recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Selective hemorrhoidal dearterialization with high mucopexy in the surgical treatment of hemorrhoidal disease

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)

Impact of Ambulatory Surgery for Hemorrhoidal Disease on Clinical Outcomes and Institutional Costs / Impacto da cirurgia ambulatória para patologia hemorroidária nos resultados clínicos e custos

Abstract Objective Transanal hemorrhoidal artery ligation with mucopexy (ligation anopexy [LA]) and open hemorrhoidectomy (OH) can both be performed under local anesthesia. The aim of the present study was to analyze the impact and the cost-effectiveness of performing these techniques in an ambulatory setting of an Italian academic center on the postoperative outcome. Methods A series of 122 consecutive patients with grades II and III hemorrhoidal disease undergoing ambulatory surgical treatment of hemorrhoids in 2015 to 2018 (group A) was comparedwith 122 patients operated at the same institution in the same period (group H) in a hospital setting. The primary outcome was the number of days required to return to work/daily activities. Secondary outcomes included postoperative pain and complications, costeffectiveness, patient satisfaction, and recurrence at 12 months. In group A, all the procedures were performed under local anesthesia with early discharge. In group H, the procedureswere performed under general or loco-regional anesthesia with hospital admission. Results The mean number of days required to return to work/daily activities was 8.4 ± 4.8 days in group A, compared with 12.5 ± 3 days in group H (p<0.001). The visual analog scale (VAS) pain score at 1 week, 2 and 3 weeks, and 1 month after surgery was lower for patients undergoing LA in the ambulatory setting (p<0.01). We observedmore postoperative complications in hospitalized (12.5%) than in ambulatory patients (7.5%) (p<0.001). The total mean direct costs per patient were significantly lower in the ambulatory setting versus the hospital stay group (351.3 versus 1,746 euros). Conclusion Implementing ambulatory surgery for hemorrhoids is feasible, safe, and cost-effective.

Resumo Objetivo A ligação transanal da artéria hemorroidária com mucopexia e a hemorroidectomia aberta (HA) podem ser realizadas em anestesia local. O objetivo do presente estudo foi analisar o impacto no resultado pós-operatório e a relação custo-eficácia da realização destas técnicas em ambiente ambulatorial de um centro acadêmico italiano no desfecho pós-operatório. Métodos Uma série de 122 pacientes consecutivos com patologia hemorroidária de graus II e III submetidos a cirurgia de hemorroidas em regime ambulatório de 2015 a 2018 (grupo A) foi comparada com 122 pacientes operados na mesma instituição no mesmo período (grupo H) por hospitalização. O desfecho primário foi o número de dias necessários para regressar ao trabalho/atividades diárias. Os desfechos secundários incluíram dor e complicações pós-operatórias, custo-eficácia, satisfação do paciente, e recidiva aos 12 meses. No grupo A, todos os procedimentos foram realizados em anestesia local. No grupo H, os procedimentos foram realizados em anestesia geral ou loco-regional. Resultados A espera média para o regresso ao trabalho foi de 8,4 ± 4,8 dias no grupo A em comparação com 12,5 ± 3 dias no grupo H (p<0,001). A pontuação na escala visual analógica (EVA) da dor 1 semana, 2 e 3 semanas, e 1 mês após a cirurgia foi mais baixa para os pacientes submetidos a cirurgia de ligadura com anopexia em ambiente ambulatorial (p<0,01). Observamosmais complicações pós-operatórias empacientes hospitalizados (12,5%) do que em pacientes ambulatórios (7,5%) (p<0,001). Os custos diretosmédios totais por paciente foram mais baixos em ambiente ambulatório do que no grupo de hospitalização (351,3 contra 1.746 euros). Conclusão A implementação da cirurgia ambulatória para hemorroidas é possível, segura e rentável.

Características clínicas de Soiling en pacientes postoperados de enfermedades anales en el Hospital General San Juan de Dios / Clinical settings of patients with postoperative Soiling at San Juan de Dios Hospital

Introducción: El soiling es el escape inconsciente de pequeñas cantidades de materia fecal después de una evacuación normal. Se ha reportado una prevalencia del 7-23% en otros países y se ha observado una alta incidencia después de esfinterotomías y fistulotomías (35-45%). Material y Métodos: Se realizó un estudio observacional que incluyó 80 pacientes con patologías anales que acudieron a la consulta externa del Hospital General San Juan de Dios donde se aplicó un cuestionario de 8 ítems. Resultados: Se evaluaron 80 pacientes, la mayoría son hombres, de la quinta década. La enfermedad anal más frecuente son las hemorroides y el tratamiento quirúrgico más frecuente la hemorroidectomía. La incidencia de soiling definitivo (presencia de manchado a los 6 meses) es del 22.5%. Las variables asociadas fueron el género masculino, el tipo de enfermedad y procedimiento quirúrgico, el enrojecimiento, la picazón anal, el uso de protector en la región anal, la sensación de materia fecal y la limpieza en región anal. El ser hombre presenta un riesgo 6 veces mayor y el presentar enrojecimiento en la región anal aumenta el riesgo de 27 veces de presentar soiling definitivo. Conclusión: El soiling se presenta en un quinto de los pacientes que son operados de patologías anales en el Hospital General San Juan de Dios. La presencia de eritema, picazón anal, el uso de protector en la región anal, la sensación de materia fecal y la limpieza en región anal son variables estadísticamente asociadas al mismo. (AU)

