Abstract:Introduction Surgical treatment of hemorrhoidal disease is used in about 5–10% of cases where conservative treatments have not been effective.
Objective To learn the surgical techniques used in the treatment of hemorrhoidal disease grades III and IV in the light of literature.
Methods This is an exploratory study, with an integrative review of literature published from 2009 to 2015 from databases LILACS, SciELO, MEDLINE, PUBMED and the Portal of CAPES, using the following descriptors: “hemo… Show more
“…The open Milligan -Morgan technique was first introduced by Salmon in 1830, then popularized by Milligan Morgan in 1937 [3]. It is an open surgical technique through which the hemorrhoidal mass is excised and the pedicle is controlled with Vicryl suture and the wound left open to heal by secondary intention [4]. Milligan -Morgan's technique is advocated in the United Kingdom while Ferguson's technique is most commonly used in the U.S [5].…”
BACKGROUND: Hemorrhoids are a common problem faced in the surgical practice that cause a variety of symptoms ranging from bleeding per rectum to prolapsed, non-reducible and painful anal masses. Therefore, hemorrhoidectomy is one of most frequently performed surgical procedures worldwide.
AIM: In this study, we will compare between the conventional surgical method and between LigaSure™ hemorrhoidectomy.
PATIENTS AND METHODS: All 120 patients underwent hemorrhoidectomy by conventional and LigaSure™ method between September 2015 and September 2018 in Al-Kafeel hospital in Karbala city in Iraq. All cases underwent surgery by the three authors under regional anesthesia or general anesthesia by anesthetic team. A thorough history taking and physical examination were done and an informed consent has been taken from each patient before the surgery. Conventional hemorrhoidectomy was done for 50 patients randomly selected. The operation was done in the open method (Milligan Morgan’s). LigaSure™ hemorrhoidectomy was done for 70 patients randomly selected as well. Quantification of intra-operative bleeding was done by counting the number of gauzes. Patients were evaluated 5 days and a month and 3 months after the operation for complications and improvement of symptoms. The data were analyzed using Statistical Package for Social Sciences version 22.0.
RESULTS: There were significant differences regarding the operation time, number of gauzes soaked with blood, hospital stay, pain score, post-operative bleeding, wound infection, residual mass, fecal incontinence and anal stenosis in favor of the LigaSure™ method. There was no significant difference regarding urine retention and post-operative discharge between the two methods.
CONCLUSION: LigaSure™ hemorrhoidectomy can be a good alternative to conventional methods to reduce pain and make a more rapid recovery after hemorrhoidal surgery.
“…The open Milligan -Morgan technique was first introduced by Salmon in 1830, then popularized by Milligan Morgan in 1937 [3]. It is an open surgical technique through which the hemorrhoidal mass is excised and the pedicle is controlled with Vicryl suture and the wound left open to heal by secondary intention [4]. Milligan -Morgan's technique is advocated in the United Kingdom while Ferguson's technique is most commonly used in the U.S [5].…”
BACKGROUND: Hemorrhoids are a common problem faced in the surgical practice that cause a variety of symptoms ranging from bleeding per rectum to prolapsed, non-reducible and painful anal masses. Therefore, hemorrhoidectomy is one of most frequently performed surgical procedures worldwide.
AIM: In this study, we will compare between the conventional surgical method and between LigaSure™ hemorrhoidectomy.
PATIENTS AND METHODS: All 120 patients underwent hemorrhoidectomy by conventional and LigaSure™ method between September 2015 and September 2018 in Al-Kafeel hospital in Karbala city in Iraq. All cases underwent surgery by the three authors under regional anesthesia or general anesthesia by anesthetic team. A thorough history taking and physical examination were done and an informed consent has been taken from each patient before the surgery. Conventional hemorrhoidectomy was done for 50 patients randomly selected. The operation was done in the open method (Milligan Morgan’s). LigaSure™ hemorrhoidectomy was done for 70 patients randomly selected as well. Quantification of intra-operative bleeding was done by counting the number of gauzes. Patients were evaluated 5 days and a month and 3 months after the operation for complications and improvement of symptoms. The data were analyzed using Statistical Package for Social Sciences version 22.0.
RESULTS: There were significant differences regarding the operation time, number of gauzes soaked with blood, hospital stay, pain score, post-operative bleeding, wound infection, residual mass, fecal incontinence and anal stenosis in favor of the LigaSure™ method. There was no significant difference regarding urine retention and post-operative discharge between the two methods.
