Nivel de conocimientos de enfermeras sobre intervenciones de enfermería en personas con cirugía ambulatoria por enfermedades anorrectales / Level of Knowledge of Nurses about Nursing Interventions in Outpatient Surgery for Anorectal Diseases

Introducción: Para el desarrollo exitoso de la cirugía ambulatoria de afecciones anorrectales se requiere de profesionales de enfermería con conocimientos juicio y clínico de las intervenciones que realizan. Objetivo: Identificar el nivel de conocimientos de enfermeras sobre intervenciones de enfermería en personas con cirugía ambulatoria por enfermedades anorrectales. Métodos: Estudio descriptivo transversal, contextualizado en los servicios de Cirugía Ambulatoria de hospitales provinciales de Camagüey, desde agosto de 2018 hasta septiembre de 2020. Universo constituido por 52 enfermeras, con más de 5 años de experiencia en esos servicios. Para obtener información sobre nivel de conocimientos se aplicó una encuesta con Alfa de Cronbach de 0,647, lo que confirma su unidimensionalidad y aditividad. Para procesar la información se utilizó el software estadístico IMB SPSS Statistics v23 x64, según los presupuestos establecidos por la estadística descriptiva. Resultados: En cuanto al dominio del instrumental quirúrgico el 48,07 por ciento de las enfermeras identificó el de operar Fístulas, 26,92 por ciento el de fisuras y 19,23 por ciento identificó el instrumental a emplear en la Cirugía Ambulatoria de Hemorroides. Al evaluar los conocimientos básicos, 65,38 por ciento pudo mencionar las principales enfermedades anorrectales, 40,38 por ciento mencionó las complicaciones más frecuentes; los cuidados de enfermería en el preoperatorio fueron identificados por 34,61 por ciento del total de enfermeras evaluadas y solo el 1,92 por ciento pudo definir la conducta a seguir frente a las complicaciones. Conclusiones: Se identificó que el nivel de conocimientos de las enfermeras sobre intervenciones de enfermería en personas con cirugía ambulatoria por enfermedades anorrectales es insatisfactorio(AU)

Introduction: Nursing professionals with judgment and clinical knowledge of the interventions they perform are required for successful development of outpatient surgery for anorectal conditions. Objective: To identify the level of knowledge of nurses about nursing interventions in outpatient surgery for anorectal diseases. Methods: A descriptive cross-sectional study was done in the Ambulatory Surgery services of Camagüey provincial hospitals, from August 2018 to September 2020. A universe was 52 nurses, with more than 5 years of experience in these services. To obtain information on the level of knowledge, a survey with Cronbach's Alpha of 0.647 was applied, which confirmed unidimensionality and additivity. To process the information, the statistical software IMB SPSS Statistics v23 x64 was used, according to the assumptions established by descriptive statistics. Results: Regarding the domain of surgical instruments, 48.07 percent of the nurses identified that of operating fistulas, 26.92 percent that of fissures, and 19.23 percent identified the instruments to be used in outpatient hemorrhoid surgery. When evaluating basic knowledge, 65.38 percent were able to mention the main anorectal diseases, 40.38 percent mentioned the most frequent complications; nursing care in the preoperative period was identified by 34.61 percent of the total number of nurses evaluated and only 1.92 percent were able to define the behavior to follow in the face of complications. Conclusions: The nurses' level of knowledge about nursing interventions in outpatient surgery for anorectal diseases was identified as unsatisfactory(AU)

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)

Hemorrhoids and related complications in primigravid pregnancy / Hemorroidas e complicações relacionadas na gestação de primigestas

ABSTRACT Purpose: To identify the effect of pregnancy on the development of external hemorrhoids and constipation. Subjects and methods: This pilot study involved 61 primigravid women without a history of perianal diseases. Each patient was examined and filled a questionnaire between the 11th and 14th gestational week prior to prenatal screening tests. Patients were re-examined and questioned in relation to perianal symptoms and hemorrhoidal changes again in the 24th and 37th gestational weeks. Results: A total of 5, 8, and 11 women had symptomatic external hemorrhoids with or without perianal complications in the 11-14th, 24th, and 37th gestational weeks, respectively. Meanwhile, 27, 25, and 29 women complained about constipation in the 11-14th, 24th, and 37th gestational weeks, respectively. Only 4 (6.6%) patients experienced painful hemorrhoids. The overall morbidity rate was 18% (11 cases). We found a statistically significant relationship between external hemorrhoids/perianal complications and gestation-induced constipation through logistic regression analysis (p < 0.001). Conclusion: Various risk factors and biological explanations exist for the high frequency of hemorrhoids during pregnancy. Because participants were primigravid women without a history of perianal complaints, findings suggest a direct effect of pregnancy itself on the development of external hemorrhoids/perianal symptoms.

