Caracterización de las técnicas quirúrgicas para el tratamiento de la enfermedad hemorroidal

Introducción: En el tramo distal del conducto anal es normal la presencia de unas estructuras a modo de cojines, constituidas por tejido vascular, denominadas plexos hemorroidales. Objetivo: Comparar las técnicas quirúrgicas abiertas y cerrada en la enfermedad hemorroidal en la provincia Camagüey, en el periodo comprendido desde enero de 2021 a enero de 2023. Métodos: Se realizó un estudio observacional, analítico de corte transversal. El universo lo conformaron 135 pacientes que acudieron a consulta con el diagnóstico de enfermedad hemorroidal. Se le realizó un muestreo aleatorio simple, donde se tomaron 15 pacientes de cada uno de los grupos para conformar una muestra total de 45, cada grupo fue tratado con una técnica quirúrgica diferente. Resultados: En relación al sexo predominó el femenino, el tiempo quirúrgico fue dado a los 30 minutos en las técnicas abiertas. El dolor postoperatorio como complicación inmediata fue significativo con la utilización de la técnica abierta Whitehead clásico, no existieron complicaciones mediatas en el estudio; mientras que en las tardías la estenosis anal fue la que más se manifestó. Conclusiones: Existió predomino del sexo femenino, el tiempo de quirúrgico de mayor frecuencia fue de 30 minutos en los pacientes operados con la técnica abiertas, en la mayor parte de los pacientes se constató dolor excesivo como complicación inmediata con las técnicas de Milligan-Morgan y Whitehead clásico abiertas no así con la cerrada de Ferguson. La estenosis anal fue la complicación quirúrgica tardía más frecuente asociada a la técnica de Whitehead clásico.

Introduction: In the distal section of the anal canal, the presence of "cushion"-like structures, mainly made up of vascular tissue, called hemorrhoid plexuses. Objective: To compare the open and closed surgical techniques in hemorrhoid disease in Camagüey province, in the period from January 2021 to January 2023. Methods: An observational, analytical, cross-sectional study was carried out. The universe was made up of 135 patients who attended the consultation with the diagnosis of hemorrhoid disease. A simple random sampling was carried out, where 15 patients from each of the groups were taken to form a total sample of 45 patients, each group was treated with a surgical technique. Results: In relation to sex, the female sex predominated, the surgical time was given at 30 minutes in the open techniques. Postoperative pain as an immediate complication was significant with the use of the classic Whitehead open technique; there were no mediate complications in this study; while in the late ones, anal stenosis was the one that manifested itself the most. Conclusions: There was a predominance of the female sex, the most frequent surgical time was 30 minutes in patients operated with the open technique, in most patients excessive pain was found as an immediate complication with the Milligan-Morgan and classic Whitehead open techniques, but not so with the closed technique of Ferguson. Anal stenosis was the most frequent late surgical complication associated with the classic Whitehead technique.

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)

Postoperative Complications in Hemorrhoidal Disease and Special Conditions.

BACKGROUND: Hemorrhoidal disease is still one of the most prevalent proctological diseases. Pain is the most common complication after surgery but bleeding, urinary retention and perianal infection are also frequent. There is also an important group of patients, such as those with inflammatory bowel disease, pregnancy or immunosuppression, who can present an increased rate or more severe complications. OBJECTIVE: To describe the complications following different surgical and instrumental techniques for hemorrhoids in a literature review. Special situations were reviewed to determine how they affect the management of the disease. METHODS: During August 2019, a narrative review of hemorrhoid surgery complications and special situations was performed using the Pubmed MESH DATABASE. CONCLUSION: Pain, urinary retention and bleeding remain the most frequent complications after surgery for hemorrhoids; however, special situations must be taken into account in order to choose the best technique to prevent more severe complications.

Postoperative results of 407 patients submitted to Doppler-guided transanal hemorrhoidal dearterialization / Resultados pós-operatórios de 407 doentes submetidos à desarterialização hemorroidária guiada pelo Doppler

ABSTRACT Introduction: The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective: To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods: This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results: The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion: The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.