Introduction: Soiling is the unconscious escape of small amounts of fecal matter after a normal bowel movement. A prevalence of 7-23% was reported in other countries and a high incidence was observed after sphincterotomies and fistulotomies (35-45%). Material and Methods: A observational study that included 80 patients with anal pathologies who attended the outpatient clinic of the San Juan de Dios General Hospital during 2018-2019, where an 8-item questionnaire was applied. Results: Eighty patients were evaluated, the majority are men, in their fifth decade. The most common anal disease is hemorrhoids, and the most common surgical treatment is hemorrhoidectomy. The incidence of definitive soiling (presence of spotting at 6 months) is 22.5%. The variables associated with definitive soiling were male gender, type of disease and surgical procedure, redness, anal itching, use of a protector in the anal region, the sensation of fecal matter, and cleanliness in the anal region. Being male presents a 6 times greater risk of definitive soiling and having redness in the anal region presents a 27 times greater risk of definitive soiling. Conclusion: Soiling occurs in a fifth of the patients operated for anal pathologies at the San Juan de Dios General Hospital. The presence of erythema, anal itching, the use of a protector in the anal region, the sensation of stool, and cleanliness in the anal region are statistically associated variables with soiling. (AU)

Consensus of Chinese experts on treatment of prolapsed hemorrhoids with transanal stapler / 中华胃肠外科杂志

Prolapsed hemorrhoids is a common clinical disease, and severe symptoms can significantly affect work and life. The transanal stapler has the advantages of simple operation and less trauma in treating prolapsed hemorrhoids. Its clinical efficacy is closely related to the selection of indications, the standardization of surgical operations, and the prevention and treatment of complications. In current clinical practice, there is no consensus on the treatment of prolapsed hemorrhoids with transanal stapler. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the indications, contraindications, operating specifications and perioperative management of prolapsed hemorrhoids. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.

Hemorroidopexia. Nuestra experiencia. Análisis descriptivo de las complicaciones de la técnica de hemorroideopexia con sutura mecánica y el grado de satisfacción / Hemorroidopexy Our experience. Descriptive analysis of the complications of the hemorrhoidepexy technique with mechanical suture and the degree of satisfaction

Introducción: La hemorroidopexia con sutura mecánica, es una técnica eficaz para los prolapsos hemorroidales grado III y IV. Objetivo: Describir nuestra experiencia con dicho método. Material y métodos: Se realizó un análisis descriptivo, retrospectivo sobre una base de datos cargada en forma prospectiva. Se analizaron pacientes con hemorroides grado III y IV, en quienes se realizó hemorroidopexia con PPH- 03, desde enero del 2010 hasta diciembre de 2017. Se evaluaron las variables demográficas, las complicaciones y el grado de satisfacción. Se realizó seguimiento postoperatorio semanal, a los 15 días, al mes, a los 6 meses y finalmente un control telefónico. Resultados: Se estudiaron 452 pacientes. La edad media fue de 46 años (rango: 20-75), siendo el 63% (n=291) del sexo masculino. El 84% (n=387) presentaban hemorroides grado III. El índice de complicación fue del 25% (n=115) durante el periodo de seguimiento, en el postoperatorio inmediato, 60 (52%) pacientes presentaron un evento considerado como complicación, y 55 (48%) pacientes presentaron complicaciones mediatas y tardías. Las complicaciones más frecuentes fueron: dolor en 37 (8%) de los pacientes, seguida por proctorragía en 18 casos (4%) y trombosis hemorroidal externa en 15 pacientes (3,3%). (AU)

Background: Hemorrhoidopexy with mechanical suture is an effective technique for hemorrhoidal prolapses grade III and IV. Objective: Describe our experience with this method. Material and methods: A descriptive, retrospective analysis was performed on a prospectively loaded database. Patients with grade III and IV hemorrhoids were analyzed, in whom hemorrhoidopexy was performed with PPH-03, from January 2010 to December 2017. Demographic variables, complications and degree of satisfaction were evaluated. Weekly postoperative follow-up was performed at 15 days, at month, at 6 months and finally a telephone control. Results: 452 patients were studied. The average age was 46 years (range,: 20 - 75), being 63% (n = 291) of the male sex. 84% (n = 387) had grade III hemorrhoids. The complication rate was 25% (n = 115) during the follow-up period, in the immediate postoperative period, 60 (52%). The most frequent complications were: pain in 37 (8%) patients, follow-up by proctorrhagia in 18 cases (4%) and hemorrhoidal thrombosis external in 15 patients (3.3%). (AU)

Hemorroidopexia con sutura mecánica: ¿Qué hemos aprendido? / Hemorrhoidopexy with mechanical suture: What have we learned?

Introducción: El procedimiento ideal para el tratamiento de la Enfermedad Hemorroidal debe aliviar los síntomas, conservar la funcionalidad anorrectal y minimizar las complicaciones. En los Grados III y IV estos objetivos representan un verdadero desafío. Objetivo: Comunicar la experiencia de un equipo quirúrgico con el procedimiento de Hemorroidopexia con sutura mecánica y revisar la evidencia nacional e internacional. Diseño: Análisis retrospectivo sobre una base de datos prospectiva. Material y método: Entre junio de 2007 y diciembre de 2016, fueron intervenidos 135 pacientes con Enfermedad Hemorroidal sintomática Grados III y IV. Se analizan las variables demográficas, indicaciones, técnica, morbilidad a corto y largo plazo. Resultados: 59% de los operados fueron mujeres. La edad promedio con todos los procedimientos fue de 51 años. El 52% de los pacientes presentaban Hemorroides Grado III y el 47% Hemorroides Grado IV. La Hemorroidopexia se realizó como Cirugía ambulatoria en el 17% de los casos. El índice global de complicaciones fue de 11,11%, que agrupamos según Clasificación de Dindo-Clavien. No se registraron complicaciones graves ni mortalidad. Conclusiones: La Hemorroidopexia con sutura mecánica es un procedimiento seguro y efectivo para el tratamiento de los grados avanzados de Enfermedad Hemorroidal. Puede llevarse a cabo en forma ambulatoria. Son esenciales la correcta indicación y capacidad para el manejo de probables complicaciones. (AU)