RESUMO Objetivo: Identificar o efeito da gestação sobre o desenvolvimento de hemorroidas externas e obstipação. Indivíduos e métodos: Este estudo piloto envolveu 61 mulheres primigestas sem história de doenças perianais. Cada paciente foi examinada e preencheu um questionário entre a 11ª e a 14ª semanas de gestação antes dos exames de triagem pré-natal. As pacientes foram reexaminadas e questionadas sobre sintomas perianais e mudanças hemorroidais novamente na 24ª e 37ª semanas de gestação. Resultados: Um total de 5, 8 e 11 mulheres apresentaram hemorroidas externas sintomáticas com ou sem complicações perianais na 11-14ª, 24ª e 37ª semanas de gestação, respectivamente. Enquanto isso, 27, 25 e 29 mulheres queixaram-se de obstipação na 11-14ª, 24ª e 37ª semanas de gestação, respectivamente. Apenas 4 (6,6%) pacientes apresentaram hemorroidas dolorosas. A taxa global de morbidade foi de 18% (11 casos). Encontramos uma relação estatisticamente significativa entre hemorroidas externas/complicações perianais e obstipação induzida por gestação por meio de análise de regressão logística (p < 0,001). Conclusão: Existem vários fatores de risco e explicações biológicas para a alta frequência de hemorroidas durante a gravidez. Como os participantes eram mulheres primigestas sem história de queixas perianais, os achados sugerem um efeito direto da gestação em si sobre o desenvolvimento de hemorroidas externas/sintomas perianais.

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)

Caracterización epidemiológica de la enfermedad hemorroidal aguda en hospitales seleccionados en Cuba (noviembre de 2011 a enero 2012) / Epidemiological characterization of acute hemorrhoidal disease in selected hospitals in Cuba (November 2011 to January 2012)

Introducción: la enfermedad hemorroidal constituye un problema de salud mundial y Cuba; sin embargo, la literatura no recoge información epidemiológica sobre la población cubana. Por lo que este trabajo caracteriza la enfermedad hemorroidal aguda en hospitales cubanos seleccionados, con particular énfasis en los factores de riesgo que favorecen su aparición. Objetivos: identificar los principales factores de riesgo, sus características demográficas y de base; hábitos tóxicos y alimenticios, así como modos y estilos de vida, que favorecen la aparición de una enfermedad hemorroidal aguda. Métodos: se realizó un estudio observacional descriptivo en 11 servicios cubanos de Coloproctología. Se incluyeron 510 pacientes con diagnóstico de enfermedad hemorroidal aguda, con edades comprendidas entre 18 y 75 años, que dieron su consentimiento de participación en el estudio. A todos los pacientes se les aplicó una encuesta epidemiológica que indagaba acerca de los hábitos tóxicos y alimenticios, así como modos y estilos de vida, los cuales son reconocidos como factores de riesgo para la aparición de la enfermedad. Resultados: casi el 75 por ciento de los pacientes comenzó con la enfermedad. Predominaron las hemorroides externas y los signos y síntomas más frecuentes fueron el dolor anal, la sensación de masa, el edema y el sangramiento rectal. La mitad de los pacientes ingiere bebidas alcohólicas y la mayoría consume café, alimentos condimentados y requiere una posición erecta o permanecer sentado durante largos períodos de tiempo, para sus actividades cotidianas. Pocos pacientes consumen altos contenidos de fibras en la dieta, así como abundante agua. Conclusiones: se corrobora la presencia de factores de riesgo e inadecuados modos y estilos de vida en la población cubana que facilitan o propician la aparición de un episodio agudo hemorroidal(AU)

