ABSTRACT
AIM: The aim of our study was to evaluate, through prospective randomized study, the outcome and the immediate and late complications of the two types of surgery most widely used for degree III-IV haemorrhoids. METHODS: A total of 122 patients with degree III and IV hemorrhoids were elected for surgical intervention and, randomly, underwent surgery for PPH or THD. We assessed the most common immediate postoperative complications. The patients have been followed for three months with a mean follow-up at 1 month and 3 months after surgery. Parameters taken into consideration were: bleeding, pain at rest and after evacuation, soiling, constipation and tenesmus. RESULTS: Five patients in PPH group (7.9%) had a major postoperative bleeding, whereas no such episode occurred in THD group (P=ns). In percentage terms, VAS score was lower in THD group than in PPH group, although the difference was not statistically significant. Finally parameters values observed, during the follow-up, proved to be lower for THD group compared to PPH group. CONCLUSION: PPH and THD are two surgical treatments for degree III and IV haemorrhoids with low perioperative complications and good results in the short term. However, our experience shows that better results in terms of pain and fewer postoperative complications are obtained after THD surgery, such surgery is less invasive and more adaptable to the needs of day surgery.
Subject(s)
Hemorrhoidectomy/methods , Hemorrhoids/surgery , Female , Hemorrhoidectomy/adverse effects , Hemorrhoids/pathology , Humans , Male , Middle Aged , Prospective Studies , Severity of Illness IndexABSTRACT
Although colonic diverticulum is a common disease, affecting about 35% of patients above the age of 60, giant sigmoid diverticulum is an uncommon variant of which only relatively few cases have been described in the literature. We report on our experience with a patient affected by giant sigmoid diverticulum who was treated with diverticulectomy. Resection of the diverticulum is a safe surgical procedure, provided that the colon section close to the lesion presents no sign of flogosis or diverticula; in addition, recurrences are not reported after 6-year follow-up.
ABSTRACT
About half of the carcinomas and polyps of the large intestine is placed in the descendent colon and in the sigma, where most frequently the diverticula are found. Literature refers to them as varying percentage of association diverticulosis-carcinoma between 2 to 8 percent. The increase of the frequency of neoplasms and diverticula in the same population classes may indicate common factors in their development. The study includes 1149 cases of colo-rectal neoplasms examined in the Department of Scienze Chirurgiche--University of Siena, from january 1981 to december 1993. The association of carcinomas and diverticula has been found in 8.96% of the cases (103 pts) and the tumours with stenosis in 59,2% of the cases. The colonoscopy is very important for a more precise differential diagnosis especially in occlusive forms, in which a multiple biopsy is indispensable. Referring to the data of literature, the authors consider that patients with symptomatic diverticular disease have a major general risk for cancer of the large intestine; the existence of certain common symptoms in either disease (especially the bleeding) may not exclude the presence of a tumor in patients with diverticular disease.
Subject(s)
Colonic Neoplasms/complications , Diverticulum, Colon/complications , Adult , Aged , Aged, 80 and over , Colectomy , Colonic Neoplasms/diagnosis , Colonic Neoplasms/surgery , Colonoscopy , Colorectal Neoplasms/complications , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/surgery , Diagnosis, Differential , Diverticulum, Colon/diagnosis , Diverticulum, Colon/surgery , Female , Humans , Male , Middle Aged , Rectal Neoplasms/complications , Rectal Neoplasms/diagnosis , Rectal Neoplasms/surgery , Sigmoid Neoplasms/complications , Sigmoid Neoplasms/diagnosis , Sigmoid Neoplasms/surgeryABSTRACT
The Authors report their experience in the surgical management of cancer in the aged (over 65 year old patients), during the period 1988-1992 at the Istituto Policattedra di Scienze Chirurgiche, University of Siena. They consider colon and rectum, breast, stomach, pancreas and biliary tract neoplasms in relation to site, staging, emergency or delayed surgical treatment, and early postoperative results. Finally, they outline the frequently encountered problems in treating old patients and the most appropriate surgical approach.