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Background: Hemorrhoids are symptomatic anal cushions containing arteriovenous anastomosis. Patient with haemorrhoids can present as bleeding per rectum, something (mass) coming out per rectum, perianal itching, Anaemia due to occult blood loss. Various modalities of treatment have been developed to treat symptomatic haemorrhoids. This study was undertaken to determine the efficacy of rubber band ligation in the management of haemorrhoids.Methods: This study was a prospective study conducted in the Department of Surgery, Government Medical College, Srinagar from June 2015 to June 2018. Patients at any age with first, second- or third-degree internal haemorrhoids were included in the study. Patients with fourth degree, complicated haemorrhoids, previous anorectal surgery or anorectal pathology, and chronic liver disease were excluded. A total of 212 patients were included in the study. Rubber band ligation was done as an OPD procedure. The patients were followed at 2 weeks, 4 weeks, 3-month, 6 month and 1 year after the procedure.Results: In this study, out of 212 patients, 154(72.6%) were males and 58(27.4%) females. The mean age of this study was 38.7 yr. (Range 17-73 yr.). Patients presented with the complaints of bleeding (184, 86.8%), prolapse (114, 53.7%), constipation (116, 54.7%), priuritis ani (36, 17.0%), pain (12, 5.6%). Band ligation was successful in 188(88.8%) patients, 169(79.7%) patients were cured and in 19(8.9%) improvement was obtained. Various complications occurred after band ligation including vasovagal syncope (2, 0.9%), bleeding per anum (6, 2.8%), pain (12, 5.6%), fissure in ano (1, 0.5%). Recurrence after one year was seen in 9(4.2%) patients.Conclusions: Author concluded in this study that RBL is an effective outpatient treatment for grade II and III internal haemorrhoids without much complications.
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Anorectal cancer is traditionally treated via abdominoperineal resection and/or chemoradiation. Currently, endoscopic submucosal dissection (ESD) is widely used to treat early gastrointestinal epithelial neoplasias. However, the use of ESD to treat lesions of the anal canal raises concerns that do not arise when treating lesions of the stomach and colorectum. Therefore, particular care is needed when treating lesions in the anal area. We recently treated a 75-year-old woman who was scheduled for surgical resection to treat anorectal cancer. The lesion was successfully removed using ESD. This is the first report of the use of ESD to treat anorectal cancer in Korea. Here, we present our case report and review the relevant literature.
Subject(s)
Aged , Female , Humans , Anal Canal , Korea , StomachABSTRACT
Objective To explore the correlation of the distance between anastomosis and dentate line in patients with severe circumferential prolapsed haemorrhoids treated by stapled haemorrhoidectomy with the patients' postoperative clinical manufestival score, and assess its value in the choice of anastomosis site in stapled haemorrhoidectomy. Methods One hundred and six patients with severe circumferential prolapsed haemorrhoids was treated by stapled haemorrhoidectomy. The distance between anastomosis and dentate line was documented during the operation, effect of the treatment and complications were also documented postoperatively. All above-mentioned data were analysed statisticaly by one-way ANOVA and ridit test.Results Four groups were established in 106 patients according to the distance between anastomosis and dentate line. Patients with distance less than 1.0cm were defined as group A, between 1.0 cm and 1.5 cm as group B, between 1.5 cm and 2.0 cm as group C, more than 2.0 cm as group D. Concerning the postoperative incontinence score, satisfaction index and complications such as haemorrhage,ederma of anal everage,residal skin-tags, there was no significant difference between all groups. But there was significant difference between four groups in score of pain. Conclusions Patients with severe circumferential prolapsed haemorrhoids treated by Stapled haemorrhoidectomy tend to have good clinical outcome. The appropriate distance between anastomosis and dentate line should be chosed by the status of prolapsed haemorrhoids.
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Objective To explore the causes of more frequently happened painful prostate biopsy at the prostatic apex rather than at other areas of the gland and develop maneuvers to avoid this painful apical prostate biopsy. Methods The prostate apical biopsy needle ptmeture sites in the rectum were recorded and accessed. Two maneuvers were developed to avoid the pain. There were 3 groups in this clinical trail. Ten patients in the control group were performed the apical biopsies routinely without any maneuver. Ten patients in the anal canal local anesthesia group were exposed to local anesthesia with 1% lidocaine injected into anal canal ventral hemieyele prior inserting the ultrasound probe, then the ultrasound guided apical biopsies were performed. Fifteen patients were assigned to the rectal pain sensation test group. In this group, the dentate line ot anal canal was detected before the biopsy needle was aimed at apex and touched the rectal mucosa lightly. There would be no painful sensation if the puncture was above the dentate line and the painful sensation would be sharp if the puncture was below the dentate line. Then the apical biopsy was performed above the dentate line. All patients were offered apical prostate biopsies and then other areas of prostate would be biopsied. Patients were asked to score the visual analog scale (VAS) immediately after the prostate apical biopsy. Results The VAS score of apical biopsy in 3 groups were 4. 46±1.24 in control group, 1.84± 0. 75 in anal canal local anesthesia group, 1.98±0. 67 in rectal pain sensation test group (P<0.05), respectively. So, patient would have painful sensation if the prostate apical biopsy puncture site was below the rectal dentate line. The VAS score of patient was 5.24±0.83 at the time of applying the anal canal local anes thesia. There was no significant difference comparing to the control group (P>0. 05). In this study, there was 1 patient with crissum pain after biopsy in control group and 1 patient in anal canal local anesthesia group, separately. 1 patient suffered high fever (38.4 ℃) in rectal pain sensation test group. Conclusions The prostate biopsy puncture site below or above the dentate line decides if it will be a painful prostate apical biopsy or not. We can significantly decrease the painful sensation by aim the puncture sites above the anal canal dentate line. The application of anal canal anesthesia can decrease pain score caused by prostate biopsy. However, this application itself can provoke obvious pain. So the application of anal canal anesthesia has limited role in patient's pain control during the prostate biopsy.
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The lenght from incisor to dentate line of the cardia was measured by watching esophageal cavity by means of endoscope Studying a total of 644 cases (380 males and 264 females) we found ①The average length from incisor to dentate line of the cardia was 41.084?2.032 cm for male, 38.24?2.08 cm for female and the difference between male and female was statistically significant (P