Background: The best surgical procedure for the Hemorrhoidal Disease must relieve the symptoms, retain anorrectal functionality and minimize complications. At Grades III and IV those aims are a real challege. Objective: To comunicate the one surgical team experience whit stapled Hemhoirrodopexy and to analyse the national and international evidence. Design: Análisis retrospectivo sobre una base de datos prospectiva. Methods: From June 2007 to December 2016 we operated 135 patients to have Hemorrhoidal Disease Grade III and IV. We described demographics dates, indications, and surgical procedure, short and long morbidity. Results: 59% of the patientes was female. In all procedures, de mean age was 50. 52% of the patients was Hemhorroid Disease Grade III and 47% was Grade IV. The Stapled Hemhoirrodopexy was Ambulatory in 17%. The global morbidity was 11,11%. No, have mortality with the surgical procedure. Conclusions: The Stapled Hemohoirodopexy is a safe and effective surgical procedure to treatment of symptomatic Grade III and IV of Hemorrhoidal Disease. It can be carried out as ambulatory surgery. Are clues the right indication and the capacity to resolve complications. (AU)

Pph and biological glue in patients with high risk of bleeding in stapled hemorrhoidopexy / Pph e cola biológica em pacientes com alto risco de sangramento em hemorroidopexia por grampeamento

ABSTRACT Background: Stapled hemorrhoidopexy is a common treatment for grade 3 hemorrhoids. Patients with conditions that increase the risk of bleeding, as cardiac stents usage with clopidogrel bissulfate and liver cirrhosis, should receive an extra care in surgical procedures due to the high risk of bleeding. For this reason and for patients with third degree hemorrhoids we propose the use of stapled hemorrhoidopexy followed by the use of biological glue. Aim: Assess surgical outcomes in patients with hemorrhoids and high risk of bleeding submitted to stapled hemorrhoidopexy followed by biological glue. Methods: Between 2005 and 2015, 22 patients were analyzed, in a retrospective cohort study. Results: From 22 patients submitted to stapled hemorrhoidopexy followed by the use of biological glue, only one (4.5%) presented bleeding in the surgical postoperative. Patients do not have any other complications and pain in the postoperative period. The median (IQR) operation duration was 55 (12) min and the median (IQR) length of hospital stay after surgery was 3 (2) days. Conclusion: Patients with high risk of bleeding submitted to stapled hemorrhoidopexy followed by the use of biological glue presented very low rates of bleeding in the postoperative period.

RESUMO Racional: Procedimento para o prolapso hemorroidário é uma forma de tratamento comum para hemorróidas de grau 3. Pacientes que apresentem condições que aumentam o risco de sangramento, como o uso de stents cardíacos associado ao uso de clopidogrel e cirrose hepática, devem receber cuidado redobrado em procedimentos cirúrgicos, devido ao alto risco de sangramento. Por esta razão é aqui proposto o procedimento para prolapso hemorroidário seguido da aplicação de cola biológica em pacientes com hemorróida de grau 3. Objetivo: Avaliar os desfechos cirúrgicos em pacientes com hemorróida de grau 3 e alto risco de sangramento submetidos ao procedimento para o prolapso hemorroidário seguido da aplicação de cola biológica. Métodos: Entre 2005 e 2015, 22 pacientes foram analisados, em estudo coorte retrospectivo. Resultados: Dos 22 pacientes submetidos ao procedimento para o prolapso hemorroidário seguido pelo uso de cola biológica, apenas um (4.5%) apresentou sangramento no pós-operatório. Os pacientes não apresentaram nenhuma outra complicação ou dor no período pós-operatório. O tempo mediano da operação foi de 55 (12) min e a média do tempo de internação hospitalar foi de três (2) dias. Conclusão: Os pacientes com alto risco de sangramento submetidos ao procedimento de prolapso hemorroidário seguidos pela aplicação da cola biológica apresentaram baixa taxa de sangramento.

Hemorroidopexia por grampeamento parcial: aspectos clínicos e impacto sob a fisiologia anorretal / Partial stapled hemorrhoidopexy: clinical aspects and impact on anorectal physiology

RESUMO Objetivo: avaliar o impacto na fisiologia anorretal da hemorroidopexia por grampeamento parcial, das complicações relacionadas à técnica cirúrgica, dor e sangramento pós-operatório e recidiva de doença hemorroidária após um ano de cirurgia. Métodos: estudo prospectivo, descritivo, em pacientes consecutivos, portadores de doença hemorroidária do tipo mista ou interna, com componente interno classificado como grau III ou IV, submetidos à hemorroidopexia por grampeamento parcial. Resultados: foram estudados 17 pacientes, dos quais 82% apresentavam hemorroidas internas grau III, e 18% grau IV. A média de tempo operatório foi de 09:09 minutos (07:03 a 12:13 minutos). A mediana de dor no pós-operatório imediato avaliada pela escala numérica de dor foi de 1 (0 a 7). A mediana de retorno ao trabalho foi de nove dias (4 a 19). Nenhum paciente apresentou estenose de canal anal e 76% ficaram satisfeitos com a cirurgia com 90 dias de pós-operatório. Comparando-se os dados manométricos pré-operatórios e após 90 dias, nenhuma das variáveis avaliadas apresentou diferença com significância estatística. Não houve recidiva da doença hemorroidária com um ano de acompanhamento pós-operatório. Conclusão: a hemorroidopexia por grampeamento parcial não demonstrou impacto na fisiologia anorretal, apresentando baixos níveis de complicações e de dor pós-operatória, e sem recidivas após um ano de acompanhamento.