Introduction: hemorrhoidal disease is a global health problem. In Cuba, however, epidemiological data about the population is not available in the literature on the subject. That is the reason why the present paper is aimed at characterizing acute hemorrhoidal disease in selected Cuban hospitals, with particular emphasis on the risk factors leading to its appearance. Objectives: identify the main risk factors, demographic and base features, toxic and eating habits, and life styles and modes, leading to the appearance of acute hemorrhoidal disease. Methods: an observational descriptive study was conducted in 11 Cuban coloproctology services. The sample consisted of 510 patients aged 18-75 diagnosed with acute hemorrhoidal disease, who gave their consent to participate in the study. All patients were given an epidemiological survey about toxic and eating habits, and life styles and modes perceived as risk factors for the disease. Results: almost 75 percent of the patients developed the disease. There was a predominance of external hemorrhoids, and the most common signs and symptoms were anal pain, mass sensation, edema and rectal bleeding. Half the patients consume alcohol and most drink coffee, eat spicy foods and must remain in a standing or sitting position for long periods during their daily activities. Few patients consume a fiber-rich diet and abundant water. Conclusions: corroboration was made of the presence of risk factors and inadequate life styles and modes among the Cuban population which lead to the occurrence of acute hemorrhoidal episodes(AU)

Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

The analysis of 2,840 cases of hemorrhoidectomy by open techniques of Milligan-Morgan (2,189 cases), Ferguson (341 cases) and mixed (310 cases) in 11,043 patients with hemorrhoidal disease (HD) allowed the following conclusions. The patients' acceptance of surgical indication for hemorrhoidectomy was 25.7%. Hemorrhoidectomy was more common among women (53.8%) than men (46.2%), and more accepted by women (26.5%) than men (24.8%). Hemorrhoidectomy was more common in patients of the fourth (27.7%), fifth (21.9%) and third (21.0%) decades of age. Most patients who agreed to undergo hemorrhoidectomy were those of the second (38.2%), eighth (35.9%) and ninth (34.5%) decades of age. The overall incidence of surgical complications was 3.0% (87 cases): anal stenosis (1.8%), bleeding (0.8%), worsening of anal hypotonia (0.2%), sepsis (0.1%) and systemic complications (0.1%), with no difference among the techniques used. The incidence of surgical complications by Milligan-Morgan technique was 3.0% - stenosis (1.9%), bleeding (1.9%), worsening of anal hypotonia (0.2%) and systemic complications (0.04%). The incidence of surgical complications by Ferguson's technique was 3.5% - stenosis (1.7%), bleeding (0.6%), worsening of anal hypotonia (0.6%) and sepsis (0.6%). And the incidence of surgical complications by mixed techniques was 2.5% - stenosis (1.0%), bleeding (0.3%), worsening of anal hypotonia (0.3%), sepsis (0.3%) and systemic complications (0.3%). The incidence of surgical complications according to gender was 3.0% among women and 3.2% among men, with higher incidence of stenosis in women (2.0%) and hemorrhage in men (1.1%). Surgical complications were more observed in the eighth (5.1%) and seventh (3.8%) decades of age. The incidence of anal stenosis was 1.8%, being 64.0% without hypotonia and 66.0% without anal fissure (66.0%), with annular stenosis as the most common anatomical shape (70.0%). Anal stenosis was more common among women (2.0%) presenting mean age of 38.2 years, with no relation to age decades. The most common technique for anal stenosis was single anotomy without sphincterotomy (46.0%). All cases of anal bleeding had surgical ligation of all hemorrhoidal pedicles, no matter if the bleeding site was found or not. (AU)