RESUMO Introdução: O tratamento da doença hemorroidária pelas técnicas convencionais cursa com significante redução da qualidade de vida do doente, principalmente relacionada à dor pós-operatória e ao considerável tempo de afastamento do trabalho. A técnica de desarterialização hemorroidária associada à mucopexia retal é uma opção cirúrgica pouco invasiva, a qual é utilizada com o objetivo de tratar a doença hemorroidária e reduzir seus inconvenientes. Objetivo: Analisar os resultados encontrados após sete anos de seguimento em doentes submetidos à técnica da desarterialização hemorroidária associada à mucopexia para o tratamento da doença hemorroidária. Método: Foram estudados 407 portadores de doença hemorroidária de graus II, III e IV, submetidos à técnica da desarterialização hemorroidária no Hospital das Clínicas Luzia de Pinho Melo de Mogi das Cruzes, durante o período de Dezembro de 2010 a Dezembro de 2017. Vinte e sete doentes (6,6%) apresentavam doença hemorroidária de grau II, 240 (59,0%) do grau III e 117 (28,8%) do grau IV. Em 23 doentes (5,7%) não foram encontradas a classificação nos prontuários. Todos os doentes foram operados pelo mesmo cirurgião e sob anestesia raquidiana. Os 407 doentes foram submetidos à desarterialização, variando de um até seis ramos arteriais seguidos de mucopexia por sutura contínua. Oitenta e dois (20,14%) necessitaram ressecções associadas por plicomas ou hemorroidas externas. No pós-operatório foram avaliados os seguintes parâmetros: dor, tenesmo, sangramento, prolapso, trombose e recidiva. Resultados: O tenesmo foi a queixa pós-operatória referida por 93,36% dos doentes. Quarenta e três (10,5%) apresentaram tenesmo intenso e 44 (22%) de moderado a intenso. Quatro (0,98%) doentes apresentaram sangramento de maior intensidade no pós-operatório e em 1 (0,5%) houve necessidade de hemostasia cirúrgica, em nenhum deles houve necessidade de reposição sanguínea. O prolapso ocorreu em 18 (4,42%) doentes, trombose em 11 (2,7%) e houve 19 (4,67%) recidivas reoperados durante o período. Conclusão: A desarterialização hemorroidária apresenta bons resultados, complicações leves e de fácil resolução e pouca dor pós-operatória.

Comparison of clinical outcomes of multi-point umbrella suturing and single purse suturing with two-point traction after procedure for prolapse and hemorrhoids (PPH) surgery.

OBJECTIVES: To compare the clinical outcomes of multipoint umbrella suture and single-purse suture with two-point traction after procedure for prolapse and hemorrhoids surgery (PPH) for the treatment of mixed hemorrhoids. METHODS: Ninety patients were randomly divided into a PPH plus single-purse suture group (Group A) and a PPH plus multipoint umbrella suture (Group B). All operations were performed by an experienced surgeon. Operation time, width of the specimen, hemorrhoids retraction extent, postoperative pain, postoperative bleeding, and length of hospitalization were recorded and compared. Statistical analysis was conducted by t-test and χ2 test. RESULTS: There were no significant differences in sex, age, course of disease, and degree of prolapse of hemorrhoids between the two groups. The operative time in Group A was significantly shorter than that in Group B (P < 0.05). However, the incidence rates of submucosal hematoma and incomplete hemorrhoid core retraction were significantly lower in Group B (P < 0.05), whereas the width of the specimens in Group B was greater than that in Group A (P < 0.05). There were fewer redundant skin tags in Group B at three months follow-up. No significant difference in postoperative pain, postoperative bleeding, and time of hospital stay (P > 0.05 for all comparisons) was observed. CONCLUSION: The multipoint umbrella suture showed better clinical outcomes because of its targeted suture according to the extent of hemorrhoid prolapse.

Double Denenate Excision - Ligation Combinedwith Pad Preservation for the Treatment ofIncarcerated Annular Mixed Hemorrhoids / 广州中医药大学学报

[Objective] To search for a new technique for incarcerated annular mixed hemorrhoids (IAMH) . [Methods] One hundred and eighteen cases of IAMH (group A) were treated by double denenate excision-ligation combined with pad preservation and 53 eases (group B) by external-exfoliation and internal-ligation. Cure rate, wound-healing time, anal function and postoperative complications were observed in the two groups. [Results] Cure rate was 96.6% in group A and 84.9% in group B; wound-healing time was (17 ? 5) days in group A and (24 ? 5) days in group B ( P

Whitehead's Operation: Should We Abandon It?

PURPOSE: Total prolapse of internal hemorrhoids around the entire anal circumference still remains as a challenging problem. Whitehead's circumferential hemorrhoidectomy is one of the surgical options. To elucidate efficacy of Whiteheads operation, we analyzed the surgical outcomes of Whiteheads operation. METHODS: The medical records of 165 consecutive patients who underwent Whiteheads operation for end-stage hemorrhoids were retrospectively reviewed. The mean operation time, the mean blood loss, and the mean hospital stay were examined. Also the types of complications were identified. All patients were followed for extended periods and in May 2003 they were asked to appraise their satisfaction (mean follow-up duration was 45.5 months, 12~93 month range). RESULTS: The mean operation time was 21.5+/-5.3 minutes, the mean blood loss was 50.5+/-22.0 cc, and the average hospital stay was 5.5+/-1.5 days. Early postoperative complications were fecal incontinence (60.6%) and voiding difficulty (53.3%). These problems were spontaneously resolved within 2 weeks. Pain was the most difficult problem, and all patients required a parenteral opioid for relief of pain. The only late complication was anal stenosis. Objectively, anal stenosis was found in 66 patients; however, 22 patients (13.3%) complained of defecation difficulty. Among them, only 4 patients required surgical treatment. The average score of satisfaction according to the patients themselves was 4.0+/-2.2, 0 being no satisfaction and 5 being complete satisfaction. CONCLUSIONS: The Whitehead operation, if performed properly for the selected patients, still remains as one of the best surgical options for end-stage hemorrhoids.

