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OBJECTIVE@#To observe the clinical effect of high suspension and low incision (HSLI) surgery on mixed haemorrhoids, compared with Milligan-Morgan haemorrhoidectomy.@*METHODS@#A multi-centre, randomized, single-blind, non-inferiority clinical trial was performed. Participants with mixed haemorrhoids from Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing Rectum Hospital, Air Force Medical Center of People's Liberation Army of China, and Puyang Hospital of Traditional Chinese Medicine were enrolled from September 2016 to March 2018. By using a blocked randomization scheme, participants were assigned to two groups. The experimental group was treated with HSLI, while the control group was treated with Milligan-Morgan haemorrhoidectomy. The primary outcome was the clinical effect evaluated at 12 weeks after operation. The secondary outcomes included the number of haemorrhoids treated during the operation, pain scores, use of analgesics, postoperative oedema, wound healing, incidence of anal stenosis, anorectal manometry after operation, as well as surgical duration, length of stay and total hospitalization expenses. A safety evaluation was also conducted.@*RESULTS@#In total, 246 eligible participants were enrolled, with 123 cases in each group. There was no significant difference in the clinical effect between the two groups (100.00% vs. 99.19%, P>0.05). Compared with the control group, the number of external haemorrhoids treated during the operation and the pain scores after operation were significantly reduced in the experimental group (P0.05). The surgical duration and length of stay in the experimental group were significantly longer than those in the control group, and the total hospitalization expense was significantly higher than that in the control group (all P<0.05). No adverse events were reported in either group during the whole trial or follow-up period.@*CONCLUSION@#HSLI had the advantages of preserving the skin of anal canal completely, alleviating postsurgical pain and promoting rapid recovery after operation. (Registration No. ChiCTR1900022883).
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ABSTRACT Background: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. Aim: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. Methods: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. Results: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. Conclusions: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.
RESUMO Racional: Veias varicosas aparecem acima e abaixo da linha dentada nas hemorroidas mistas, afetando seriamente a função anal e a qualidade de vida. Objetivo: Propor melhoria na terapia de seleção de tecido de reparo do coxim anal combinado com retenção completa epitelial do canal anal em comparação com a operação de Milligan-Morgan. Métodos: Estudo prospectivo randomizado controlado foi desenhado envolvendo 200 pacientes com hemorroidas graus III e IV. Eles foram divididos em grupos de controle e observação. O controle recebeu operação de Milligan-Morgan, e o de observação procedimento de seleção de tecido modificado combinado com operação completa de preservação do canal anal. Todos os pacientes foram acompanhados por seis meses para avaliar as diferenças de tratamento. Resultados: No final, o grupo controle incluiu 82 e o de observação 87. O tempo médio de operação do grupo controle foi significativamente menor do que o de observação, enquanto o volume de sangramento foi significativamente menor no grupo controle. O escore VAS do grupo controle foi 3 (1, 4) e no de observação 4 (2, 5). Não houve diferença significativa na incidência de retenção urinária, sangramento e edema da margem da ferida no pós-operatório de um mês. A incidência de estenose anal digital no grupo observação foi significativamente menor do que no controle; o mesmo ocorreu com as margens anais residuais. O diâmetro do canal anal pós-operatório foi significativamente maior nele do que o grupo controle. A pontuação de incontinência anal de Wexner mostrou que nenhuma incontinência ocorreu em ambos os grupos, e a pontuação do grupo de controle foi significativamente maior do que no de observação. Nos últimos seis meses de acompanhamento, o grupo observação não teve nenhuma recaída e quatro casos foram encontrados entre os controles. A satisfação com o tratamento do grupo observação foi maior. Conclusões: Nas hemorroidas graus III e IV, o tratamento de seleção de tecido modificado combinado com a preservação completa do canal anal teve melhor prognóstico e satisfação do que com o procedimento de Milligan-Morgan, e é um novo método cirúrgico para pacientes com hemorroidas mistas avançadas.
