0480 1382grid.412966.eDepartment of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Laurents P. S. Stassen
- 0000 0004 0480 1382grid.412966.eDepartment of Surgery and Colorectal Surgery, Academic Hospital Maastricht, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| | - Stéphanie O. Breukink
- 0000 0004 0480 1382grid.412966.eDepartment of Surgery and Colorectal Surgery, Academic Hospital Maastricht, Maastricht University Medical Center, PO box 5800, 6202 AZ Maastricht, The Netherlands
| |
Collapse
|
17
|
Owen HA, Buchanan GN, Schizas A, Emmanuel A, Cohen R, Williams AB. Quality of life following fistulotomy - short term follow-up. Colorectal Dis 2017; 19:563-569. [PMID: 27704667 DOI: 10.1111/codi.13538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/25/2016] [Indexed: 01/16/2023]
Abstract
AIM Anal fistula causes pain and discharge of pus and blood. Treatment by fistulotomy has the highest success, but can risk continence; treatment needs to balance cure with continence. This study assessed the impact of fistulotomy on quality of life (QOL) and continence. METHOD Patients selected for fistulotomy prospectively completed the St Mark's Continence Score (full incontinence = 24) and Short Form-36 questionnaires preoperatively at two institutions with an interest in anal fistula. Patients were reassessed 3 months' postoperatively. RESULTS There were 52 patients with a median age of 44 (range 19-82) years; 10 were women. Preoperative continence scores were median 0 (range 0-23) and there was no significant difference compared with postoperative scores (median 1, range 0-24). Following fistulotomy QOL was significantly improved in four of eight domains - Bodily Pain (P < 0.001), Vitality (P < 0.01), Social Functioning (P < 0.05) and Mental Health (P < 0.001) - and returned to that of the general population. QOL for patients with intersphincteric fistula improved postfistulotomy, and for those with trans-sphincteric fistula it remained the same. Data were further examined in two groups, with and without deterioration in continence score. Where continence improved postoperatively, QOL improved in three domains; where continence deteriorated QOL improved in two domains (P < 0.05). Patients with postoperative continence scores of < 5 had worse QOL than those scoring 4 or less. CONCLUSION QOL significantly improved at 3 months' follow-up after fistulotomy where continence was maintained or a small reduction occurred.
Collapse
Affiliation(s)
- H A Owen
- The Pelvic Floor Unit, Department of Surgery, Guy's & St Thomas' Hospital, London, UK.,Department of Surgery, St Mark's Hospital, Harrow, UK.,Department of Surgery, University College London Hospital, London, UK
| | - G N Buchanan
- Department of Surgery, St Mark's Hospital, Harrow, UK.,Department of Surgery, Charing Cross Hospital, London, UK
| | - A Schizas
- The Pelvic Floor Unit, Department of Surgery, Guy's & St Thomas' Hospital, London, UK
| | - A Emmanuel
- Department of Surgery, St Mark's Hospital, Harrow, UK.,Department of Surgery, University College London Hospital, London, UK
| | - R Cohen
- Department of Surgery, St Mark's Hospital, Harrow, UK.,Department of Surgery, University College London Hospital, London, UK
| | - A B Williams
- The Pelvic Floor Unit, Department of Surgery, Guy's & St Thomas' Hospital, London, UK.,Department of Surgery, St Mark's Hospital, Harrow, UK
| |
Collapse
|
18
|
Abstract
Anorectal surgery is well tolerated. Rates of minor complications are relatively high, but major postoperative complications are uncommon. Prompt identification of postoperative complications is necessary to avoid significant patient morbidity. The most common acute complications include bleeding, infection, and urinary retention. Pelvic sepsis, while may result in dramatic morbidity and even mortality, is relatively rare. The most feared long-term complications include fecal incontinence, anal stenosis, and chronic pelvic pain.
