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The authors present their first results with the treatment of hemorrhoids with the new therapeutic technique D.G.H.A.L. at the Surgical Clinic of Teaching Hospital with Policlinic in Ostrava. The aim of the paper is to inform medical public about the new surgical method.
The data on incidence of detection of associated rectal diseases--hemorrhoids and anal fissures--are presented. The indications for operative treatment are considered, a method suggested by the authors for surgical treatment of the mentioned diseases, which was used in 62 patients, is described. Use of the improved operative technique contributed to reduction in number of complications. Duration of treatment has shortened by 7 days.
Anatomical and physiological aspects of the chronic hemorrhoids formation with a detailed description of physiopathologic mechanisms at this disease have been stated. Up-to-date aspects of surgical treatment with the assessment of positive and negative points of each method have been e analyzed. Prospects of the complex conservative treatment are given based on many-sided pathogenesis aspects.
We report a case of a 47-year-old woman found to have a rectal gastrointestinal stromal tumor discovered on routine pathological examination of the resected hemorrhoidal donut after a stapled hemorrhoidopexy. There was no evidence of metastatic spread. No further therapy will be instituted.
Intra- and early (first week) post-operative haemorrhages are the most common complications in stapled hemorrhoidectomy PPH (Procedure for Prolapse and Hemorrhoids) and in circumferential resection of the rectal prolapse STARR (Stapled Trans Anal Rectal Resection). Performing PPH and STARR we employed a gelatin based haemostatic sealant with thrombin component (FloSeal) to control intra-operative bleeding and to reduce post-operative bleeding avoiding haemostatic stitches on suture line. We report the preliminary results on 197 PPH and 64 STARR; 44 PPH (22.4%) and 27 STARR (42.2%) were treated by FloSeal. No major post-operative bleeding was observed in all patients treated by FloSeal, compared to 1.3% and 2.7% of hemorrhage respectively in PPH and STARR patients treated without sealant. Post-operative pain was less severe in patients treated by FloSeal, without a difference statistically significant. The data are preliminary and must be confirmed in prospective randomized trials in larger series.
OBJECTIVE: To evaluate the effect of titanoreine on early postoperative symptoms after procedure for prolapse and hemorrhoids (PPH). METHODS: From November 2002 to July 2003, 80 patients who received PPH were randomly divided in to titanoreine group (n=42) and control group without titanoreine (n=38). Symptom relief was recorded 24 hours, 6 days and 12 days after PPH, urine retention 24h after PPH, first stool time, wound healing time, mean hospital stay were also recorded. RESULTS: The score of symptom was lower in titanoreine group (4.4) than that in the control group (6.1) 24 hours after PPH (P< 0.05), but no significant difference in symptom grade was found between the two groups 6 days and 12 days after PPH (P> 0.05). Decrements of symptom grade were lower in titanoreine group than those of control group at any point after PPH (P< 0.05). There was no significant difference in urine retention rate and mean hospital stay between two groups(P> 0.05). CONCLUSIONS: Titanoreine can effectively relieve the early postoperative symptoms after PPH.
Acute thrombosis of hemorrhoidal nodes (ATHN) was treated in 402 patients aged from 19 through 73 years of age. It was found that the decision for the volume and method of treatment should be determined individually and differentially, paying special attention to the degree of microcirculatory alterations in the walls of cavernous veins. Multi-component conservative therapy is the method of choice for treatment of ATHN of the 1st severity degree. For the II and III degree operation is indicated which should be fulfilled urgently (within 3 days) or in a postponed (within 5-7 days) order. Hemorrhoidectomy by Milligan-Morgan method with the tight suturing of the postoperative wounds and complete restoration of the mucous membrane of the anal canal allowed getting better immediate and long-term results.
Current conceptsof ethiopathogenesis and classification of hemorrhoids are presented based on the literature and own experience of the authors. Different surgical and non-surgical methods are discussed with additional description of postoperative treatment and complications.
Painless bright red peranal bleeding is a leading symptom of first and second degree hemorrhoid. After having excluded the possibility of bleeding in an upper region diagnosis is made proctoscopically, which is generally followed by injection therapy. Arterial blood supply can be reliably imaged with the aid of 20 MHz microvascular Doppler sonography and the success of therapy can be verified as well as documented after injecting a sclerosing substance.