O seguimento de uma casuística de 2.840 hemorroidectomias pelas técnicas de Milligan-Morgan (2.189 casos), Ferguson (341 casos) e mista (310 casos) em 11.043 pacientes portadores de doença hemorroidária (DH) permitiu as seguintes conclusões. A aceitação da indicação cirúrgica para doença hemorroidária (DH), pelos pacientes, foi de 25,7%. A doença hemorroidária (DH) foi mais comum entre mulheres (53,8%) que em homens (46,2%) e a hemorroidectomia foi mais aceita pelas mulheres (26,5%) que pelos homens (24,8%). A hemorroidectomia foi mais realizada em pacientes de quarta (27,7%), quinta (21,9%) e terceira (21,0%) décadas etárias. Os pacientes que mais aceitaram a indicação cirúrgica foram os da segunda (38,2%), oitava (35,9%) e nona (34,5%) décadas etárias. A incidência global de complicações cirúrgicas foi de 3,0% (87 casos): estenose anal (1,8%), hemorragia grave (0,8%), agravamento da hipotonia anal (0,2%), sepse (0,1%) e sistêmicas (0,1%), sem diferença entre as técnicas usadas. A incidência de complicações cirúrgicas pela técnica de Milligan-Morgan foi de 3,0%: estenose (1,9%), hemorragia grave (1,9%), agravamento da hipotonia anal (0,2%) e sistêmicas (0,04%). A incidência de complicações cirúrgicas pela técnica de Ferguson foi de 3,5%: estenose (1,7%), hemorragia grave (0,6%), agravamento da hipotonia anal (0,6%) e sepse (0,6%). A incidência de complicações cirúrgicas pela técnica mista foi de 2,5%: estenose (1,0%), hemorragia grave (0,3%), agravamento da hipotonia anal (0,3%), sepse (0,3%) e sistêmicas (0,3%). A incidência de complicações cirúrgicas pelos gêneros foi de 3,0% entre as mulheres e 3,2% entre os homens, com maior incidência de estenose nas mulheres (2,0%) e hemorragia nos homens (1,1%). As décadas em que mais ocorreram complicações foram a oitava (5,1%) e a sétima (3,8%). A incidência de estenose anal foi de 1,8%, prevalecendo sem hipertonia anal (64,0%) e com fissura anal (66,0%), sendo a forma anatômica mais comum a anular (70,0%); foi mais comum entre mulheres (2,0%) com idade média de 38,2 anos, sem relação com as décadas etárias. A cirurgia corretiva da estenose anal mais usada foi a anotomia simples ou com fissurectomia sem esfincterotomia (46,0%). Em todos os casos de hemorragia anal cirúrgica foi feita ligadura de todos os pedículos da ressecção hemorroidária, independentemente de se encontrar ou não o local da hemorragia. (AU)

Endoscopic diagnosis and treatment of severe lower gastrointestinal bleeding.

Severe hematochezia is a common reason for hospitalization but the causes have changed in the last decade. Changes are in part related to the aging population, the evaluation and treatment by colonoscopists rather than surgeons or non-endoscopists, and the changes in colonoscopic practices such as piecemeal polypectomy. A careful history, physical examination, rectal examination, and nasogastric lavage may help localize the bleeding site and focus the differential diagnosis. This should be routine while resuscitating the patient. However, purging the colon for urgent colonoscopy may be the most definitive way to combine diagnosis and treatment of bleeding colonic lesions. Complete colonoscopy with intubation of the terminal ileum is recommended, and also examination of the rectum with a slotted anoscope. If those examinations are negative, a push enteroscopy is recommended for combined diagnosis and treatment. With recent advances in colonoscopic hemostasis, patients will benefit from diagnosis and treatment by experienced colonoscopists. Also, urgent colonoscopy after purge has been reported to be more cost-effective than elective colonoscopy or other strategies for diagnosis of severe hematochezia.

Hemorroidectomia: estudo de 2.417 pacientes submetidos à cirurgia para tratamento da doença hemorroidária / Hemorrhoidectomy: 2417 operated patients for hemorrhoidal disease treatment