ABSTRACT Objective: to evaluate the impact of partial stapled hemorrhoidopexy on anorectal physiology, the complications related to this surgical technique, pain, postoperative bleeding and recurrence of hemorrhoidal disease one year after surgery. Methods: this is a prospective, descriptive study in consecutive patients with mixed or internal hemorrhoidal disease, the internal component being classified as grade III or IV, undergoing partial stapled hemorrhoidopexy. Results: we studied 17 patients, 82% of them with internal hemorrhoids grade III and 18% grade IV. The mean operative time was 09:09 minutes (07:03 to 12:13). The median pain in the immediate postoperative period evaluated by the numerical pain scale was one (0 to 7). The median time to return to work was nine days (4 to 19). No patient had anal stenosis and 76% were satisfied with the surgery 90 days postoperatively. When comparing the preoperative manometry data with that measured 90 days after surgery, none of the variables studied showed statistically significant difference. There was no recurrence of hemorrhoidal disease with one year of postoperative follow-up. Conclusion: partial stapled hemorrhoidopexy showed no impact on anorectal physiology, presenting low levels of complications and postoperative pain, without recurrence of hemorrhoidal disease in one year of follow-up.

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy / Estudo clínico randomizado do efeito analgésico da infiltração local versus bloqueio espinal para hemorroidectomia

ABSTRACT BACKGROUND AND OBJECTIVES: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION: ClinicalTrials.gov NCT02839538.

RESUMO CONTEXTO E OBJETIVO: A analgesia pós-operatória e a recuperação precoce são relevantes para a alta hospitalar. O objetivo primário deste estudo foi comparar a eficácia analgésica da infiltração perianal e da anestesia subaracnóidea para hemorroidectomia. O objetivo secundário foi comparar o tempo para alta, efeitos adversos e complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado prospectivo e comparativo, no Hospital Dr. Mário Gatti. MÉTODOS: Foram incluídos 40 pacientes com idades 18-60 anos, na categoria 1 ou 2 de status físico da Sociedade Americana de Anestesiologistas. O grupo local (LG) recebeu infiltração local (ropivacaína a 0,75%) sob anestesia geral; o espinal (SG) recebeu bloqueio subaracnóideo (2 ml de bupivacaína a 0,5%). A suplementação analgésica foi com fentanil para LG e lidocaína para SG. Foram avaliados: intensidade da dor no pós-operatório, relaxamento do esfíncter, força dos membros inferiores, tempo de alta, dose de analgésico em uma semana e efeitos adversos. RESULTADOS: Onze (52,4%) pacientes em LG necessitaram de complementação, e nenhum em SG. A intensidade da dor foi maior para LG até 120 minutos, sem diferenças em 150 ou 180 minutos. Não houve diferenças na necessidade de paracetamol ou tramadol. O tempo para a primeira complementação analgésica e a alta hospitalar foram maiores para SG. Os efeitos adversos foram náuseas, tonturas e retenção urinária. CONCLUSÕES: A intensidade da dor foi maior na LG que na SG nas primeiras 2 horas, porém sem diferenças após 150 e 180 minutos. O tempo para a primeira suplementação foi menor na LG; sem diferenças nas doses de paracetamol e tramadol e efeitos adversos. REGISTRO: ClinicalTrials.gov NCT02839538.

LASER hemorrhoidal dearterialization / Desarterialização hemorroidária a LASER

ABSTRACT Introduction: Hemorrhoidal disease is associated with the theory of arterial blood hyperflow causing swellings in hemorrhoids and, consequently, hyperplasia and venous congestion. The technique helps to promote the obliteration of the terminals of the superior rectal artery branches without the need for anesthesia by electrofulguration with diode fiber LASER. The objective of this study is to describe the results of 55 patients with hemorrhoidal disease treated by the Hemorrhoidal LASER Procedure technique. Method: Without the need of anesthesia, terminal arterioles of the upper rectal artery are identified by a Doppler transducer (20 MHz probe 3 mm) placed on a specially designed proctoscope. After identification, it promotes arteriolar electrofulguration at 980 nm fiber laser diode, causing interruption of hemorrhoidal flow. This procedure is repeated circumferentially, following the clockwise positions. Results: Between 2011 and 2014, 55 patients underwent the Hemorrhoidal LASER Procedure technique for hemorrhoidal disease grades I, II and III. There was no need for anesthesia and only two patients required sedation for the procedure. The overall satisfaction rate was 89%, with symptom resolution in 84% and a decrease of at least one grade in hemorrhoidal disease in 80% of cases. Conclusion: Hemorrhoidal LASER Procedure is a painless outpatient technique that does not require anesthesia, in addition to being safe and easy to perform. It is effective in reducing symptoms and complications of the hemorrhoidal disease grades I and II, with high satisfaction rates.

RESUMO Introdução: A doença hemorroidária está associada a teoria vascular de hiperfluxo arterial causando dilatações nos plexos hemorroidários e, consequentemente, hiperplasia e congestão venosa. A técnica HeLP promove a obliteração dos ramos terminais da artéria retal superior, sem a necessidade de anestesia, através da eletrofulguração com fibra de diiodo LASER.O objetivo deste trabalho é descrever os resultados de 55 pacientes com doença hemorroidária tratados pela técnica HeLP. Método: Sem a necessidade de anestesia, as arteríolas terminais da artéria retal superior são identificadas através de um transdutor doppler (20mhz probe de 3 mm) locado em um proctoscópio especialmente desenhado. Após a identificação, promove-se a eletrofulguração arteriolar através de uma fibra de 980 nm de diiodo LASER, ocasionando interrupção do hiperfluxo hemorroidário. Este procedimento é repetido circunferencialmente, seguindo-se as posições das horas de um relógio. Resultados: Entre 2011 e 2014, 55 pacientes foram submetidos a técnica HeLP para doença hemorroidária de graus I, II e III. Nenhum paciente utilizou anestesia e apenas dois necessitaram sedação para a realização do procedimento. O índice de satisfação global atingiu 89%, houve resolução dos sintomas em 84% e diminuição de ao menos um grau, na doença hemorroidária, em 80% dos casos. Conclusão: HeLP é uma técnica ambulatorial e indolor, que não utiliza qualquer anestesia, é segura e fácil de ser realizada. Eficiente para reduzir sintomas e complicações da doença hemorroidária graus I e II, com índice de satisfação elevada.