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Humans , Hemorrhoidectomy , Hemorrhoids/surgery , Anal Canal/surgery , Quality of Life , Prospective Studies , Treatment OutcomeABSTRACT
Hemorrhoidal disease is a common reason for consultation in proctology and a public health problem responsible for discomfort and urgent request relief. Patients mostly complain of pain, discomfort, bleeding, and itching. Currently, combining an anoscope and a Doppler transducer makes it possible to detect and bind the arteries responsible for congestion selectively thereby reducing the blood flow and thus collapsing haemorrhoids.(1) Doppler-guided ligation of haemorrhoidal vessels is being proposed as a treatment of grade 2 and 3 haemorrhoids.(2)METHODSAll patients attending the outpatient department of general surgery at Sri Siddhartha Medical College and Research Institute with characteristics of grade 2 and grade 3 haemorrhoids were included in the study. In this prospective study, we compared the results of open haemorrhoidectomy and DGHAL techniques by means of duration of surgery, postoperative pain, post-operative need for analgesics, post hospital stay, and complications. Ninety-six patients were enrolled in this study and were subsequently divided into two groups of 48 members in each. Group A patients received an open haemorrhoidectomy and Group B received a DGHAL.RESULTSDuration of surgery was for DG-HAL group is significantly lesser than open haemorrhoidectomy. Post-operative pain score using VAS was significantly lesser in DG-HAL than open haemorrhoidectomy. Post-operative need for analgesics was significantly lesser in DG-HAL than open haemorrhoidectomy. Post-operative hospital stay, and complications were significantly lesser in DG-HAL group than Open haemorrhoidectomy.CONCLUSIONSDG HAL repair seems to be a safe method of treatment of 2nd and 3rd grade haemorrhoidal disease with no major complications and a high rate of good short-term results. DGHAL is more useful when compared to Milligan–Morgan technique in terms of duration of surgery, post-operative pain, post-operative need for analgesics, post-operative hospital stay, as DGHAL reduces the complications in surgery.
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Background: Haemorrhoids are one of the most common benign anorectal problems worldwide. The treatment of thirdand fourth-degree haemorrhoids is surgical. Surgical haemorrhoidectomy and Stapled haemorrhoidopexy are the currently available surgical interventions in the management of haemorrhoids. The aim of the study is to evaluate the effectiveness of open haemorrhoidectomy with minimal invasive procedure for haemorrhoids (MIPH). Methods: 80 cases were selected for this study which were divided into two groups of 40 each. Open surgery (Milligan-morgan haemorrhoidectomy ) was done in one group and MIPH in the other group .The follow up period was one year. The duration of post. operative pain, complications, level of satisfaction was documented. The relative merits and demerits of the procedures were assessed and the results documented.Results: MIPH is a safe and effective procedure in patients presenting with haemorrhoids .Duration of hospital stay is less and hence return to work is earlier. Conclusion: MIPH can be considered as a procedure of choice in patients presenting with grade II,grade III and grade-IV haemorrhoids.
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OBJECTIVE@#To investigate the effect of electroacupuncture preconditioning combined with induced urination on urinary retention after milligan-morgan hemorrhoidectomy.@*METHODS@#Eighty patients with mixed hemorrhoids were randomly divided into an electroacupuncture group and a routine group, 40 cases in each group. Anesthesia at Yaoshu (GV 2) was given in the two groups. In the electroacupuncture group, electroacupuncture at Zhongji (CV 3)，Guanyuan (CV 4)，Pangguangshu (BL 28) and Sanyinjiao (SP 6) was applied with tolerant intensity for 30 min before operation, 2 Hz/100 Hz in frequency. After operation, induced urination was given, namely hot compress of bladder area and sound of hearing water. In the routine group，induced urination was given after operation. The score of the first urination waiting time, the distension of lower abdomen on the evening of the postoperative, the first time urinary volume and incidence of urinary retention were compared between the two groups.@*RESULTS@#The scores of the first urination waiting time after operation and distension of lower abdomen in the evening of the postoperative in the electroacupuncture group were lower than those in the routine group, the first time urinary volume was more than that in the routine group, and the incidence of urinary retention was lower than that in the routine group (5.0% (2/40) vs 22.5% (9/40), all <0.05).@*CONCLUSION@#Electroacupuncture preconditioning combined with induced urination can effectively prevent the incidence of urinary retention after milligan-morgan hemorrhoidectomy.
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Humans , Electroacupuncture , Hemorrhoidectomy , Hemorrhoids , Urinary Retention , Therapeutics , UrinationABSTRACT
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.