Em 34.000 pacientes coloproctológicos foi feito o diagnóstico de DH, como doença coloproctológica principal, em 9.289 pacientes (27,3 por cento), dos quais 2.417 (26,0 por cento) foram submetidos à hemorroidectomia. O objetivo deste trabalho é estudar estes 2.417 pacientes submetidos à hemorroidectomia, com análise dos aspectos epidemiológicos (idades, sexos), dos aspectos envolvendo a cirurgia (posições do pacientes, anestesias usadas e técnicas cirúrgicas praticadas e complicações cirúrgicas), comparando os achados com os da literatura correlata. Dos 2.417 pacientes operados a maioria apresentava hemorróidas de terceiro (30,5 por cento) e de quarto (60,2 por cento). Predominou, de forma estatisticamente significativa, a incidência de DH entre mulheres (5.007 mulheres, 53,9 por cento) sobre homens (4.282 homens, 46,1 por cento), bem como de cirurgias (1.330 mulheres ou 26,6 por cento de 9.289 portadores de DH ou 55,0 por cento dos 2.417 operados). A média etária dos pacientes por ocasião do diagnóstico foi 39,9 anos, sendo 74,8 por cento entre 21 e 50 anos de idade; e a média etária por ocasião da cirurgia foi 41,6 anos, sendo 71,8 por cento entre 21 e 50 anos de idade. Foram encontradas, por ocasião do diagnóstico da DH 1.122 casos (12,1 por cento) de doenças anais concomitantes, sobretudo fissuras anais (5,8 por cento) e hipertrofia de papilas anais (3,4 por cento). A incidência de DAC operadas foi de 30,1 por cento (729 pacientes), sendo a fissurectomia (13,1 por cento) e a papilectomia (11,0 por cento) as duas DAC mais comumente operadas em concomitância à DH. Dos 2.417 pacientes operados de DH 45 pacientes (1,9 por cento) foram operados de outras doenças que não no ânus, sobretudo plástica de períneo e varizes de membros inferiores, tendo, ainda, 26 pacientes (2,0 por cento) sido operados em situações patológicas e fisiológicas especiais, sobretudo gravidez (8 casos, 0,3 por cento). A anestesia mais usada foi a peridural (42,3 por cento) e a local assocociada...

The author had the opportunity in a 38-year period of practice in Coloproctology, to attend 34,000 patients. Diagnose of hemorrhoid as the main cause of the symptoms presented was achieved in 9,289 patients (27.3 percent). 2,417 of the 9,289 patients (26.0 percent) underwent hemorroidectomy. The aim of this report is to analyse 2,417 operated patients as far as epidemiologic aspects are concerned (age and gender), surgical procedures (table operative position, anesthesy, surgical techniques, associated anorectal diseases as well as surgical complications). Results are correlated to the literature. Most of the patients submitted to hemorrhoidectomy presented third (30.5 percent) and fourth grade (60.2 percent) hemorrhoid. As far as gender is concerned the incidence of hemorrhoid was statistically significant higher among women (5,007 cases, 53.9 percent) than in men (4,282 cases, 46.1 percent). And although not statistically significant surgery for hemorrhoid in women (1,330 : 5,007) was more common (26.6 percent) than in men (1,087 : 4,282) (25.4 percent). But in relation to the patients who underwent hemorrhoidectomy (2,417) surgery was statistically significant more common among women (1,330 : 2,417 or 55.0 percent) than in men (1,087 : 2,417 or 45.0 percent). Mean age of the patients by occasion of diagnose of hemorrhoids was 39.9 year-old, being 74.8 percent between 21 and 50 year of age; and mean age by occasion of surgery was 41.6 year-old, being 71.8 percent between 21 and 50 year of age. In 1,122 patients haemohrroids were associated with several anorectal diseases (12.1 percent), mainly anal fissures (5.8 percent) and hyperthrofied anal papila (3.4 percent). The incidence of surgery for associated anorectal disease was 13.1 percent (729 patients), being fissurectomy (13.1 percent) and papilectomy (11.0 percent) the two most frequently surgery carried out during hemorrhoidal approach. 45 patients (1.9 percent) were operated for other extra-anal diseases...

Doença hemorroidária: aspectos epidemiológicos e diagnósticos de 9.289 pacientes portadores de doença hemorroidária / Hemorroidal disease: epidemiologic aspects and diagnosis of 9289 carrying patients of hemorroidal disease

