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[PMID]:27771095
[Au] Autor:Bjelanovic Z; Draskovic M; Veljovic M; Lekovic I; Karanikolas M; Stamenkovic D
[Ad] Endereço:Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia. Electronic address: vojislavma2@sbb.rs.
[Ti] Título:Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease.
[Ti] Título:Desarterialización hemorroidal transanal, un procedimiento seguro y eficaz para el tratamiento ambulatorio de la enfermedad hemorroidal..
[So] Source:Cir Esp;94(10):588-594, 2016 Dec.
[Is] ISSN:1578-147X
[Cp] País de publicação:Spain
[La] Idioma:eng; spa
[Ab] Resumo:INTRODUCTION: This prospective, observational study evaluated transanal dearterialization (THD) efficacy and safety in grade 2-4 hemorrhoids (HD). METHODS: THD was performed under sedation-locoregional anesthesia in 402 outpatients. Patients had follow-up evaluation 3 days, 2 weeks, 1, 6 and 12 months postoperatively. Postoperative complications and recurrence of symptoms at 12 months were analyzed. The relationship between the learning curve and the number of postoperative complications was studied. RESULTS: Mean patient age was 46.4 (range 20-85) years. A total of 268 patients (66.6%) were male. Sixteen patients (4.0%) had grade 2 HD, 210 (52.2%) had grade 3 and 176 (43.8%) had grade 4 HD. Surgery lasted 23 (17-34) min. A total of 67 patients had complications: bleeding in 10 patients (2.5%), hemorrhoidal thromboses in 10 (2.5%), perianal fistulas in 5 (1.2%), fissures in 14 (3.5%), urinary retention in 3 (0.8%), residual prolapse in 19 (4.7%), severe anal pain in 3 (0.8%), and perianal abscess in 3 patients (0.8%). Recurrent HD occurred in 6.3% (1/16) of grade 2 HD patients, 5.8% (12/210) of grade 3 patients and 9.7% (17/176) of grade 4 patients. Twelve months after THD, bleeding was controlled in 363 patients (90.5%), prolapse was controlled in 391 (97.3%) and pain markedly improved in 390 patients (97%). CONCLUSION: THD appears safe and effective for grade 2-4 HD, and the number of complications decreased with increasing surgeon experience. THD advantages include mild pain, fast recovery, early return to daily activities and low incidence of complications.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Ambulatórios
Hemorroidectomia/métodos
Hemorroidas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Canal Anal
Artérias/cirurgia
Feminino
Hemorroidectomia/efeitos adversos
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171130
[Lr] Data última revisão:
171130
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28658138
[Au] Autor:Lin G; Ge Q; He X; Qi H; Xu L
[Ad] Endereço:Department of Anorectal Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
[Ti] Título:A novel technique for the treatment of stages III to IV hemorrhoids: Homemade anal cushion suspension clamp combined with harmonic scalpel.
[So] Source:Medicine (Baltimore);96(26):e7309, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To compare the efficacy of homemade anal cushion suspension clamp combined with harmonic scalpel (ACS) and Milligan-Morgan hemorrhoidectomy combined with electric knife (MMH) in the treatment of stages III to IV hemorrhoids. We conducted a retrospective study of 99 patients with stages III to IV hemorrhoids hospitalized from January to December in 2013. Among them, 51 patients were treated with ACS, while 48 patients received MMH. Data from clinical recording and follow-up included operative time, intraoperative blood loss, hospitalization information, postoperative pain, and postoperative complications. Operative time, intraoperative blood loss and hospitalization time in ACS group were significantly less than those in MMH group (P < .05). Compared with MMH group, ACS group had a lower postoperative static pain score from days 1 to 14 (P < .01). The patients in ACS group exhibited less postoperative defecation pain scores from days 3 to 20 than those of MMH group (P < .05). The incidence of postoperative anal edema and delayed wound healing in ACS group was lower than that in MMH group (P < .05). Compared with MMH, our novel technique ACS was more effective and had fewer postoperative complications in the treatment of stages III to IV hemorrhoids.
[Mh] Termos MeSH primário: Hemorroidectomia/instrumentação
Hemorroidectomia/métodos
Hemorroidas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Perda Sanguínea Cirúrgica
Defecação
Edema
Desenho de Equipamento
Feminino
Seguimentos
Seres Humanos
Tempo de Internação
Masculino
Duração da Cirurgia
Medição da Dor
Dor Pós-Operatória
Estudos Retrospectivos
Índice de Gravidade de Doença
Resultado do Tratamento
Cicatrização
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170629
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007309