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Humans , Follow-Up Studies , Hemorrhage , Hemorrhoidectomy , Hemorrhoids , Pain, Postoperative , Postoperative Complications , Recurrence , Retrospective StudiesABSTRACT
OBJECTIVE@#To compare the effect of electroacupuncture preconditioning with different frequencies on anal pain after milligan-morgan hemorrhoidectomy.@*METHODS@#A total of 120 patients with mixed hemorrhoids were randomly divided into an electroacupuncture group A (dilatational wave, 2 Hz/100 Hz in frequency), an electroacupuncture group B (continuous wave, 2 Hz in frequency) and an electroacupuncture group C (continuous wave, 100 Hz in frequency), 40 cases in each group. Electroacupuncture at Xialiao (BL 34) and Chengshan (BL 57) was applied with tolerant intensity for 30 min before operation in all groups. The number of additional anesthetic drugs in the 3 groups, the visual anal pain score (VAS) and limb activity score at 4, 12, and 24 h after operation, the maximum VAS score within 24 h after surgery and oral dose of aminophenol dihydrocodeine were compared.@*RESULTS@#The number of additional anesthetic drugs in the electroacupuncture group A, the electroacupuncture group B and the electroacupuncture group C were 4, 5, 4 respectively, and there was not statistically significant (>0.05). There was no significant difference in the anal pain VAS score and limb activity score at 4 h after operation among the 3 groups (>0.05), at the 12 h after operation, the VAS scores and limb activity scores in the electroacupunctures group A and B were lower than those in the electroacupuncture group C (<0.05), at 24 h after operation, the VAS score and limb activity score in the electroacupuncture group A were lower than those in the electroacupuncture group B and C (<0.05), the maximum VAS score within 24 h and oral dose of aminophenol dihydrocodeine within 24 h after operation in the electroacupuncture group A were lower than those in the electroacupuncture group B and C (<0.05).@*CONCLUSION@#Different frequency electroacupuncture preconditioning has the effect of alleviating anal pain after milligan-morgan hemorrhoidectomy. The analgesic effect of electroacupuncture with different frequencies is different. The electroacupuncture analgesic effect of 2 Hz /100 Hz dilatational wave is better than 2 Hz and 100 Hz continuous waves.
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Humans , Anal Canal , Electroacupuncture , Hemorrhoidectomy , Hemorrhoids , Therapeutics , Pelvic PainABSTRACT
Objective To study the effect of Longxuejie capsule combined with Jiuhua ointment treatment on wound after ring-like mixed hemorrhoid surgery.Methods A total of 107 patients with ring-like mixed hemorrhoid (RMH) were randomly divided into the control group and the treatment group.All the patients were treated with the surgery,and then the control group were treated with Mayinglong ointment,while the treatment group were treated with Longxuejie capsule combined with Jiuhua ointment.The two groups were treated for 10 days.The clinical efficacy of the two groups after treatment were compared.The VAS score,edema degree score,wound drainage score,wound area score and wound granulation tissue score of the two groups were compared before and after treatment.The serum VEGF,PDGF and bFGF of the two groups were compared before and after treatment.The adverse reactions rates of the two groups during the treatment were compared.Results The total efficacy rate of the treatment group was 92.59％ (50/54),which was significantly higher than 77.4％ (41/53) of the control group (x2=4.881,P=0.027).After treatment,the VAS (0.8 ± 0.2 vs.1.6 ± 0.3,t=13.915),edema degree score(0.3 ± 0.2 vs.0.8 ± 0.2,t=12.690),wound drainage (0.2 ± 0.2 vs.0.7 ± 0.2,t=l 3.054),area (0.4 ± 0.2 vs.0.9 ± 0.3,t=10.044) and wound granulation tissue (0.4 ± 0.2 vs.0.7 ± 0.2,t=7.427) of the treatment group were significantly lower than the control group (P＜0.01).After treatment,the serum VEGF (126.43 ± 14.68 ng/L vs.107.78 ± 12.26 ng/L,t=7.126),PDGF (59.42 ± 9.73 ng/L vs.48.27 ± 7.08 ng/L,t=6.767) and bFGF (99.86 ± 12.61 ng/L vs.83.67 ± 11.15 ng/L,t=7.031) of the treatment group were significantly higher than the control group (P＜0.01).Conclusions Longxuejie capsule combined with Jiuhua ointment can promote the recovery of wound of the patients after ring-like mixed hemorrhoid surgery.Its mechanism may be correlated with regulation of the expressions of VEGF,PDGF and bFGF,and promotion of formation of granulation tissue growth and repair.
