Our initial experience of three versus two rows circular stapler devices for stapled hemorrhoidopexy: a single institution review of 224 cases

Background: Stapled haemorrhoidopexy is a non-excisional approach for haemorrhoids as opposed to conventional open Milligan-Morgan and Ferguson closed haemorrhoidectomy techniques. It repositions the prolapsed haemorrhoid tissue and also causes vascular interruption to the haemorrhoids. This causes faster recovery and lesser post-operative pain.Methods: In authors institute, stapled haemorrhoidopexy was being carried out using two rows proximate PPH circular haemorrhoidal stapler. In February 2018, MIRUS three rows circular stapler was introduced. This is a retrospective observational study carried out at Artemis Hospital, Gurgaon, India. Authors studied records and operative notes of all patients who underwent stapled haemorrhoidopexy between February 2018 and September 2019 and compared key parameters.Results: A total of 224 patients underwent stapled haemorrhoidopexy between February 2018 and September 2019. 116 using MIRUS three rows circular stapler and 108 using two rows proximate PPH circular haemorrhoidal stapler. Most of the studied parameters were comparable with only significant statistical difference seen in higher use of haemostatic sutures in two rows stapler group compared to three rows stapler group. Haemostatic sutures were needed in three row stapler group for 27 patients and in two rows stapler group for 39 patients.Conclusions: Author’s initial experience shows slightly better haemostasis with three rows stapled haemorrhoidopexy with no significant difference in other parameters.

Clinical Evaluation Of Apamarga Prati-sharaniya (teekshna) Kshara (local Application) Haritaki Churna In The Management Of Arsha (hemorrhoids)

Arsha (Hemorrhoids) is one of the most common conditions affecting peoples since time immemorial. The prevalence is equal in both sexes, peaks between the ages of 45 and 65 and declining thereafter. The main cause of hemorrhoids is constipation over a prolonged period of time and has to strain to pass stools, it can damage the lining of anal canal. Sushruta the Father of Surgery advocated four method of treatment of Arsha, which are Bheshaja, Kshara, Agni and Shastra. Under Sushrutas operative procedure local application of Pratisharaniya Kshara in the prolapse piles mass helps to reduce pile mass effectively (Ref.Su.Chi.6). It is safe, cheap, effective, simple, easily approachable procedure and ambulatory treatment and the patients acceptability is good to overcome such problem. Aims & Objective is to evaluate the clinical efficacy of Apamarga Pratisharaniya teekshna kshara in the management of Arsha. & to evaluate the safety of Apamarga Pratisharaniya teekshna kshara in the management of Arsha. Material and Methods: 30 patients were enrolled for the study within a period of one year and Teekshna pratisharaniya kshara was applied on piles mass intra anally under operative procedure with the help of a instrument proctoscope. Observation and result: Reduction in the piles mass evident by Inspection/ proctoscopy /Visual perception was observed remarkably.Bleeding and pain were also reduced remarkably in all the piles patient. 100% relief in bleeding, reduction of pile mass and total reduction in size of pile mass was recorded. Conclusion: Recently these Oldest technique advocated by Sushruta have been proven to be most effective and free from post-operative complications.

Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients

PURPOSE: Despite the minimally invasive nature of transanal hemorrhoidal dearterialization (THD) with Doppler arterial identification procedures, hemorrhoidectomy is still considered the gold standard procedure for hemorrhoidal disease. However, the classical techniques of hemorrhoidectomy have a high rate of postoperative complications. The main purpose of this study is to demonstrate the efficacy and complications of these techniques used for grades II and III hemorrhoids. METHODS: A retrospective (case-control) study was carried out from January 2009 to May 2014, and all patients undergoing surgical procedures for hemorrhoidal disease in two French clinics were considered. Application of inclusion and exclusion criteria identified 270 eligible patients (163 undergoing Doppler THD and 107 treated with Milligan Morgan hemorrhoidectomy). Statistical analysis was calculated considering immediate postoperative complications, functional results, chronic complications, and recurrences. RESULTS: Analysis of primary outcomes showed a significant difference between the 2 groups concerning postoperative pain, which had a lower rate in THD (P = 0.0001) and in postoperative bleeding (P = 0.02) than hemorrhoidectomy. However, long-term follow-up at three years showed a superior rate of recurrence in the THD group (P = 0.009). CONCLUSION: The THD technique is a safe and effective procedure for grades II and III hemorrhoids, has lower rates of post-operative pain and bleeding, and allows faster hospital discharge; however, it also shows a higher rate of recurrence at three years of follow-up.

