Stapled hemorrhoidectomy versus diathermy hemorrhoidectomy: the outcomes after two years

Excisional hemorrhoidectomy such as Milligan-Morgan or diathermy hemorrhoidectomy has for long remained the standard procedure in the operative management of hemorrhoids. Innovations in surgical techniques have recently been introduced in an attempt to decrease the pain associated with it. The notable popularity of stapled hemorrhoidectomy in recent years has stimulated the comparison of this technique with diathermy hemorrhoidectomy which is a standard technique for hemorrhoidectomy. To compare the outcomes of stapled hemorrhoidectomy [SH] versus diathermy hemorrhoidectomy [DH] for both, the short-term as well as the long-term follow up periods. Seventy patients with third degree piles have been randomly assigned for SH or DH with postoperative follow up and evaluation for two years. SH had a lower pain scores, less analgesic requirement and shorter recovery period than DH. Anal complications over the long-term follow up were higher for SH than DH. Stapled hemorrhoidectomy is associated with anal complications which may persist or evolve over the long-term follow-up. Until the pathophysiological sequelae of stapling the hemorrhoids are fully-investigated, it may be prudent to keep its use under close scrutiny and to avoid its use as the standard care of hemorrhoidectomy. Diathermy hemorrhoidectomy offers a better long term control of bleeding and recurrence

Feeding gastrostomy: surgical or endoscopic ? a prospective study

This study compared operative gastrostomy [OG] [performed by surgeons] with percutaneous endoscopic gastrostomy [PEG] [performed by physician endoscopists] in a prospective randomized fashion to determine whether one technique was superior. PEG [Sachs-Vine] and OG [Stamm] were done using local anesthesia. Patients were assessed for complications, mortality, tube Junction, and cost Groups were equally matched for indications and underlying disease. Fifty-seven had OG and 64 had attempted PEG. Complications occurred in 26% of OG patients and 9% died. Complications occurred in 25% of PEG patients and 12% died. Tube feeding was initiated in both groups within a mean of 29 [24 to 72] hours of the gastrostomy placement OG costed 1675 and PEG 979 local currency units to perform. We conclude that, there is no difference between OG [using local, anesthesia] and PEG with regard to morbidity, mortality, or tube Junction. The endoscopic technique does appear to have economic advantage