Simple non-adherent dressing versus gelatin foam sponge plug after haemorrhoidectomy: A prospective randomized trial

Myles, L. M.; Aitken, Robert; Griffiths, John M.

doi:10.1002/bjs.1800810948

Cited by 16 publications

(10 citation statements)

References 3 publications

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“…A ligature to the haemorrhoidal pedicle might impinge on the internal anal sphincter, thereby causing post-operative pain, so where possible haemostasis should be achieved by diathermy alone 19. A dressing pack may increase pain and is not necessary as long as adequate intra-operative haemostasis is achieved 26 27. A significant part of post-operative pain may be caused by sphincter spasm, so some form of chemical sphincter relaxation seems sensible, such as topical 2% diltiazem or topical 0.4% glyceryl trinitrate 28 29…”

Section: Managementmentioning

confidence: 99%

Haemorrhoids: modern diagnosis and treatment

Hollingshead

Phillips

2015

Postgraduate Medical Journal

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Haemorrhoids present often to primary and secondary care, and haemorrhoidal procedures are among the most common carried out. They may co-exist with more serious pathology, and correct evaluation is important. In most cases a one-off colonoscopy in patients aged 50 or above with flexible sigmoidoscopy in younger patients is reasonable. Many people with haemorrhoids do not require treatment. Topical remedies provide no more than symptomatic relief-and even evidence for this is poor. Bulk laxatives alone may improve symptoms of both bleeding and prolapse and seem as effective as injection sclerotherapy. Rubber band ligation is effective in 75% of patients in the short term, but does not treat prolapsed haemorrhoids or those with a significant external component. Conventional haemorrhoidectomy remains the most effective treatment in the long term, the main limitation being post-operative pain. Metronidazole, topical sphincter relaxants and operative technique have all been shown to reduce pain. Stapled haemorrhoidectomy and haemorrhoidal artery ligation techniques are probably less effective but less painful. Long-term data are poor for all procedures, with many studies reporting only 1-3 years of follow-up data. Haemorrhoids are common in pregnancy, occurring in 40% of women. They can usually be treated conservatively during pregnancy, with any treatment delayed until after delivery. Acutely strangulated haemorrhoids may be treated either conservatively or operatively. There is an increased risk of anal stenosis after acute surgery, but the risks of sepsis and sphincter damage are less significant than previously thought. The majority of patients who are treated conservatively will still require definitive treatment at a later date.

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Section: Managementmentioning

confidence: 99%

Haemorrhoids: modern diagnosis and treatment

Hollingshead

Phillips

2015

Postgraduate Medical Journal

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“…Two randomized studies evaluated the effects of anal tampons after hemorrhoidectomy. Myles et al compared a simple, non-adherent wound pad with a gelatin sponge plug [23]. Ingram et al performed a study comparing a calcium alginate dressing with standard gauze packing after hemorrhoidectomy [24].…”

Section: Introductionmentioning

confidence: 99%

Tamponade dressings versus no tamponade after hemorrhoidectomy: study protocol for a randomized controlled trial

Langenbach

Seidel

2019

Trials

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Background Symptomatic hemorrhoids are one of the most common anorectal disorders. Many surgeons use tamponades after open hemorrhoidectomy to manage postoperative bleeding. The question of whether a tamponade is necessary and beneficial after hemorrhoidectomy has not yet been conclusively answered. A previously conducted single-center pilot trial included 100 patients after Milligan–Morgan hemorrhoidectomy. The data indicated that insertion of an anal tamponade after hemorrhoidectomy does not reduce postoperative bleeding but causes significantly more pain. The findings of this pilot trial are now to be verified by means of a multicenter randomized clinical study called NoTamp. Methods We plan to include 953 patients after Milligan-Morgan or Parks hemorrhoidectomy in the NoTamp study. The aim is to demonstrate that using no tamponade dressing after open hemorrhoidectomy is not inferior to using tamponades with respect to postoperative bleeding, and that the patients report less pain. Primary endpoints of the trial are the maximum postoperative pain within 48 h and the incidence of severe postoperative bleeding that requires surgical revision within 7 days after the surgical procedure. Secondary endpoints of the study are the use of analgesics in the postoperative course, the lowest hemoglobin documented within 7 days, quality of life and patient satisfaction. Safety analysis includes all adverse and serious adverse events in relation to the study treatment. Further information can be found in the registration at the German Registry of Clinical Studies (DRKS00011590) and on the study webpage ( https://notamp.de/en-GB/trial/main/setLocale/en_GB/ ). The study is financed by the HELIOS research funding. Discussion The study received full ethics committee approval. The first patient was enrolled on 3 May 2017. This trial will finally answer the question whether the insertion of a tamponade after open hemorrhoidectomy is necessary and beneficial. Trial registration German Clinical Trials Register (Deutsches Register Klinischer Studien (DRKS), DRKS00011590 . Registered on 12 April 2017.

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“…Even for inpatients we did not find it necessary to keep them in hospital to wait for the first bowel motion. We never used anal packing because it was too uncomfortable and there were no data to show that it improved immediate haemostasis 1 . In fact, we have not encountered a case of significant reactionary (within 24 h) bleeding with our patients.…”

Section: Discussionmentioning

confidence: 88%