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[PMID]:28562733
[Au] Autor:Borges LA; da Cunha Leal P; Rey Moura EC; Sakata RK
[Ad] Endereço:MD. Anesthesiologist, Hospital Municipal Dr. Mário Gatti, Campinas (SP), Brazil.
[Ti] Título:Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy.
[So] Source:Sao Paulo Med J;135(3):247-252, 2017 May-Jun.
[Is] ISSN:1806-9460
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES:: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING:: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS:: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS:: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS:: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION:: ClinicalTrials.gov NCT02839538.
[Mh] Termos MeSH primário: Analgesia/métodos
Anestesia Local/métodos
Raquianestesia/métodos
Hemorroidectomia/métodos
Dor Pós-Operatória/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Adulto
Canal Anal
Analgésicos/uso terapêutico
Anestesia Local/efeitos adversos
Raquianestesia/efeitos adversos
Feminino
Hemorroidectomia/efeitos adversos
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Medição da Dor
Complicações Pós-Operatórias
Estudos Prospectivos
Valores de Referência
Reprodutibilidade dos Testes
Estatísticas não Paramétricas
Espaço Subaracnóideo
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Analgesics)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170601
[St] Status:MEDLINE


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[PMID]:28267013
[Au] Autor:Wanis KN; Emmerton-Coughlin HM; Coughlin S; Foley N; Vinden C
[Ad] Endereço:1 Department of Surgery, Western University, London Health Sciences Centre, London, Canada 2 Department of Physical Medicine & Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
[Ti] Título:Systemic Metronidazole May Not Reduce Posthemorrhoidectomy Pain: A Meta-Analysis of Randomized Controlled Trials.
[So] Source:Dis Colon Rectum;60(4):446-455, 2017 Apr.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hemorrhoidectomy is associated with significant postoperative pain. Oral metronidazole has been recommended as an adjunct to improve posthemorrhoidectomy analgesia. OBJECTIVE: This study aimed to evaluate the impact of oral metronidazole on patient-reported pain following hemorrhoidectomy. DATA SOURCES: We conducted a systematic search in the MEDLINE, EMBASE, ISI Web of Science, and Cochrane Central Register of Controlled Trials databases. STUDY SELECTION: Randomized controlled trials examining adults who underwent surgical hemorrhoidectomy were included. Participants in an active intervention group received oral metronidazole postoperatively, and those in a control group received placebo or usual care. Postoperative pain was assessed for at least 3 days postoperatively. INTERVENTION: A random-effects model was used. MAIN OUTCOMES MEASURES: The primary outcome was pain during the first 2 postoperative weeks, measured on a visual analogue scale. The secondary outcome was time to return to normal activities. RESULTS: Patients who received oral metronidazole had significantly lower reported pain scores on postoperative day 1 (standardized mean difference, -0.87 ± 0.44; 95% CI, -1.73 to -0.015; p = 0.046; n = 4) and day 4 (standardized mean difference, -1.43 ± 0.71; 95% CI, -2.83 to -0.037; p = 0.044; n = 3). Metronidazole use was associated with a significantly shorter time to return to normal activities (standardized mean difference, -0.76 ± 0.34; 95% CI, -1.43 to -0.088, p = 0.027). The improvements disappeared in a sensitivity analysis excluding the largest trial with a high risk of bias, and no significance was observed during the remaining postoperative days. LIMITATIONS: The meta-analysis was limited by lack of double blinding, absence of a placebo, and unclear or high risk of bias in a proportion of the included trials. CONCLUSIONS: Although a favorable adverse effect profile supports consideration of oral metronidazole to reduce posthemorrhoidectomy pain, pooled analysis reveals inconsistent results with no pain reduction on most postoperative days. The current recommendation for routine prescription of oral metronidazole should be reevaluated in the absence of additional well-designed trials.
[Mh] Termos MeSH primário: Anti-Infecciosos/uso terapêutico
Hemorroidectomia
Hemorroidas/cirurgia
Metronidazol/uso terapêutico
Dor Pós-Operatória/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração Oral
Analgésicos/uso terapêutico
Seres Humanos
Medição da Dor
Ensaios Clínicos Controlados Aleatórios como Assunto
Recuperação de Função Fisiológica
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Analgesics); 0 (Anti-Infective Agents); 140QMO216E (Metronidazole)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170831
[Lr] Data última revisão:
170831
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170308
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000792