Haemorrhoid and Milligan-Morgan operation

Milligan-Morgan operation was the most frequent method for treatment of haemorrhoid. The operation indicated for haemorrhoid grade III and IV (frequent prolapsed haemorrhoid), perianal haemorrhoid with embolism, bleeding haemorrhoid or anal fissure and haemorrhoid failed by internal treatment and other procedure.

Using Milligan-Morgan procedure for haemorrhoids in Intestinal Surgery Department of Viet DucHospital

Between 1/1993-12/1996, 58 patients (48 males, 15 females) with haemorrhoids of grade 3 or 4 underwent Milligan-Morgan procedure in ViÖt §øc Hospital. Ages range from 29 to 70, with an average of 45 years. Most of these patients were operated on elective surgery, only some of them on emergency because of complications of haemorrhoids (thrombosis...). Post-operative measurements were favourable with 4 days of hospitalization in average. Good results were obtained in more than 94% of patients by 4 years of follow-up.

Some convenient factors for haemorrhoid thrombosis

1506 Phan Hoµi Trung: Some convenient factors for haemorrhoid thrombosis: Vn J Med 2001 Aug.,262(8):64-67:(CIMSI) By studying 106 cases of hemorrhoid thrombosis, the statistical significant high risk factors promoting thrombosis are bleeding antecedent, weather changes, strenous overworking, wine. With the combination of these 4 factors, the thrombosis risks are up to 38.6-42.5%.

Some opinions of local anesthesia in haemorrhoidectomy

This study was undertaken to evaluate the local anesthesia with lidocain 0.5% in hemorrhoidectomy to supervise the analgesia of 157 patients with local anesthsia with lidocaine 0.5% for hemorrhoidectomy. Results: good: 96.18%, average: 3.18%, bad: 0.64%. Local anesthesia is quite good for hemorrhoidectomy

Results of treatment of haemorrhoid by sclerotization injection with kinurea

46 patients with internal haemorrhoid with grade I-II of haemorhage in which 10 patients with haemorrhoid grade III, (22%), grade II (63%) and grade I (15%) injected by kinurea for sclerotization round of injection: 1 round (91%), 2 rounds (7%) and 3 rounds (92%)- hemostastic effects: very good (24%), good (65%) and normal (11%). There were no complications from procedure

Ambulatory haemorrhoidectomy by laser CO2

A prospective study of ambulatory CO2 laser hemorrhoidectomy. 295 consecutive patients (147 males, 148 females), mean age of 39 years (18-72), 97 cases of them (41 circumferential hemorrhoids, 56 piles) were strict follow-up from 3 months to one year. All had been operated by “restricted and pile-size hemorrhoidectomy” technique and performed with CO2¬ laser. Less operative bleeding (about 90% <20 ml), operating faster (average: 23.58 min), less painful (78.4% degree A + B), none post - op, hemorrhage, mean wound healing within 4 weeks, none late complication (anal fissure, fistula, deformity...) and recurrence. Hemorrhoidectomy using CO2 laser and author’s technique is safe, effective and no-hospitalization.

The modified handsew technique, a method of painless haemorrhoidectomy

The stapling procedure of hemorrhoid surgical therapy, reported from 1998, is a very good new technique especially by significantly pain reduction. One of its disadvantage is the cost of 300-400 USD/case. That is why, the author uses a modified technique by realizing a circular handsew-technique, of U or X shaped points at 1.5 cm - 2 cm above the dentate line. By good results of 72 cases, the modified handsew technique is well appreciated. The indication is for 2nd, 3rd and 4th (not too big) degree piles. For big and mixed hemorrhoid especially with circumferential prolape the modified technique is combined with Milligan Morgan procedure. Further study with randomised groups and long follow up results are needed.