Long term results after stapled hemorrhoidopexy alone and complemented by excisional hemorrhoidectomy: a retrospective cohort study / Resultados tardios após hemorroidopexia mecânica isolada e complementada por operação excisional

ABSTRACT Background: Stapled hemorrhoidopexy is associated with less postoperative pain and faster recovery. However, it may be associated with a greater risk of symptomatic recurrence. We hypothesized that undertaking a limited surgical excision of hemorrhoid disease after stapling may be a valid approach for selected patients. Aim: To compare long-term results after stapled hemorrhoidopexy with and without complementation with closed excisional technique. Method: In a retrospective uni-institutional cohort study, sixty-five (29 men) patients underwent stapled hemorrhoidopexy and 21 (13 men) underwent stapled hemorrhoidopexy with excision. The same surgeons operated on all cases. Patients underwent stapled hemorrhoidectomy associated with excisional surgery if symptoms attributable to external hemorrhoid piles were observed preoperatively, or if residual prolapse or bulky external disease was observed after the firing of the stapler. A closed excisional diathermy hemorrhoidectomy without vascular ligation was utilized in all complemented cases. All clinical variables were obtained from a questionnaire evaluation obtained through e-mail, telephone interview, or office follow-up. Results: The median duration of postoperative follow-up was 48.5 (6-40) months. Patients with grades 3 and 4 hemorrhoid disease were operated on more frequently using stapled hemorrhoidopexy complemented with excisional technique (95.2% vs. 55.4%, p=0.001). Regarding respectively stapled hemorrhoidopexy and stapled hemorrhoidopexy complemented with excision, there was no difference between the techniques in relation to symptom recurrence (43% and 33%, p=0.45) and median interval between surgery and symptom recurrence (30 (8-84) and 38.8 (8-65) months, p=0.80). Eight (12.3%) patients were re-operated after stapled hemorrhoidopexy and 2 (9.6%), after hemorrhoidopexy with excision (p=0.78). Patient distribution in both groups according to the degree of postoperative satisfaction was similar (p=0.97). Conclusion: Stapled hemorrhoidopexy combined with an excisional technique was effective for more advanced hemorrhoid disease. The combination may have prevented symptomatic recurrence associated to stapled hemorrhoidopexy alone.

RESUMO Racional: A hemorroidopexia com grampeador está significativamente associada a menor dor pós-operatória e recuperação mais rápida. No entanto, há evidência de que possa ter maior taxa de recorrência sintomática. A hipótese é que empreender excisão cirúrgica limitada da doença hemorroidária após o grampeamento pode ser abordagem válida para pacientes selecionados. Objetivo: Avaliar os resultados comparativos a longo prazo após a técnica de grampeamento isolada ou associada à complementação por técnica excisional fechada. Método: Coorte retrospectiva, com 65 (29 homens) pacientes submetidos à hemorroidopexia por grampeamento e 21 (13 homens) a ela complementada por técnica excisional. Os pacientes foram submetidos à complementação do grampeamento se sintomas atribuíveis às hemorróidas externas fossem observados no pré-operatório, ou se prolapso residual ou doença externa volumosa existisse após o disparo do grampeador. A hemorroidectomia excisional fechada por eletrocauterização sem ligadura vascular foi utilizada em todos os casos de complementação. Todas as variáveis ​​clínicas foram obtidos a partir de um questionário eletrônico, entrevista por telefone, ou em consulta. Resultados: A duração média do seguimento pós-operatório foi de 48,5 (6-40) meses. Os pacientes com graus hemorroidários 3 e 4 foram operados com mais frequência usando grampeamento complementado por técnica excisional (95,2% vs. 55,4% - p=0,001). Os pacientes operados por grampeamento sem e com complementação por técnica excisional, não houve diferença entre os grupos quanto a recidiva dos sintomas (43% vs. 33%, p=0,45, respectivamente) ou quanto ao intervalo médio entre a opração e a recorrência dos sintomas (30 (8-84) vs. 38,8 (8-65) meses, p=0,80). Oito (12,3%) pacientes foram reoperados após grampeamento isolado e 2 (9,6%), após grampeamento complementado por técnica excisional (p=0,78). O grau de satisfação pós-operatória foi semelhante entre as técnicas (p=0,97). Conclusão: A hemorroidopexia por grampeamento combinada com técnica excisional foi eficaz para a doença hemorróida mais avançada. A combinação pode ter impedido a recorrência sintomática associada a hemorroidopexia isolada.

Hemorroidectomía con ligasure®: ¿mejoran el tiempo quirúrgico y la evolución postoperatoría? Comparación de los resultados con la cirugía clásica / Hemorrhoidectomy with ligasure®: do they improve surgical time and postoperative evolution? Comparison of the results with classical surgery

INTRODUCCIÓN: La hemorroidectomía es un procedimiento muy frecuentemente utilizado en la práctica diaria del coloproctólogo. Distintas técnicas fueron propuestas. Las más utilizadas son las abiertas (MilliganMorgan) o las cerradas (Ferguson). Iniciamos en 2010 nuestra experiencia utilizando el Ligasure® con una pinza especialmente diseñada a tal efecto. Los buenos resultados iniciales obtenidos nos motivaron a evaluar objetivamente esta técnica. OBJETIVO: Comparar los resultados de las hemorroidectomías utilizando el Ligasure® y los obtenidos con la clásica cirugía de Milligan-Morgan. DISEÑO: Retrospectivo sobre una base de datos de pacientes prospectiva. PACIENTES Y MÉTODO: Se evaluaron 230 pacientes operados consecutivamente entre enero de 2011 y diciembre de 2014 con el uso del Ligasure®. Estos resultados se compararon con los de otro grupo de 230 pacientes operados previamente con la técnica clásica de hemorroidectomía abierta (grupo control). El seguimiento mínimo fue de 6 meses para todos los pacientes...