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Objective To observe the clinical effect of thrombus removal of external hemorrhoid combined with procedure for prolapse and hemorrhoids(PPH) in the treatment of circumferential mixed hemorrhoid with incarceration.Methods A total of 118 cases of circumferential mixed hemorrhoid with incarceration were divided into two groups:experimental group of 60 cases was treated by thrombus removal combined with PPH;control group of 58 cases was treated by Milligan-Morgan.We observed the differences of postoperative visual analogue scale (VAS)score,edema,bleeding,residual skin tag,wound healing time,anal stenosis,fecal incontinence,anorectal manometry and satisfaction in the two groups.Results There was significant difference between the experimental group and the control group in postoperative edema,bleeding and residual skin tag(χ2=6.63,4.19,6.64,P0.05).Postoperative VAS score,wound healing time,satisfaction,anal resting and anal maximal squeeze pressure between the two groups were all statistically different(P<0.01).Conclusion The operation of thrombus removal of external hemorrhoid combined with PPH can effectively reduce the postoperative complications and promote recovery.
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Objective To observe the curative effect of abdominal acupuncture on postoperative pain of patients with mixed hemorrhoid after Milligan-Morgan hemorrhoidectomy.Methods A total of 100 mixed hemorrhoid patients with postoperative pain after Milligan-Morgan hemorrhoidectomy under spinal anaesthesia from September of 2014 to December of 2015 were included into the study.The patients were evenly randomized into trial group and control group.The trial group was treated with abdominal acupuncture at acupoints of Shuifen,Guanyuan,Qihai,Sanxing needles under Qihai,lower Fengshi,Tianshu for 15-30 min.The control group was treated with intramuscular injection of Tramadol Injection 0.1 g.Before treatment and 0.5,1,2,3 hours after treatment,the pain visual analogue scale (VAS) scores and body activity scores were recorded.Results (1) After treatment,pain VAS scores of the two groups at different time points were obviously decreased(P ＜ 0.05 compared with those before treatment),and the decrease of pain VAS scores of the treatment group 0.5 hours after treatment was superior to that of the control group (P ＜ 0.05),but there was no significant difference between the two groups at other time points (P ＞ 0.05).(2) After treatment,body activity scores of the two groups at different time points were obviously decreased(P ＜ 0.05 compared with those before treatment),but the difference was insignificant between the two groups(P＞ 0.05).(3) The average dose of Tramadol Injection used in the trial group was 0.013 ± 0.034 1 g,while was 0.103 ± 0.017 7 g in the control group,the difference being significant (P ＜ 0.05).Conclusion The analgesic effect of abdominal acupuncture is similar to that of Tramadol Injection.For its safety,and being cheap,practical and painless,abdominal acupuncture can be expected to be another option of effective analgesic method for the postoperative pain of patients with mixed hemorrhoid after Milligan-Morgan hemorrhoidectomy.
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Background: There are various modalities of treatment available for management of hemorrhoids ranging from conservative measures including dietary measures, sclerotherapy to surgical techniques including band ligation, excision. Appropriate modality should be tailored on individual basis. Objective: To compare the results with those after open hemorrhoidectomy performed under spinal anesthesia (SA) and local anesthesia (LA). Methods: Present randomized controlled trail was carried out in the Department of Surgery, N.S.C.B. Medical College, Jabalpur, 24 cases with hemorrhoids. Cases were randomized with a help of randomization sequence generated with a help of statistician into either local or under SA group. Results: Mean visual analog scale (VAS) score signifi cantly low at 90 min and 6 h in LA group. Post-operative complications such as hypotension, urinary retention, and bleeding are not found in both groups except headache which is signifi cant in SA group. Post-operative hospital stays signifi cantly low in LA group. Conclusion: Open Milligan–Morgan hemorrhoidectomy is feasible under LA. Post-operative outcomes are better under LA in terms of pain, bladder evacuation, hospital stay and cost effectiveness with comparable complications.