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[PMID]:28103166
[Au] Autor:Cabalzar-Wondberg D; Turina M
[Ad] Endereço:1 Departement Chirurgie, Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich.
[Ti] Título:Das Hämorrhoidalleiden ­ ein Therapiealgorithmus aus chirurgischer Sicht..
[So] Source:Praxis (Bern 1994);106(2):77-83, 2017 Jan.
[Is] ISSN:1661-8157
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Algoritmos
Hemorroidectomia
Hemorroidas/cirurgia
[Mh] Termos MeSH secundário: Estudos Transversais
Feminino
Hemorroidectomia/instrumentação
Hemorroidectomia/métodos
Hemorroidas/classificação
Hemorroidas/diagnóstico
Hemorroidas/epidemiologia
Seres Humanos
Masculino
Instrumentos Cirúrgicos
Grampeamento Cirúrgico/instrumentação
Grampeamento Cirúrgico/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170621
[Lr] Data última revisão:
170621
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170120
[St] Status:MEDLINE
[do] DOI:10.1024/1661-8157/a002583


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[PMID]:28098569
[Au] Autor:Hui Y; Quddus MR; Murthy JN; Yang D; Sung CJ; Lu S; Resnick MB; Wang LJ
[Ad] Endereço:Departments of *Pathology and Laboratory Medicine, Rhode Island Hospital †Pathology and Laboratory Medicine, Women and Infants Hospital of Rhode Island ‡Pathology and Laboratory Medicine §Pathology and Laboratory Medicine, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI.
[Ti] Título:Human Papillomavirus Genotyping of Incidental Malignant and Premalignant Lesions on Hemorrhoidectomy Specimens.
[So] Source:Am J Surg Pathol;41(3):382-388, 2017 Mar.
[Is] ISSN:1532-0979
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Routine histopathologic examination of hemorrhoidectomy specimens is controversial having been described as not useful and expensive with few of these common cases demonstrating incidental lesions. However, unexpected premalignant and malignant lesions have been detected on excised hemorrhoids. The high-risk human papillomavirus (HR-HPV) types associated with these incidentally identified high-grade lesions are presently unknown. We aimed to identify cases of incidental high-grade anal intraepithelial neoplasia (HG-AIN) and anal squamous cell carcinoma incidentally discovered on hemorrhoidectomy specimens, genotype HR-HPVs from these lesions, and assess p53 and p16 expression by immunohistochemistry to identify risk factors for their development. With institutional approval, cases with associated demographics from 1995 to 2015 were reviewed to identify and confirm incidental HG-AIN or squamous cell carcinoma in hemorrhoidectomy specimens. Genotyping for HR-HPV types and immunohistochemical staining for p53 and p16 was performed. Statistical analysis comparing HPV genotypes, p53 and p16 staining, and potential risk factors by the Fisher exact test was performed. In the largest series of incidental high-grade lesions on hemorrhoidectomy, HPV 16 was the most common HR-HPV detected though multiple-type infections were common including some HPV 16/18-negative cases. By genotyping, HPV 39 was significantly associated with IV-drug abuse history (P=0.0015) and HIV-positive status (P=0.037), whereas HPV 58 detection correlated with chemotherapy-induced immunosuppression (P=0.029). There was frequent overlap between p53 staining and HPV positivity, particularly when HPV 31 was detected. We also identified several mimickers of HG-AIN that may present diagnostic challenges in these specimens. Our data support continued routine examination of hemorrhoidectomy specimens and suggest that adjunctive studies such as immunohistochemistry for challenging cases may be useful.
[Mh] Termos MeSH primário: Neoplasias do Ânus/virologia
Carcinoma in Situ/virologia
Carcinoma de Células Escamosas/virologia
Hemorroidectomia
Papillomaviridae/genética
Infecções por Papillomavirus/diagnóstico
Lesões Pré-Cancerosas/virologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Neoplasias do Ânus/diagnóstico
Neoplasias do Ânus/patologia
Carcinoma in Situ/diagnóstico
Carcinoma in Situ/patologia
Carcinoma de Células Escamosas/diagnóstico
Carcinoma de Células Escamosas/patologia
DNA Viral/análise
Feminino
Genótipo
Técnicas de Genotipagem
Seres Humanos
Achados Incidentais
Masculino
Meia-Idade
Papillomaviridae/isolamento & purificação
Infecções por Papillomavirus/complicações
Infecções por Papillomavirus/virologia
Lesões Pré-Cancerosas/diagnóstico
Lesões Pré-Cancerosas/patologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (DNA, Viral)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170721
[Lr] Data última revisão:
170721
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170119
[St] Status:MEDLINE
[do] DOI:10.1097/PAS.0000000000000809