BACKGROUND: Hemorrhoidectomy is daily performed in colorectal practice. Open and closed procedures has been described. In 2010 we start to perform hemorrhoidectomy with the use of the Ligasure® with a special device. The results obtained were the base to start a comparison with our standard technique. OBJECTIVE: To compare results between Ligasure® hemorrhoidectomies and classical surgical hemorrhoidectomies (control group). DESIGN: Restrospective comparison with prospective data. PATIENTS AND METHOD: Results of 230 consecutive patients operated on with the Ligasure® were compared with similar series of 230 patients operated with classical open technique. Follow-up was at least 6 months in both groups...

Vigencia y utilidad de la operación de Buie modificada en el tratamiento del prolapso hemorroidal / Validity and usefulness of the modified Buie operation in the treatment of hemorrhoidal prolapse

Introducción: La cirugía del prolapso hemorroidal puede ser controversial, en particular cuando éste es circunferencial o en corona; diversos procedimientos han sido propuestos, algunos de ellos con complicaciones difíciles de solucionar. La técnica de Buie modificada puede resolver esta patología evitando las mismas. Objetivo: Evaluar prospectivamente los resultados obtenidos en la cirugía del prolapso hemorroidal mediante el empleo de la técnica de Buie modificada, sola o combinada con otra técnica. Diseño: Prospectivo observacional. Pacientes y Método: 37 pacientes consecutivos, operados entre agosto de 2007 y mayo de 2014, por prolapso hemorroidal con la técnica de Buie modificada, sola o combinada con otra técnica. Resultados: La edad promedio de la muestra fue 46,48; de los cuales el 62,16% fueron de sexo masculino; todos los pacientes eran portadores de un prolapso hemorroidal parcial o circunferencial o en corona. El sangrado ocasional fue el síntoma más frecuente (75,67%), seguido de la humedad perianal (67,57%). La técnica de Buie modificada se llevó a cabo solo en el 32,43% y combinado con la técnica de Ferguson en el 67,57%. El promedio de días de internación fue de 1,11. Cinco pacientes evidenciaron un sangrado escaso y de presentación irregular siendo la única complicación postoperatoria (13,5%). En el control a 30 días todos los enfermos tuvieron una adecuada cicatrización. No se constataron estenosis anal o ano húmedo por ectropión mucoso. Conclusiones: La técnica de Buie modificada sola o combinada resultó un procedimiento adecuado y efectivo para el tratamiento del prolapso hemorroidal con una estadía sanatorial corta, bajo costo y un índice de complicaciones postoperatorias más que aceptables.

Introduction: Prolapsed hemorrhoid surgery can be controversial, in particular when the surgery involves prolapsed hemorrhoids partial or in “crown”. Several procedures have been proposed, some of which have provided with complications difficult to solve. Buie’s modified technique can resolve this pathology, preventing these complications. Objective: To assess prospectively the acquired results obtained from prolapsed hemorrhoid surgery after Buie’s modified technique, alone or in combination with another technique. Design: Prospective observational. Patients and Method: 37 consecutive patients underwent surgery after Buie’s modified technique alone, or combined with another technique, between August 2007 to May, 2014. Results: The average mean age of the patients was 46,48; from which 62, 16% were males; all carried partial or in “crown” prolapsed hemorrhoids. Occasional bleeding was the most frequent symptom (75, 67%), followed by perianal moisture (67,57%). The Buie’s modified technique was performed alone in 32,43% and in combination with the Ferguson technique in 67, 57%. The average days of patients admission was 1,11. Five patients showed scanty and irregular bleeding, this being the only post-operative complication (13,5%). After a 30-day checkup, all patients presented reasonable scaring. No evidence was found for anal stenosis or moist anus by mucosal ectropion. Conclusions: The Buie’s modified technique, alone or combined, turned out to be the most effective and proper procedure for the treatment of prolapsed hemorrhoids; it is inexpensive, besides the patient is admitted to the hospital for a short period of time with a more acceptable index of post-operative complications.

Tratamiento quirúrgico de la enfermedad hemorroidaria: estudio comparativo entre una técnica convencional y dos de reciente aplicación / Surgical treatment of hemorrhoidal disease: a comparative study between a conventional technique and two newly implemented

Antecedentes: la enfermedad hemorroidaria afecta al 4 a 5 por ciento de la población y ninguno de los tratamientos actuales han dado una solución definitiva. Su indicación se encuentra condicionada a factores como: experiencia del operador, deseos del paciente, acceso a nuevas tecnologías y grado de afección. Objetivo: comparar resultados del tratamiento quirúrgico de la enfermedad hemorroidaria mediante dos técnicas recientes y una clásica. Diseño: estudio prospectivo no randomizado, comparativo. Pacientes y Métodos: análisis de 123 pacientes operados entre enero de 2006 y diciembre de 2010, distribuidos en tres grupos. Grupo I: Hemorroidectomia convencional (47); Grupo II, Resección con electrobisturí de alta frecuencia (46) y Grupo III, hemorroidopexia (30). Control con un seguimiento mínimo de 18 meses. Resultados: no hubo diferencias en la distribución etaria, sexo, ASA, paquetes promedio resecados entre el Grupo I y II (2,39 versus 2,74), complicaciones (8,5 por ciento, 19,6 por ciento y 6,6 por ciento) y estadía hospitalaria (17,4 hs; 15,8 hs; 12,4 hs) respectivamente. Hubo menos dolor en el procedimiento de mucosectomía (3,06), en relación al convencional (6.06, p<0,05) y al de EAF (6,25, p<0,05). El tiempo operatorio promedio fue de 17,5 minutos; 7,3 y 2,1 (EAF vs convencional, p<0,05) y el sangrado 5,3; 0,4 y 0,6 (Convencional vs mucosectomia y EAF, p<0,05). Se constató una recidiva (3,3 por ciento) en el grupo mucosectomía, con alto grado de satisfacción en los 3 grupos, 91,6 por ciento, 94,2 por ciento y 95,8 por ciento respectivamente. Conclusiones: el procedimiento de mucosectomía presenta menor dolor, la resección por alta frecuencia, menor tiempo operatorio y la resección convencional mayor sangrado.