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Background: Haemorrhoidectomy remains the treatment of choice for symptomatic grade-III and IV hemorrhoids. Milligan and Morgan’s haemorrhoidectomy is the most widely used procedure in the surgical management of hemorrhoids. Aim: This study was done to evaluate and analyze statistically whether stapler haemorrhoidectomy is better than Milligan Morgan haemorrhoidectomy in terms of Post operative pain, Duration of Hospital stay. Materials and methods: Prospective analytical study of 124 patients of haemorrhoids Grade II to Grade IV admitted , all adults aged 18 to 75 years with grade II to grade IV haemorrhoids admitted with ASA GRADE < III were included in our study. Two groups were constituted a stapled haemorrhoidectomy group and a Milligan Morgan group operated using standard open haemorrhoidectomy. Pain was assessed and recorded at 0, 15, 30, 45, 60 minutes after the patient attains a score of 4/4 on Bromage scale. Pain was assessed using visual analogue scale (VAS). K Tirumala Prasad, R V Apparao. Stapler hemorrhoidectomy versus Milligan Morgan hemorrhoidectomy in hemorrhoids in terms of post-operative pain and hospital stay - A prospective randomized control trial. IAIM, 2016; 3(12): 59-67. Page 60 Results: It was observed that at 0 minutes out of 62 patients in Milligan Morgan group 47 patients had moderate pain, 15 had mild pain. (mean VAS score was 4.242), at 15 minutes out of 62 patients in Milligan Morgan group 38 patients had moderate pain, 24 had mild pain (mean VAS score was 3.82). At 30 minutes out of 62 patients in Milligan Morgan group 25 patients had moderate pain 37 had mild pain (mean VAS score was 3.50).At 45 minutes out of 62 patients in Milligan Morgan group 19 patients had moderate pain 43 had mild pain (mean VAS score 3.342). At 60 minutes out of 62 patients in Milligan Morgan group 14 patients had moderate pain 48 had mild pain.(mean VAS score 3.016)/ In the stapler group the VAS scale at the same intervals were 1.712, 1.06, 0.966, 0.647, and 0.407 respectively. At all the intervals the P value was <0.005. Thus establishing the fact that stapler haemorrhoidectomy is less painful procedure than Milligan Morgan hemorrhoidectomy. The mean duration of hospital stay in the Milligan Morgan group was 2.532 days and stapler haemorrhoidectomy was 1.136 days with a P value <0.005. Conclusion: The circular stapled procedure for haemorrhoids is superior in terms of postoperative pain, discomfort, anaesthesia time and return to normal activity.
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Objective To explore the effect of multiple positioning procedure for prolapse and hemorrhoids (PPH) in treatment of connective tissue type mixed hemorrhoids,and compare the results between PPH and Milligan-Morgan surgery.Methods One hundred and sixteen patients with connective tissue type mixed hemorrhoids were divided into treatment group (62 cases) and control group (54 cases)according to random digits table method.The patients in treatment group received multiple positioning PPH,and the patients in control group received Milligan-Morgan surgery.The operative time,intraoperative blood loss,postoperative pain score,anal margin edema,wound healing time,perianal scar,anorectal stenosis,anal discharge and anorectal resting pressure were evaluated and compared between 2 groups.Results The operative time and intraoperative blood loss in treatment group were significantly lower than those in control group:(15.0 ± 2.3) min vs.(35.0 ± 3.4) min and (5.0 ± 2.1) ml vs.(15.0 ± 3.2) ml,and there were statistical differences (P ＜ 0.05).The postoperative pain score and wound healing time in treatment group were significantly lower than those in control group:(4.83 ± 0.62) scores vs.(7.82 ± 0.37) scores and (8.2 ± 2.6) d vs.(17.4 ± 3.8) d,the rates of anal margin edema,perianal scar and anorectal stenosis in treatment group were significantly lower than those in control group:8.1％ (5/62) vs.37.0％ (20/54),0 vs.29.6％ (16/54) and 1.6％(1/62) vs.16.7％ (9/54),and there were statistical differences (P ＜ 0.05 or ＜ 0.01).The postoperative anorectal resting pressure was significantly lower than preoperative in control group:(13.80 ± 4.20) kPa vs.(17.20 ± 5.87) kPa,and there was statistical difference (P＜ 0.05).One patient (1.6％,1/62) in treatment group occurred anal discharge,and 10 patients (18.5％,10/54) occurred anal discharge in control group.The rate of anal discharge in treatment group was significantly lower than that in control group,and there was statistical difference (P ＜ 0.01).Conclusions Multiple positioning PPH is effective for the treatment of connective tissue type mixed hemorrhoids.It improves the controllability of the amount of removal and the excision site.It decreases the incidence of anal margin edema,perianal scar and anal discharge scar,which provides an effective protection for the anal function.