The results of operative treatment of hemorrhoids in 1437 patients are presented. After hemorrhoidectomy with restoration of the rectal mucosa, the decrease in incidence of complications after operation was noted.
The article discusses the choice of the optimal therapeutic tactics, the volume of preoperative examination, and the rational techniques of surgical treatment in 65 patients with profuse bleeding from the hemorrhoids. It is shown that digital examination, proctosigmoidoscopy, as well as adequate examination of the whole large intestine must be undertaken without fail in this group of patients. Assessment of the volume of blood loss, its correction under hemoglobin control, and consideration for the patient's general condition allows radical operative treatment to be conducted in the majority of cases (96.4%). Good results were produced with the use of advanced surgical techniques of hemorrhoidectomy.
Author reports about his experience with 205 patients suffering hemorrhoid disease of grade I-III. treated by rubber band ligation and cryodestruction. Follow up was carried out with the help of a questionnary. 187 answers arrived. This was the base of the investigation. 81.8 per cent of the patients gave an account of good result. The method is recommended because of its simplicity and cheapness.
The various disorders occurring after sclerotherapy for hemorrhoids comprise excessive local reactions, necrosis followed by hemorrhage and allergic reactions. Symptoms, prevention and therapy of these adverse effects are detailed.
The internal (hemmorrhoidal) plexus consists of two groups of veins separated by the musculus canalis ani. The submucosal group forms the zona hemorrhoidalis. A direct communication between arteries and veins is the characteristic sign of this functional part of rectal circulation. In the nutrient part, the arterioles divide into capillaries. The vessels of the zona hemorrhoidalis are wrapped in by a system of elastic fibers, which split with age. Common pathogenetic factors of hemorrhoids may involve the spasm of anal sphincters and the absence of elastic fiber support of the plexus.
The treatment of bleeding and prolapsing hemorrhoids at stage I and II using infrared-coagulation is technically simple, therapeutically effective and complication-free. Comparative examinations of their efficacy compared with sclerosing injections and rubber band ligature have shown that the method of sclerosing injections is equal, opposite to the rubber band ligature, especially in stage II a little less effective, but without any complications as pain or secondary bleeding.
Radical anal varicotomy and a simultaneous intervention for associated pathology with a additional strengthening of the rectum sphincter incontinence in 97 patients gave good early results. The follow-up examination of the patients 2-8 years after operations has shown that they had no recurrences of hemorrhoids and associated diseases.
Rubber band ligation is a commonly employed office procedure for the eradication of symptomatic internal hemorrhoids. Since 1980 increasingly frequent reports of an often fatal complication--"pelvic cellulitis"--have appeared. Death has been avoided for some of these patients by early recognition and treatment. One such survivor is reported here, in a case report that illustrates the value of early recognition of symptoms and appropriate diagnostic and therapeutic intervention.
We have tried to present a comprehensive survey of present-day management of hemorrhoids, fistulae and fissures, be it in the office or in the hospital. There is great socioeconomic pressure lately for cost-containment, which is apt to effect better medical judgment in the selection of type and place of management. Minor operations can and should be done, as always, on an outpatient basis. General anesthesia is not a minor matter and hemorrhoidectomy is not a minor operation. The major function of outpatient service in the management of anal disease is that of accurate and comprehensive diagnosis. Hundreds of patients come to us only because they fear cancer and it is not enough for us to hunt for and treat the vague little disorders of which they complain. The incidence of cancer of the colon rectum in this country just recently has slightly surpassed that of lung cancer. Adjuvant treatments (e.g., chemotherapy, radiotherapy, immunotherapy and their combinations) are promising but still in the investigational stage. Early diagnosis is our finest weapon with subsequent surgical management. The challenge and responsibility for early diagnosis of colorectal cancer is ours alone. We must first recognize it and then meet it firmly and squarely. We must feel for (digital rectal), look for (sigmoidoscopy), and search for (barium enema x-ray examination) colorectal cancer in all of our patients regardless of the insignificance of anal symptoms and anal findings. Our countrymen fear cancer. We have the devices to allay their fears or to cure their cancers if they are found early enough. We have a straightforward moral commitment and a national trust.