Surgical treatment of hemorrhoids: a critical appraisal of the current options / Tratamento cirurgico das hemorroidas: uma analise critica das atuais opcoes

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results. .

Introdução : O tratamento cirúrgico da doença hemorroidária é ainda um dilema. Novas técnicas foram desenvolvidas levando à taxa menor de dor pós-operatória, contudo com maior chance de recorrência. Objetivo : Revisar as indicações atuais de tratamento cirúrgico da doença hemorroidária, assim como os resultados e complicações das técnicas hoje utilizadas. Método : Foi realizada revisão sistemática das publicações sobre as opções de tratamento cirúrgico da doença hemorroidária, utilizando dados da Medline/Pubmed, Cochrane e UpToDate, até dezembro de 2012. Resultados : As opções de tratamento cirúrgico disponíveis são procedimento para correção de prolapso (PPH), dearterialização hemorroidária trans-anal (THD) e técnicas convencionais de hemorroidectomia. As técnicas excisionais têm resultados semelhantes quanto à dor, tempo de retorno às atividades e índice de complicações. O PPH e o THD apresentam menos dor pós-operatória, menor taxa de complicações, porém têm maior recidiva pós-operatória. Conclusão : As técnicas de cirurgia convencional têm melhores resultados a longo prazo. Apesar de bons resultados no período pós-operatório imediato, PPH e THD não apresentam resultados consistentes a longo prazo. .

Análisis y resultados de la operación de Ferguson en el tratamiento de la enfermedad hemorroidal / Analysis and results of the Ferguson procedure in the treatment of the hemorrhoidal disease

Introducción: la hemorroidectomía con técnica de Ferguson ha sido asociada a mayor preservación de la sensibilidad anal, cicatrización más rápida y menor dolor postoperatorio. Objetivo: evaluar prospectivamente los resultados obtenidos a partir de una serie de hemorroidectomías efectuadas con técnica de Ferguson. Material y Método: 220 pacientes consecutivos, operados entre agosto de 2007 y agosto de 2011, por hemorroides grado II o III con esta técnica. Se excluyeron 8, por lo que la muestra final fue de 212 pacientes. Se realizó registro prospectivo de datos. Resultados: la edad promedio de la muestra fue 40,1; de los cuales el 60,4% fueron de sexo masculino; el 97,64% presentó al examen una o más hemorroides grado II o III. El sangrado ocasional fue el síntoma más frecuente (79,7%). La hemorroidectomía sobre dos paquetes fue la más efectuada: 59,9%, siendo el paquete más resecado el medial izquierdo: 82,1%. El promedio de días de internación fue de 1,06. Entre las complicaciones postoperatorias, el sangrado se observó en un paciente (0,47%); infección en dos (0,94%); fisura anal postoperatoria en seis (2,83%). El 8,01% presentó apertura parcial del lecho o retardo en la cicatrización, tanto en el control a los 15 como a los 30 días; en el control a los 6 meses todos ellos presentaron lechos correctamente cicatrizados. No se constataron estenosis anal o ano húmedo. Sólo el 1,42% (03/212) de los pacientes no concurrió al control de los 6 meses. Conclusiones: la hemorroidectomía con técnica de Ferguson resultó un procedimiento adecuado y efectivo para el tratamiento de paquetes hemorroidales grado II o III, con un bajo índice de complicaciones postoperatorias. No hubo secuelas en el seguimiento alejado.

Background: the hemorrhoidectomy with Ferguson-Procedure has been associated with a higher preservation of anal sensitivity, faster healing and lesser postoperative pain. Objective: to assess prospectively the acquired results from a series of hemorrhoidectomies carried out after the Ferguson-Procedure. Material and Methods: 220 consecutive patients operated after Ferguson-Procedure for Hemorrhoids type II or III, between August of 2007 and August of 2011. Eight patients have been excluded; therefore the final number of patients was 212. A prospective registry of information was done. Results: the average age was 40,1; 60,4% from which corresponds to males; 97,64% of them presented one or more hemorrhoids type II or III after the examination. Occasional bleeding was the most common symptom (79,7%). The Hemorrhoidectomy on two packings was the most performed: 59,9% being the dried out left medial packing: 82,1%. The average days of patients admission was 1,06. Postoperative complications were presented in one patient for bleeding (0,47%); two for infection (0,94%) and six cases for postoperative anal fissure (2,83%). 8,01% presented partial opening of beds or healing delay at checkups not only after 15 days, but also after 30 days. During checkups after 6 months every patient showed correctly healed beds. No evidence for moist anus or anal stenosis was found. Only 1,42% (03/212) of patients did not show up for a checkup after six months. Conclusions: hemorrhoidectomy after the Ferguson-Procedure turned out to be a suitable and effective treatment for hemorrhoids packings type II or III, with a low rate for postoperative complications. No consequences appeared in a long term monitoring.