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Objective To investigate the clinical curative effect of Milligan‐Morgan and Ligasure blood vessels closed system for conducting mixed hemorrhoidectomy under local anesthesia .Methods 68 inpatients with mixed hemorrhoid in the general sur‐gery department of our hospital from April 2009 to April 2012 were selected and randomly divided into the Ligasure group (observa‐tion group ,34 cases) and the Milligan‐Morgan group (control group ,34 cases) .The operation adopted the local infiltration anesthe‐sia .The postoperative followed up lasted for 6‐36 months .The operation time ,intraoperative blood loss ,total hospitalization cost , postoperative hospital stay time ,postoperative pain degree and the postoperative complications were compared between the two groups .Results The average operation time in the control group and the observation group was (32 .35 ± 10 .24)min and (20 .29 ± 7 .88) min(P=0 .000) ,the average intraoperative blood loss was (29 .71 ± 14 .67)mL and (4 .97 ± 2 .89) mL(P=0 .000) ,the aver‐age postoperative pain score was (5 .88 ± 1 .12) points and (3 .47 ± 0 .83) points(P=0 .000) ,the average postoperative hospital stay time was (7 .97 ± 2 .55) d and (2 .29 ± 1 .17) d(P=0 .000) ,and the average hospitalization expense was (1 541 .32 ± 205 .91) Yuan and (2 872 .32 ± 652 .30) Yuan ,respectively ,the differences between the two groups were statistically significant (P=0 .000) .Dur‐ing the hospitalization period and follow‐up ,the anal exudation rate and the average postoperative pain score in the control group were higher than those in the observation group(P=0 .000) ,the occurrence rate of other complications had no statistically signifi‐cant differences between the two groups .Conclusion The Ligasure operation mode has less intraoperative blood loss ,shorter opera‐tion time and shorter postoperative hospital stay time .
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Objective To compare the clinical outcome of procedure for prolapse and hemorrhoids (PPH) and PPH + selective Milligan-Morgan hemorrhoidectomy(MMH) in surgical treatment of Ⅲ ～ Ⅳ stage hemorrhoids and research the best surgical procedures.Methods Retrospective analysis was made on the clinical data of 125 cases with Ⅲ ～ Ⅳ stage mixed hemorrhoids,they were non-randomized-controlled divided into PPH group (group 1) and PPH + selective MMH group(group 2),comparing the data of recurrence,complication and symptoms relief including anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.Results While observing 3 years after operation,group 1 and group 2 both relieved symptoms of anal prolapse,bleeding,anus fall feeling,wet anus and pruritus ani.The relief rate of these symptoms in the two group were all high than 92%.There was one cases relapsed in the group 2 (the recurrence rate of 2%) was better than the group 1 (the recurrence rate of 13%) which were 8 case,there was a significant statistical significance (x2 =4.629,P ＜ 0.05) in the recurrence and clinical outcome.Conclusion Radical choose of PPH and selective MMH to treat Ⅲ ～ Ⅳ stage mixed hemorrhoids patients,which could relieve postoperative symptoms and acquire better long-term clinic outcomes.
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Objective To explore the effect of Chitosan gel (Ⅲ) on the complications from Milligan-Morgan hemorrhoidectomy for treatment of severe mixed hemorrhoids.Methods Seventy-six patients with severe mixed hemorrhoids were randomly divided into treatment group and control group with 38 cases in each group. All patients from the two groups were treated with Milligan-Morgan hemorrhoidectomy. Then Chitosan gel (Ⅲ) was used in the treatment group. The two groups were compared in terms of curative effect, pain level, complications and hospital stay.Results There was no significant difference in the curative effect (P>0.05). But the scores on pain level, hemtochezia, infection and edema of the treatment group were all significantly lower than those of the control group (allP<0.05) and the hospital stay was significantly shorter than that of the control group (P<0.05).Conclusions In the treatment of severe mixed hemorrhoids by Milligan-Morgan hemorrhoidectomy, Chitosan gel (Ⅲ) is effective in relieving pains, reducing hemorrhage, edema and preventing infections and therefore shortens the hospital stay. In view of nursing, it is critical to perform mental care as well as close observations on complications.
