Effectiveness of laser hemorrhoidoplasty in the treatment of hemorrhoidal disease.

INTRODUCTION: Minimally invasive techniques still continue to maintain their popularity in hemorrhoidal disease. In this study, we aimed to present the symptomatic recovery and recurrence rates, post-operative pain levels, and complication rates of patients treated with the laser hemorrhoidoplasty (LHP) method in our clinic. METHODS: The data of patients who underwent LHP due to Grades 2, 3, and 4 internal hemorrhoidal disease in our clinic were reviewed retrospectively. The patients enrolled in the study were followed for at least 6 months (6 months, 1 year, and 2 years) and their results were analyzed. RESULTS: A total of 103 patients were included in the study. Seventy-five (72.8%) of them were male and the mean age was 41.6 ± 13.6 years. The mean operation time was 17.9 ± 5.2 min and minor complications developed in 3 (2.9%) patients postoperatively. Mean time to return to normal daily life was 2.17 (1-11) days. Recurrence developed in 16 (17.6%) patients with Grades 2 and 3 disease and in 6 (50%) of 12 patients with Grade 4 disease (p = 0.019). CONCLUSION: LHP is a popular procedure which is effective in selected patient groups with acceptable recurrence rates.

OBJETIVO: Presentar las tasas de recurrencia y recuperación sintomática, los niveles de dolor posoperatorio y las tasas de complicaciones de los pacientes tratados con hemorroidoplastia láser en nuestra clínica. MÉTODO: Los datos de los pacientes que se sometieron a hemorroidoplastia láser debido a enfermedad hemorroidal interna de grados 2, 3 y 4 en nuestra clínica se revisaron retrospectivamente. Los pacientes incluidos en el estudio fueron seguidos durante al menos 6 meses (6 meses, 1 año y 2 años) y se analizaron sus desenlaces. RESULTADOS: Se incluyeron en el estudio 103 pacientes, de los cuales 75 (72.8%) eran de sexo masculino. La edad media fue de 41.6 ± 13.6 años. El tiempo operatorio medio fue de 17.9 ± 5.2 minutos. Se desarrollaron complicaciones menores en 3 (2.9%) pacientes en el posoperatorio. El tiempo medio de reincorporación a la vida diaria normal fue de 2.17 (1-11) días. La recurrencia se observó en 16 (17.6 %) pacientes con enfermedad de grados 2 y 3, y en 6 (50%) de 12 pacientes con enfermedad de grado 4 (p = 0.019). CONCLUSIONES: La hemorroidoplastia láser es un procedimiento popular que es efectivo en grupos de pacientes seleccionados, con tasas de recurrencia aceptables.

Prognostic Nutritional Index in Short-term Postoperative Outcomes in Hepaticojejunostomy.

OBJECTIVE: To investigate the utility of prognostic nutritional index (PNI) on short-term complications, biliary fistula, mortality, and morbidity in patients undergoing hepaticojejunostomy (HJ) procedure. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Tepecik Training and Research Hospital, Izmir, Turkey, between January 2018 and January 2020. METHODOLOGY: Patients who underwent elective HJ for benign and malignant reasons were scanned retrospectively using the hospital digital record system. Many data such as chronic diseases and PNI values of patients, postoperative 30-day mortality and morbidity, days of hospital stay (HS), postoperative complications, and data of surgery were analyzed. RESULTS: A total of 81 patients, of whom 42 (52%) were males and 39 (48%) were females, were included in the study. The mean age of the patients was 65.8 ±11.3. In 53 patients (65.4%), surgeries were performed due to malignancy. In 19 (23.4%) patients, grade 3 and 4 complications according to Clavien-Dindo Classification were observed in 12 patients (14.8%), and postoperative 30-day mortality was observed. The rate of grade 3 and 4 complications increased in patients with a PNI below 45, it was not statistically significant (p=0.165). The mortality rate was 4.5% in patients with PNI>45, and 18.6% in patients with PNI<45 but this difference was not significant (p=0.165). The mean HS was significantly shorter in patients with PNI>45 (p=0.02). CONCLUSION: At PNI>45, many complications and hospital stay become markedly shorter. Large multi-centre randomised future studies are required to confirm these findings. KEY WORDS: Prognostic nutritional index, Hepatic duct, Biliary tract, Biliary fistula.