Desarterialização transanal guiada por doppler associada ao reparo anorretal na doença hemorroidária: a técnica do THD / Transanal desarterialization guided by Doppler associated to anorectal repair in hemorrhoids: THD technic

INTRODUÇÃO: O tratamento cirúrgico para hemorroidas deve ter indicação individual e baseia-se no sintoma predominante (sangramento ou prolapso), na gravidade da doença e na presença ou ausência de componente externo (plicoma). Cabe ao cirurgião conhecer as mais variadas técnicas para que possa encontrar o tratamento mais adequado caso a caso. TÉCNICA: O procedimento THD consiste na ligadura alta seletiva e guiada por Doppler de até seis ramos arteriais submucosos que irrigam as hemorroidas, levando à sua desarterialização, associada à correção do prolapso (reparo anorretal ou lifting). Utiliza equipamento e kit especiais. CONCLUSÃO: A técnica do THD tem mostrado bons resultados iniciais. Por ser técnica cirúrgica em que se respeita a anatomia, ela age diretamente sobre a fisiopatologia da afecção e corrige suas principais consequências, ela parece bastante promissora. Sua aplicação inicial pode ser nos pacientes com doença hemorroidária de II grau, que tenham indicação de tratamento cirúrgico, e de III e IV graus, nestes últimos, podendo ser associada à ressecção de plicomas.

INTRODUCTION: Surgical treatment for hemorrhoids should be indicated individually and is based on the predominant symptom (bleeding or prolapse), severity of disease and the presence or absence of external component (plicoma). Surgeons must choose among varied techniques the one suitable for each case. TECHNIC: The THD procedure consists of Doppler guided high ligation, selective to up six submucosal arterial branches that supply the hemorrhoids, leading to its desarterialization associated with prolapse repair (anorectal repair or lifting). It uses special equipment and kit. CONCLUSION: THD technique has shown good initial results. Because surgical technique respects the anatomy, it acts directly on the pathophysiology of the disease and corrects its principal consequences; it looks quite promising. Its initial application may be in patients with hemorrhoids grade II, which have surgical indication, grades III and IV, the latter being associated with resection of plicomas.

Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases

The treatment of hemorrhoidal disease (HD) by conventional hemorrhoidectomy is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. Doppler-guided hemorrhoid artery ligation (DGHAL) is a minimal-invasive surgical treatment for HD that has been used as an alternative method in order to reduce these inconveniences. OBJECTIVE: To analyze the initial results of the DGHAL technique associated with rectal mucopexy in the treatment of HD. METHODS:Forty-two patients with stage I, III and IV hemorrhoids who were submitted to DGHAL were analyzed from December 2010 to August 2011. Eleven patients (26%) were stage II; 21 (50%), stage III; and 10 (24%), stage IV HD. All patients were operated by the same surgeon under spinal anesthesia and using the same equipment and technique to perform the procedure. The 42 patients underwent ligation of six arterial branches followed by rectal mucopexia by uninterrupted suture. Nine patients needed concomitant removal of perianal skin tag. In the postoperative, the following parameters were evaluated: pain, tenesmus, bleeding, itching, prolapse, mucus discharge and recurrence. The mean postoperative follow-up lasted four months (one to nine months). RESULTS: Tenesmus was the most common postoperative complaint for 85.7% of patients followed by pain, in 28.6%, perianal burning, in 12.3%, mucus discharge and perianal hematoma in 4.7%. Two patients had severe postoperative bleeding and required surgical haemostasis, one of which needed blood transfusion. Ninety-five percent of the patients declared to be satisfied with the method. CONCLUSION: Even though DGHAL has complications similar to those of other surgical methods, its results present less postoperative pain, allowing faster recovery and return to work. Studies with more cases and a longer follow-up are still necessary to assess the late recurrence. (AU)

O tratamento da doença hemorroidária (DH) pelas técnicas convencionais cursa com significante morbidade principalmente relacionada à dor pós-operatória e ao considerável tempo de afastamento do trabalho. A técnica de desarterialização hemorroidária transanal guiada por doppler (DHGD) associada à mucopexia retal é uma opção cirúrgica menos invasiva que vem sendo utilizada como método alternativo com objetivo de reduzir esses inconvenientes. OBJETIVO: Analisar os resultados iniciais com a técnica da DHGD associada à mucopexia retal no tratamento da DH. MÉTODO: Foram estudados 42 pacientes, portadores de DH de graus II, III e IV submetidos à técnica da DHGD, durante o período de dezembro de 2010 a agosto de 2011. Onze pacientes (26%) apresentavam DH do grau II, 21(50%) do III e 10 (24%) do IV. Todos os pacientes foram operados pelo mesmo cirurgião, sob anestesia raquidiana e sempre utilizando o mesmo equipamento e técnica para realização do procedimento. Os 42 pacientes foram submetidos à desarterialização de 6 ramos arteriais seguida de mucopexia retal por sutura contínua. Nove necessitaram remoção concomitante de plicomas perianais. No pós-operatório, foram avaliados os parâmetros: dor, tenesmo, sangramento, prurido, prolapso, perda de muco e recidiva. O seguimento médio foi de quatro meses (um a nove meses). RESULTADOS: O tenesmo foi a queixa pós-operatória referida por 85,7% dos pacientes, seguida da dor 28,6%, ardor perianal 12,3%, perda de muco e formação de hematoma perianal 4,7%. Dois pacientes apresentaram sangramento pós-operatório de maior intensidade necessitando hemostasia cirúrgica, sendo que em um houve necessidade de reposição sanguínea. Noventa e cinco por cento dos pacientes declararam-se satisfeitos com o método. CONCLUSÃO: A técnica da DHGD, apesar de apresentar complicações semelhantes a outros métodos cirúrgicos, apresenta bons resultados com pouca dor pós-operatória, possibilitando retorno rápido ao trabalho. Estudos com maior número de casos e tempo de seguimento mais prolongado ainda são necessários para avaliar a recidiva tardia. (AU)