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Objective To evaluate the clinical efficacy of procedure for prolapse and hemorrhoids (PPH)plus Milligan-Morgan methods for circumferential mixed hemorrhoid.Methods A total of 74 cases with circumferential mixed hemorrhoid were treated by PPH plus Milligan-Morgan methods.Results The anal form of all cases were changed correctly.There was no complication such as anal edema,incontinence,anal stenosis,postoperative massive bleeding and infection.Conclusion PPH plus Milligan-Morgan methods is a safe and effective way for circumferential mixed hemorrhoid.This way can decrease postoperative complications and improve the curative effect.
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Objective To demonstrate the feasibility, effectiveness and reliability of combination of procedure for prolapse and hemorrhoids (PPH) and excision-closed hemorrhoidectomy (ECH) for severe hemorrhoids. Methods Sixty patients with Ⅲ- Ⅳ degree hemorrhoids which left remnant prolapsed hemorrhoids after stapled hemorrhoidopexy, were randomly divided into group A (PPH with additional ECH group,30 cases.) and group B [PPH with additional Milligan-Morgan hemorrhoidectomy (MMH) group, 30 cases]. Ten indexes of the results in two groups were compared. ResultsThe hemorrhoidectomy lasted (35.6 ± 5.3) min in group A and (47.3 ± 10.2) min in group B. The indexes related to 24 h visual analogue scale (VAS) after operation were (2.9 ± 1.2) scores in group A and (5.7 ± 1.9) scores in group B. Wound healing time were (6.3 ± 1.4) d in group A and (28.5 ± 4.8) d in group B. Many indexes showed the results in group A was better than those in group B ( P ＜ 0.05 ). The six-month follow-up visits after operation showed no complications, such as recurrence in either group. ConclusionsCombination treatment for Ⅲ -Ⅳ degree hemorrhoids with PPH with additional ECH is a easy,safe,reliable,minimal-aching and quick-recovering method of hemorrhoidectomy with favorable results than PPH with additional MMH.
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Objective To compare the long-term effects between procedurefor prolapse and hemorrhoids(PPH) and Milligan-Morgan hemorrhoidectomy( MMH ) in the treatment of Ⅲ and Ⅳ degree of hemorrhoids. Method The clinical data of 43 cases with Ⅲ and Ⅳ degree hemorrhoids received PPH (PPH group)and 71 cases received MMH (MMH group) were analyzed retrospectively from October 2001 to July 2003. Results Late bleeding in 5 cases of PPH group and no one of MMH group (P ＜0.05).Hemorrhoidal recurrence prolapsed in 9 cases of PPH group and 5 cases of MMH group (P ＜ 0.05). The rectal neck pressure preoperative,after 6 months, 1 year and 3 years were (122.0 ± 11.3), (90.0 ± 10.4),(103.0 ± 13.8) and (113.0 ± 11.2) cm H2O (1 cm H2O =0.098 kPa) of PPH group,after 6 months was decreased obviously than preoperative (P＜0.05),and they were ( 126.0 ± 13.5), (91.0 ± 12.4), (78.0 ±9.8) and (81.0 ± 7.5 ) cm H2O of MMH group,after 6 months, 1 year and 3 years were decreased obviously than preoperative (P ＜ 0.05). Conclusion PPH is safety and effect at short time,but it brings more late bleeding and anal pain,and its rate of prospective hemorrhoidal recurrence is more higher than MMH.
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Objective To study the efficacy of external dissection & internal ligation for beating mixed hemorrhoids, and compare with Milligan-Morgan. Methods One hundred and twenty-six patients with mixed hemorrhoids were divided into two groups: treatment group(66 cases)and controlled group(60cases).In treatment group used external dissection & internal ligation for treating mixed hemorrhoids, but in eontrolled group used Milligan-Morgan. Then the differences between both groups in healing time of wound surface, as well in the statuses of bleeding, pain, edema, anus stenosis, and anus overflow liquid were observed. Results Averaged healing time in treatment group was significantly shorter than that in controlled group, (8.2±2.6)days vs (17.4±3.8)days, P＜0.01.The anus stenosis and anus overflow liquid were significantly less in treatment group than those in controlled group, P＜0.01.Conclusion External dissection & internal ligation of hemorrhoids for treating mixed hemorrhoids decreases anal transitional zone(ATZ)disorganization, shorten healing time, and significantly decreases crissum scar,protectes anus function effectively.