Efficacy of Ligasure(TM) in a Hemorrhoidectomy: Comparison with Semi-open Hemorrhoidectomy

PURPOSE: Ligasure(TM) is a feedback-controlled bipolar diathermy originally devised to seal vessels and developed to weld tissue bundles. The tissue fusion mechanism consists of melting collagen and elastin, and the tissue welding property of Ligasure(TM) can be used in a hemorrhoidectomy. To confirm the efficacy of Ligasure(TM) in hemorrhoidectomies, I compared it with the conventional semi-open method. METHODS: One hundred patients with grade III or IV hemorrhoids were randomly assigned to the Ligasure(TM) (n=50) or the conventional semi-open (n=50) hemorrhoidectomy group. The operation time, the postoperative analgesic requirement, the hospital stay, the time to return to normal life, and complications were prospectively recorded and analyzed. RESULTS: There was no difference in sex and age between the two groups. The operation time was markedly shorter in the Ligasure(TM) group than semi-open group (10.8+/-4.0 versus 23.7+/-5.2 min; P<0.001). Although the hospital stay was not statistically different, the time to return to the normal life was shorter in the Ligasure(TM) group (9.5+/-3.8 versus 12.7+/-4.0 days; P<0.05). The requirement for postoperative analgesics within 48 hours (nalbuphine, 5mg) was not significantly different. In each group, an urinary retention was noted and treated with urinary catheterization. In Ligasure(TM) group, an anal stenosis was developed and was successfully treated with advancement flap surgery. In each group a secondary bleeding and a skin tag were noted. There was no wound infection or incontinence. CONCLUSIONS: Ligasure(TM) hemorrhoidectomy reduces the operation time and the time to return to the normal life. If anal stenosis is to be prevented, careful attention is required to preserve the anal skin and mucosa. Ligasure(TM) is simple to use and is useful in the treatment of patients with grade III or IV hemorrhoids.

Is a Hemorrhoidectomy Safe in Patients Requiring Anticoagulation?

PURPOSE: The aim of this study was to determine the risks of a hemorrhoidectomy in patients requiring long-term anticoagulation. METHODS: Between March 1998 and February 2001, 13 patients requiring long-term oral anticoagulation because of prosthetic valve replacement (n=4), atrial fibrillation (n=7), and coronary artery disease (n=2) underwent a hemorrhoidectomy at Seoul National University Hospital. We performed a retrospective analysis on these patients regarding the results of the hemorrhoidectomy. The control group consisted of 148 patients without any medical problems who had undergone a hemorrhoidectomy during the same period. Patients on anticoagulation stopped their oral medication three days before the operation and full intravenous (IV) heparinization was commenced. Heparin was stopped six hours before the operation and restarted postoperatively, and warfarin was re-started on the evening of postoperative day 1. The hemorrhoidectomy consisted of excising three main piles, followed by submucosal excision of all intervening piles. Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS: The PTs (prothrombin times) of the anticoagulation group and the control group obtained at admission were INRs (international normalized ratios) of 1.75+/-0.54 and 1.04 0.08, respectively (P=0.0005). After discontinuation of oral medication and full IV heparinization, the INR of the anticoagulation group at the time of operation was 1.06+/-0.09, which was not statistically different from the PT (INR) of the control group at admission (P=0.603). There were two cases of postoperative bleeding requiring blood transfusions in the anticoagulation group (15.4%), and four cases of postoperative bleeding requiring blood transfusions in the control group (2.7%), but there was no statistical difference between the rates for the two groups (P=0.075). The mean postoperative hospital stays were 6.69+/-3.68 and 3.64+/-2.98 for the anticoagulation and control groups, respectively (P=0.074). Postoperative analgesic requirements and urinary difficulty were similar in both groups (P=0.478 and 0.397, respectively). No systemic thromboembolism in both groups, and there was no bacterial endocarditis or valvular thrombosis was seen in patients with prosthetic heart valves. CONCLUSIONS: Our results indicate that patients taking oral warfarin for anticoagulation may safely undergo a hemorrhoidectomy after strict heparinization.

Treatment of Limited External Incision and Internal Ligation Combined with Restoration of Intervenient Skin for Circumferential Mixed Hemorrhoids / 广州中医药大学学报

To explore an effective method with few operative complications for treating circumferential mixed hemorrhoids (CMH).Sixty three cases of CMH (Group A) were treated with limited external incision and internal ligation combined with restoration of intervenient skin and 34 cases (Group B) were treated with traditional external incision and internal ligation as control. Anal canal diameter (ACD), anal canal quiescent pressure (ACQP) and anal canal systolic pressure (ACSP) were determined before and after operation. Short term and long term therapeutic effects were also observed and compared in the two groups.Short term and long term therapeutic effects in Group A were better than those in Group B (P