O objetivo deste trabalho é estudar 9.289 pacientes portadores de DH e 2.417 pacientes submetidos à hemorroidectomia, extraídos de um universo de 34.000 pacientes coloproctológicos examinados no decurso de 38 anos, analisando-se os dados epidemiológicos do diagnóstico e da cirurgia. A incidência de DH como diagnóstico principal entre 34.000 pacientes foi de 27,3por cento (9.289 pacientes), tendo 26,0por cento (2.417 pacientes) deles sido submetidos a cirurgia. Predominou, de forma estatisticamente significativa, a incidência de DH entre mulheres (5.007: 9.289 ou 53,9por cento) sobre homens (4.282: 9.289 ou 46,1por cento), da mesma forma que, mas sem significado estatístico, a incidência de cirurgias entre as mulheres portadoras de DH (1.330: 5.007 ou 26,6por cento) sobre cirurgias em homens portadores de DH (1.087: 4.282 ou 25,4por cento). Todavia, quando relacionada aos 2.417 pacientes operados, a incidência de cirurgia foi, de forma estatisticamente significativa, mais comum entre as mulheres (1.330: 2.417 ou 55,0por cento) que entre os homens (1.087: 2.417 ou 45,0por cento). A média etária de diagnóstico foi de 39,9 anos, com 74,8por cento entre 21 e 50 anos; e a média de cirurgia de 41,6 anos, com 71,8por cento entre 21 e 50 anos. Os sintomas mais comuns foram presença de mamilos anais (90,5por cento), sangue nas fezes (83,0por cento), exteriorização pelo ânus ao ato defecatório (71,0por cento), ardência anal (54,0por cento), escape (soiling) (44,0por cento) e sangue nas roupas (41,0por cento). Predominou a DH de segundo (28,3por cento), terceiro (36,9por cento) e quarto graus (20,3por cento), predominando a cirurgia na DH de terceiro grau (30,5por cento), quarto grau (60,2por cento) e plicomas anais (30,9por cento). A incidência de doenças anais concomitantes à DH foi de 12,1por cento (1.122 pacientes), destacando-se as fissuras anais (5,8por cento) e a hipertrofia de papilas anais (3,4por cento). A incidência de cirurgias para doenças anais concomitantes à DH no decurso das hemorroidectomias foi de 30,1por cento (729 pacientes), destacando-se as fissuras anais (13,1por cento) e hipertrofia de papilas anais (11,0por cento).

Frequency of rectal varices in patients with cirrhosis

To document the frequency of rectal varices in patients with cirrhosis of liver and compare it with that of oesophageal varices in liver and to compare the frequency of rectal varices with non-cirrhotic controls. Design: A cross-sectional analytical survey. Place and Duration of Study: The study was conducted in the medical wards of Civil Hospital, Karachi from August 2000 to July 2001. Patients and All patients of confirmed cirrhosis of liver, presenting during the study period, were selected for initial workup. On the basis of upper gastrointestinal [GI] endoscopy, patients were segregated into those with oesophageal varices [Group-A] and those without them [Group-B]. A matched control group [Group-C] was added, which consisted of patients of irritable bowel syndrome [IBS] who underwent sigmoidoscopic/colonoscopic examination during the study period. Fiberoptic sigmoidoscopy was done in all selected patients. Statistical analysis for continuous variables was done by student's 't' test while non-continuous variables were analyzed by Mann-Whitney-U test. A total of 104 patients [males 61; females 43] were included. Hepatic encephalopathy grade was significantly lower in Group-B [p < 0.0001]. Grade-I varices were seen in 13 patients, Grade-II in 38 and Grade-III in 33 patients of Group-A. Rectal varices were present in 59.9% of patients in Group-A as compared to Group-B in which no one had them [p<0.0001]. Rectal varices are common in patients of portal hypertention

Colonic mucosal changes in portal hypertension.

Forty one consecutive patients with portal hypertension (PHT) were evaluated by colonoscopy to study the prevalence, type, extent and predictors of haemorrhoids, colorectal varices, and portal hypertensive colopathy. Specific inquiry and regular follow-up assessed frequency of hematochezia. Twenty five patients with obscure gastrointestinal bleeding without PHT who underwent colonoscopy served as controls. Haemorrhoids were seen in nine of 41 (21.9%) patients with PHT and four of 25 (16%) controls (p = ns). Colorectal varices were seen in 13/41 (31.7%) patients with PHT and none of the controls (p = 0.005). Portal colopathy was present in 15/41 (36.6%) patients with PHT and none of the controls (p = 0.0005). None of the parameters (e.g. aetiology of PHT, Child's class, oesophageal variceal eradication by EST with or without EVL, history of variceal bleeding, grade of oesophageal varices, presence of portal hypertensive gastropathy or gastric varices) predicted the occurrence of colorectal varices and portal hypertensive colopathy. Detection of colorectal varices but not portal hypertensive colopathy was associated with occurrence of hematochezia.