Collapse
Affiliation(s)
- Hiroko Kunitake
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Vitaliy Poylin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
19
|
Abstract
Radical and definitive surgical treatment is indicated in approximately one out of ten patients with hemorrhoidal disease. The Milligan and Morgan hemorrhoidectomy technique is the most widely performed in France: the technique is well-codified and results are satisfactory and durable if the indications and the post-operative follow-up are appropriately respected. Post-operative pain can be adequately controlled.
Collapse
Affiliation(s)
- H Pillant-Le Moult
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - M Aubert
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - V De Parades
- Institut de proctologie Léopold-Bellan, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| |
Collapse
|
20
|
Meurette G, Lehur PA. The future of hemorrhoidal surgery: Towards an “à la carte” choice of minimally invasive techniques? J Visc Surg 2014; 151:255-6. [DOI: 10.1016/j.jviscsurg.2014.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
21
|
Cracco N, Zinicola R. Is haemorrhoidectomy in inflammatory bowel disease harmful? An old dogma re-examined. Colorectal Dis 2014; 16:516-9. [PMID: 24422778 DOI: 10.1111/codi.12555] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/20/2013] [Indexed: 01/11/2023]
Abstract
AIM Haemorrhoidectomy and removal of anal skin tags in inflammatory bowel disease (IBD) have been considered to be potentially harmful, but the evidence for this is poor. A review of the literature was undertaken to determine the complications rate after haemorrhoidectomy in patients with IBD. METHOD A Medline, PubMed and Cochrane Library search was performed to retrieve studies reporting the surgical treatment of haemorrhoids in patients with IBD. All studies that investigated the complications of haemorrhoidectomy and skin tag removal in patients with IBD were included. Complications included local sepsis, fissure, ulcer, stenosis, faecal incontinence and the direct need for proctectomy or a stoma. RESULTS Eleven retrospective studies including 135 patients were identified. Most series were small and lacked information on the interval between surgery and the onset of complications. The range of complications ranged from 0% to 100%. Taking the studies together, complications occurred more frequently in Crohn's disease (CD) (17.1%) than in ulcerative colitis (UC) (5.5%). The risk of complication was much higher in patients with unknown than in those with known diagnosis of IBD (50% vs 9.8% in CD; 9.1% vs 4% in UC). CONCLUSION There is great variation in the incidence of complications reported after haemorrhoidectomy or removal of skin tags in patients with IBD and it is not possible to draw a firm conclusion. Nevertheless the incidence of complications is high in patients with CD.
Collapse
Affiliation(s)
- N Cracco
- Department of General Surgery, Sacro Cuore Don Calabria Hospital, Negrar, Verona
| | | |
Collapse
|
22
|
Tamponade dressings may be unnecessary after haemorrhoidectomy: a randomised controlled clinical trial. Int J Colorectal Dis 2014; 29:395-400. [PMID: 24292489 DOI: 10.1007/s00384-013-1800-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Bleeding after haemorrhoidectomy is common. Many surgical textbooks recommend insertion of an anal tampon in order to reduce postoperative bleeding. This practice, however, is bothersome and probably painful for patients. The effect of using a tamponade has not been validated in randomised controlled trials. METHODS The study included 100 patients who were scheduled for Milligan-Morgan haemorrhoidectomy. During surgery, patients were randomly assigned to receive or not to receive an anal tampon at the end of the procedure. Data on pain, complications and wound care were collected. The trial was registered (DRKS00003116) and all analyses were by intention-to-treat. RESULTS There were 48 patients in the group with tamponade, and 52 patients were left without tamponade. The trial's primary outcome and maximum pain intensity, averaged 6.1 and 4.2 in the two groups (P = 0.001). In the group with tamponade, a complication was recorded in seven patients (15 %), which was similar to the group without tamponade (21 %). Severe anal bleeding occurred in two and five patients, respectively. Bandage changes were less necessary often in the group treated without tamponade (P = 0.013). Hospital stay was 4 days in both groups. CONCLUSIONS Data indicate that insertion of an anal tampon after haemorrhoidectomy does not reduce postoperative bleeding but causes significantly more pain. After haemorrhoidectomy, anal tampons should not be used routinely but may be considered when specific indications justify its use.
Collapse
|