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[PMID]:27845508
[Au] Autor:Milito G; Lisi G; Aronadio E; Campanelli M; Venditti D; Grande S; Grande M
[Ad] Endereço:Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
[Ti] Título:May radiofrequency be the best choice for III-IV degree hemorrhoids?
[So] Source:Minerva Gastroenterol Dietol;63(1):38-43, 2017 Mar.
[Is] ISSN:1827-1642
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hemorrhoidectomy is considered the most efficient method to treat hemorrhoids of III and IV grades. The aim of this study was to compare conventional diathermy hemorrhoidectomy and radiofrequency hemorrhoidectomy based on a large series of patients. METHODS: Between June 2001 and June 2014, 1000 patients have been treated with radiofrequency hemorrhoidectomy (group A) and 500 patients have been treated with diathermy (group B) as a day-case procedure. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. RESULTS: The mean follow-up was seven years. The mean operating time for radiofrequency hemorrhoidectomy was shorter than diathermy but not significantly. Patients treated with radiofrequency had significantly less postoperative pain (measured on a Visual Analogue Scale; P=0.001), a shorter wound healing time, less time off work and postoperative complications (P=0.001) than patients who had diathermy. Neither wound healing nor mean hospital stay (day-case surgery) was significantly different. CONCLUSIONS: Radiofrequency hemorrhoidectomyis a valid alternative to the conventional diathermy technique, due to the reduction of operative time, postoperative pain, early and late complication rate.
[Mh] Termos MeSH primário: Ablação por Cateter
Diatermia
Hemorroidectomia/métodos
Hemorroidas/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Hemorroidas/classificação
Seres Humanos
Masculino
Meia-Idade
Duração da Cirurgia
Complicações Pós-Operatórias
Escala Visual Analógica
Cicatrização
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161116
[St] Status:MEDLINE
[do] DOI:10.23736/S1121-421X.16.02348-5


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[PMID]:27796581
[Au] Autor:Nielsen VG; Paidy SR; McLeod W; Fox A; Nfonsam VN
[Ad] Endereço:Department of Anesthesiology, The University of Arizona College of Medicine, P.O. Box 245114, 1501 North Campbell Avenue, Tucson, AZ, 85724-5114, USA. vgnielsen333@gmail.com.
[Ti] Título:Treatment of accidental perianal injection of topical thrombin with intravenous antithrombin.
[So] Source:J Thromb Thrombolysis;43(3):423-425, 2017 Apr.
[Is] ISSN:1573-742X
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:While topical thrombin application can markedly improve surgical hemostasis, rapid absorption of thrombin can result in pulmonary embolism and death. We report a case of accidental interstitial infiltration of topical thrombin after hemorrhoidectomy that was treated with administration of human antithrombin and heparin anticoagulation. Except for a marked decrease in antithrombin activity from super normal to normal values, the patient exhibited no laboratory or clinical signs of pulmonary embolism, thrombin mediated consumptive loss of procoagulants, or regional thrombosis. The patient had an uncomplicated recovery without sign of thrombotic morbidity. While it is hoped that such a medical misadventure should not occur, our case may serve as a reference to guide anticoagulant therapy if such a clinical scenario arises.
[Mh] Termos MeSH primário: Canal Anal/lesões
Antitrombinas/administração & dosagem
Erros Médicos/efeitos adversos
Trombina/efeitos adversos
[Mh] Termos MeSH secundário: Anticoagulantes/uso terapêutico
Antitrombinas/uso terapêutico
Feminino
Hemorroidectomia/efeitos adversos
Heparina/uso terapêutico
Seres Humanos
Meia-Idade
Embolia Pulmonar/prevenção & controle
Trombose/prevenção & controle
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Antithrombins); 9005-49-6 (Heparin); EC 3.4.21.5 (Thrombin)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161101
[St] Status:MEDLINE
[do] DOI:10.1007/s11239-016-1447-z