Sangrado digestivo bajo en una población pediátrica / Low gastrointestinal bleeding in a pediatric population

Se realizó un estudio prospectivo en cincuenta (50) niños que acudieron a la consulta de gastroenterología del Hospital Infantil Dr. Robert Reid Cabral en Santo Domingo, República Dominicana, por presentar sangrado digestivo bajo, con edades comprendidas entre 2 y 15 años, siendo el mayor grupo entre 2 y 5 años (58//) y predominando el sexo masculino (58//). Las características del sangrado bajo encontradas fueron: rojo rutilante y escaso 100//, ocurría durante la defecación 86//, indoloro 83//. Se asoció a anemia crónica en 40//, parasitismo intestinal 36//, constipación 28// y diarrea 18//. Los medios de diagnóstico auxiliares utilizados fueron el estudio de colon con doble medio de contraste 82// y la rectosigmoidoscopía 24//. La causa predominante de sangrado bajo en la población estudiada fue el pólipo juvenil 60//, encontrandose con mayor frecuencia entre las edades de 2 y 5 años

Motivos de consulta en la enfermedad hemorroidal / Reasons for consultation in relation to hemorrhoids

En este trabajo se evaluaron retrospectivamente 319 pacientes a los que se efectuó un examen rectosigmoideoscópico. De ellos 218 (68,33 por ciento) tenían hemorroides. Los motivos de consulta fueron hemoproctorragia en 115 (52,75 por ciento) pacientes, prolapso en 24 (11,01 por ciento) dolor anal en 23 (10,55 por ciento) y prurito anal en 15 (6,88 por ciento). Hubo 41 (18,81 por ciento) consultas que se tabularon como misceláneas. En forma global la mayor incidencia de hemoproctorragia se halla en grado I (66 por ciento). En los enfermos con sangrado la mayor frecuencia relativa está en el grado II (37 por ciento).

Detección de patologías anorectales en pacientes asintomáticos mayores de 40 años / Anorectal pathologies detection in asymptomatic patients above 40 year old

Se seleccionaron 70 pacientes al azar, en el Hospital Dr. Salvador B. Gautier del Instituto Dominicano de Seguros Sociales, Santo Domingo, República Dominicana. Se les realizó tacto rectal y sigmoidoscopía a cada uno de los pacientes, se encontró con relación al tacto rectal 70 por ciento el esfinter anal era autónico; en 4.29 por ciento se detectaron masas móviles; y 8.5 por ciento refería dolor al tacto rectal. Rectosigmoidoscopía: Color mucosa normal 98.5 por ciento vascularidad normal en todos casos. Se detectaron colitis inespecíficas y colitis ulcerativa

La fotocoagulación infrarroja para el tratamiento de las hemorroides / Infrared photocoagulation for the treatment of the hemorroids

Se analizaron 171 pacientes con hemorroides sintomáticas, 129 de 1er y 2do grado y 42 de 3er grado, tratadas con fotocoagulación infrarroja (F.I.). Un 94.5%de 129 enfermos seguidos 6 meses, sobre 149 con esa evolución, se hallaban sin síntomas o muy aliviados. Esta proporción de buenos resultados se mantuvo en los 91 casos seguidos 1 año, sobre 112 posibles. Entre estos últimos, hubo 98%de buenos resultados en las hemorroides de 1er y 2do grado y 86%en las de 3er grado. Un 12.8%de la serie presentó dolor, proctorragia o trombosis hemorroidaria luego de alguna sesión del tratamiento, destacándose en varios casos la relación del dolor con la reapertura de una fisura anal recientemente cicatrizada y 1 proctorragia severa al 10 día de una fotocoagulación. Estos efectos desfavorables pueden disminuirse si no se efectúan más de 6 disparos del rojo infrarrojo en una misma hemorroide, ni más de 8 en total en 2 ó más hemorroides. La fotocoagulación infarroja es un método sencillo y rápido, no interrumpe las actividades habituales del paciente, produce pocos efectos colaterales, resultados muy efectivos en hemorroides de 1er y 2do grado y satisfactorios en hemorroides de 3er grado. Estos se logran cuando el tratamiento se prolonga hasta la desaparición o disminución satisfactoria de los síntomas