CONCLUSION: LigaSure™ hemorrhoidectomy can be a good alternative to conventional methods to reduce pain and make a more rapid recovery after hemorrhoidal surgery.
“…However, the frequency of complications has decreased since 2015 [36]. Postoperative pain after stapled hemorrhoidopexy is associated with various factors such as incorrect technique, anal wounds, inflammation in the stapled ring, age, or pelvic floor nerve stimulation [38,44,54,[56][57][58]. Pain after the MM application is linked to bleeding and inflammation, often leading to acute reoperations to stop postoperative bleeding [6].…”
Hemorrhoidal disease (HD) is a chronic multifactorial disease. Increased abdominal pressure, along with hyperperfusion, neovascularization, overexpression of inflammatory mediators, and dysbiosis, contributes to the development of HD. The deterioration of the anchoring connective tissue with reduced collagen content and altered collagen ratios, dilatation of blood vessels and thrombosis, muscle injury, and inflammation gradually lead to clinically manifesting prolapse and bleeding from hemorrhoids. The associations of the ABO blood types with a disease have been investigated for the upper gastrointestinal tract only. This study aimed to evaluate HD clinical manifestations, surgeries carried out, and the status of prolapsed anorectal tissues by exploring the associations with the patients’ ABO blood groups. Clinical and various morphological methods, combined with extensive bioinformatics, were used. The blood type 0, grade III and IV HD individuals constituted the largest group in a moderately-sized cohort of equally represented males and females studied and submitted to surgical treatment of hemorrhoids. There were significantly more complaints reported by HD females compared to males (p = 0.0094). The Longo technique appeared mostly used, and there were proportionally more surgeries performed below the dentate line for HD individuals with blood type 0 compared to other blood type patients (24% vs. 11%). HD males were found to present with significantly more often inflamed rectal mucosa (p < 0.05). Loosening and weakening of collagenous components of the rectal wall combined with vascular dilation and hemorrhage was found to differ in 0 blood type HD individuals compared to other types. HD males were demonstrated to develop the ruptures of vascular beds significantly more often when compared to HD females (p = 0.0165). Furthermore, 0 blood type HD males were significantly more often affected by a disease manifested with tissue hemorrhage compared to the 0 blood type HD females (p = 0.0081). Collectively, the local status of chronically injured anorectal tissue should be considered when applying surgical techniques. Future studies could include patients with HD grades I and II to gain a comprehensive understanding of the disease progression, allowing for a comparison of tissue changes at different disease stages.
En kvinne i 40-årene med bekkensepsis | Tidsskrift for Den norske legeforening En kvinne i 40-årene med bekkensepsis NOE Å LAERE AV ØYSTEIN HØYDAHL E-post: oystein.hoydahl@gmail.com Gastrokirurgisk avdeling St. Olavs hospital Øystein Høydahl er lege i spesialisering. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. REIDUN LYNGVI FOUGNER Klinikk for bildediagnostikk St. Olavs hospital Reidun Lyngvi Fougner er spesialist i radiologi og overlege. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. TORE STORNES Gastrokirurgisk avdeling St. Olavs hospital Tore Stornes er ph.d., spesialist i generell kirurgi og i gastroenterologisk kirurgi og er seksjonsoverlege. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.En tidligere frisk kvinne i 40-årene ble operert akutt for en smertefull hemoroide. Andre postoperative dag utviklet hun alvorlig sepsis.En kvinne i 40-årene ble innlagt akutt ved sitt lokalsykehus grunnet en smertefull hemoroide. Hemoroidektomi ble utført med en kløverbladformet incisjon i huden (Milligan-Morgans operasjon). Hun ble utskrevet dagen etter inngrepet i god allmenntilstand.Hemoroider er en vanlig anorektal lidelse, definert som symptomgivende forstørrelse og forskyving av vaskulaere puter i anus. Putenes funksjon er å skape anal kontinens, de bidrar med 15-20 % av hviletrykket i endetarmen og er en naturlig del av lukkefunksjonen (1). Hemoroider har en prevalens på 4,4 %, forekommer oftest i aldersgruppen 45-65 år og er uvanlig før 20 års alder (2). Tilstanden er vanlig hos gravide kvinner (3).
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