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[PMID]:27768009
[Au] Autor:Milito G; Lisi G; Aronadio E; Campanelli M; Venditti D; Grande S; Grande M
[Ad] Endereço:Department of Surgery, University Hospital of Tor Vergata, Rome, Italy.
[Ti] Título:LigasureTM hemorrhoidectomy: how we do.
[So] Source:Minerva Gastroenterol Dietol;63(1):44-49, 2017 Mar.
[Is] ISSN:1827-1642
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hemorrhoidectomy is considered the gold standard and the most effective and definitive treatment for grades 3 or 4 hemorrhoids, and Milligan-Morgan's and Ferguson's procedures are the most widely used techniques throughout the world. The aim of the study was to present our surgical technique using LigasureTM vessel sealing, focus on technical aspects and surgical tricks showing our results with a huge number of patients and a long-term follow-up. METHODS: Between June 2001 and June 2014 at the University Hospital of Tor Vergata, Rome, Italy, 1000 patients were selected to underwent LigasureTM hemorrhoidectomy for III and IV degree hemorrhoids. Age range 19-80 years, ASA I-II-III. Operating time, postoperative pain score, hospital stay, early and late postoperative complications, wound healing time and time to return to normal activities were assessed. Patients were followed-up at one week, one month, six, and twelve months after the operation and after 60 months they responded to the follow-up telephone interview and replied to the questionnaire. RESULTS: One-thousand patients were undergone LigasureTM hemorrhoidectomy. The mean follow-up was 7 years and 110 (11%) patients was lost from the follow-up after the first postoperative month. Among early postoperative complications, 21 patients (2.1%) has urinary retention treated with a urinary catheter and removed before the discharge. 3 (0.3%) patients had a minor bleeding that required a package of hemostatic absorbable sponge, as late complications, in 35 patients (4%) anal fissure due to hard stool, an incomplete healing was observed in 11 patients (1.1%) after the first month. Three transphincteric anal fistulas (0.3%) were collected and four perianal abscess (0.4%) were observed during the first month of the follow-up and they required a delayed surgical treatment. At the end of the seven years of follow-up 70 recurrences (7.8%) and 35 anal stenosis (4%) were detected. CONCLUSIONS: If technical guidelines are respected rigorously and the device is applied correctly, feared late complications, such as impaired fecal continence, anal stricture and postoperative pain can be minimized.
[Mh] Termos MeSH primário: Hemorroidectomia/instrumentação
Hemorroidas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Doenças do Ânus/etiologia
Constrição Patológica/etiologia
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias
Recidiva
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161022
[St] Status:MEDLINE
[do] DOI:10.23736/S1121-421X.16.02343-6


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[PMID]:25214362
[Au] Autor:Talha A; Bessa S; Abdel Wahab M
[Ad] Endereço:Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt.
[Ti] Título:Ligasure, Harmonic Scalpel versus conventional diathermy in excisional haemorrhoidectomy: a randomized controlled trial.
[So] Source:ANZ J Surg;87(4):252-256, 2017 Apr.
[Is] ISSN:1445-2197
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study was designed to compare the surgical outcomes of haemorrhoidectomy performed by the Ligasure, Harmonic Scalpel with that performed by the conventional diathermy. METHODS: A total of 180 patients were randomized to Ligasure, Harmonic Scalpel and diathermy haemorrhoidectomy, 60 patients for each group. The operative time, post-operative pain scores, parenteral analgesic requirements in the first 24 h, post-operative complications and wound healing rates were documented. RESULTS: The median operative time was 8 min (range, 7-18) for the Ligasure and Harmonic Scalpel groups and 18 min (range, 15-21) for the diathermy group (P < 0.001). Throughout the first post-operative week, the daily median pain score was lower in the Ligasure and Harmonic Scalpel groups than in the diathermy group (P < 0.001). The median number of analgesic ampoules during the first 24 h post-operatively was lower in the Ligasure and Harmonic Scalpel groups (P < 0.001). There was no statistically significant difference in the incidence of post-operative complications. At 6 weeks post-operation, more patients in the Ligasure and Harmonic Scalpel groups had complete healing of wounds (P = 0 < 0.001). CONCLUSION: Ligasure and Harmonic Scalpel provide a superior alternative to conventional diathermy in haemorrhoidectomy with no difference between them in reducing the operative time, post-operative pain, analgesic requirements during the first 24 h and time to complete healing of wounds.
[Mh] Termos MeSH primário: Diatermia/métodos
Hemorroidectomia/instrumentação
Hemorroidectomia/métodos
Hemorroidas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Tempo de Internação
Ligadura/instrumentação
Ligadura/métodos
Masculino
Meia-Idade
Duração da Cirurgia
Complicações Pós-Operatórias/etiologia
Resultado do Tratamento
Cicatrização/fisiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170601
[Lr] Data última revisão:
170601
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140913
[St] Status:MEDLINE
[do] DOI:10.1111/ans.12838



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