ABSTRACT
The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective: To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method: A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with highmucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence. Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion: Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD. (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Hemorrhoids/therapy , Treatment Outcome , Ultrasonography, Doppler , Hemorrhoidectomy/methodsABSTRACT
Resumo Este artigo é uma pesquisa que visa a demonstrar a relevância do debate epistemológico para compreender as bases teóricas, vertentes e tipos de metodologia de análise que balizam o campo das políticas públicas, com base em revisão de literatura de autores clássicos como Putnam, Arretche, Farah, Secchi e Howlett. O estudo demonstra que a distinção entre fato e valor é importante para compreender a diferença entre a análise teórico-descritiva e a análise aplicada-prescritiva de políticas públicas, assim como a polêmica entre as vertentes positivistas e pós-positivistas que marcou a virada argumentativa a partir de 1990. Conclui-se que a compreensão das questões epistemológicas é de grande relevância para fundamentar metodologias de análise.
Abstract This article aims to demonstrate the relevance of the epistemological debate to understand the theoretical bases, the strands and the types of analysis methodology that target the field of public policies. This is a theoretical-explanatory research, based on a literature review of classical authors, such as Putnam, Arretche, Farah, Secchi and Howlett. The study demonstrates that the epistemological distinction between fact and value is an important key to understand on the one hand, the difference between the theoretical-descriptive analysis and the applied-prescriptive analysis of public policies, and on the other, the controversy between the positivist and post positivist strands, which marked the argumentative turn starting in 1990. It was concluded that the understanding of the epistemological issues is of great relevance to the rationale behind the analysis methodologies.
Résumé L'objectif de cet article est de demontrer l'importance du débat épistémologique pour comprendre quelles sont les bases théoriques, les différents courants et les types de méthodologie d'analyse qui servent de répère au domaine des politiques publiques. Après avoir passé en revue les travaux classiques sur le sujet des auteurs tels que Putnam, Arretche, Farah, Secchi et Howlett, ce travail démontre que la distinction entre fait et valeur est importante pour comprendre non seulement la différence entre l'analyse théorique descriptive et l'analyse appliquée prescriptive des politiques publiques, mais aussi la controverse entre les courants positivistes et post-positivistes à l'origine du tournant argumentatif initié en 1990. La conclusion montre que la compréhension des questions épistémologiques est d'une grande pertinence pour étayer les méthodologies d'analyse.
Resumen Este artículo es una investigación que tiene como objetivo demostrar la relevancia del debate epistemológico para comprender las bases teóricas, las vertientes y tipos de metodología de análisis que guían el campo de las Políticas Públicas, basándose para ello en la revisión de la literatura de autores clásicos, como Putnam, Arretche, Farah, Secchi y Howlett. Se demuestra que la distinción entre hecho y valor es importante para comprender la diferencia entre el análisis teórico-descriptivo y el análisis aplicado-prescriptivo de políticas públicas. Del mismo modo es significativa la controversia entre las vertientes positivistas y pospositivistas que marcó un punto de inflexión a partir de 1990. Se concluye que la comprensión de las cuestiones epistemológicas es de gran relevancia para fundamentar las metodologías de análisis.
ABSTRACT
ABSTRACT Introduction: The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective: To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods: This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results: The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion: The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.
RESUMO Introdução: O tratamento da doença hemorroidária pelas técnicas convencionais cursa com significante redução da qualidade de vida do doente, principalmente relacionada à dor pós-operatória e ao considerável tempo de afastamento do trabalho. A técnica de desarterialização hemorroidária associada à mucopexia retal é uma opção cirúrgica pouco invasiva, a qual é utilizada com o objetivo de tratar a doença hemorroidária e reduzir seus inconvenientes. Objetivo: Analisar os resultados encontrados após sete anos de seguimento em doentes submetidos à técnica da desarterialização hemorroidária associada à mucopexia para o tratamento da doença hemorroidária. Método: Foram estudados 407 portadores de doença hemorroidária de graus II, III e IV, submetidos à técnica da desarterialização hemorroidária no Hospital das Clínicas Luzia de Pinho Melo de Mogi das Cruzes, durante o período de Dezembro de 2010 a Dezembro de 2017. Vinte e sete doentes (6,6%) apresentavam doença hemorroidária de grau II, 240 (59,0%) do grau III e 117 (28,8%) do grau IV. Em 23 doentes (5,7%) não foram encontradas a classificação nos prontuários. Todos os doentes foram operados pelo mesmo cirurgião e sob anestesia raquidiana. Os 407 doentes foram submetidos à desarterialização, variando de um até seis ramos arteriais seguidos de mucopexia por sutura contínua. Oitenta e dois (20,14%) necessitaram ressecções associadas por plicomas ou hemorroidas externas. No pós-operatório foram avaliados os seguintes parâmetros: dor, tenesmo, sangramento, prolapso, trombose e recidiva. Resultados: O tenesmo foi a queixa pós-operatória referida por 93,36% dos doentes. Quarenta e três (10,5%) apresentaram tenesmo intenso e 44 (22%) de moderado a intenso. Quatro (0,98%) doentes apresentaram sangramento de maior intensidade no pós-operatório e em 1 (0,5%) houve necessidade de hemostasia cirúrgica, em nenhum deles houve necessidade de reposição sanguínea. O prolapso ocorreu em 18 (4,42%) doentes, trombose em 11 (2,7%) e houve 19 (4,67%) recidivas reoperados durante o período. Conclusão: A desarterialização hemorroidária apresenta bons resultados, complicações leves e de fácil resolução e pouca dor pós-operatória.