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[The surgical therapy of hemorrhoidal pathology performed in one-day surgery].

BACKGROUND: The surgical procedure in the haemorrhoidal disease, performed in one day surgery, using a local anaesthesia (posterior perineal block), where suggested and possible, presents many advantages: for the patient whose stay in the hospital is shorter, for the hospital which is facilitated in the organization and planning of admissions, for the surgeon who is gratified by results. Personal experience is reported and the operation performed during one year, the surgical, anaesthetic and therapeutic technique used, and the results obtained are analyzed. METHODS: 32 selected patients with haemorrhoidal disease affections: (haemorrhoidal nodules by third and fourth degree). We have been examined. The operation was performed in all patients in one day surgery. The technique used was haemorrhoidectomy according to Milligan Morgan modified Phillips, using a coagulator, and without ligation of the pedicles. Anaesthesia was performed by Back perineal block according to M. C. Marti; particular attention was paid to the post-operative control that, in personal opinion, must be done weekly, for at last 4 weeks. RESULTS AND CONCLUSIONS: Results, which seem satisfactory, and approval manifested by the patients, encourage to continue in this direction.

Adult↗
PubMed2000

[Surgical treatment of hemorrhoidal disease using circular mechanical stapler. Analysis of costs].

BACKGROUND: An analysis of surgical treatment costs of haemorrhoid disease with the use of a new circular stapler, is made comparing this operation with Milligan Morgan's technique. The money and management saving due to the reduction of operation time and postoperative stay compensates present costs due to stapler. METHODS: 35 uniform patients (number, age, sex, grade of haemorrhoid disease and surgical equipe) are considered and divided into two groups of study to evaluate perspectively the surgical costs. RESULTS: The cost of treatment with stapler per patient is like Milligan Morgan's treatment (1.714.681 lire versus 1.681.893), with an important management saving of postoperative days (16 hours versus 42 hours). CONCLUSIONS: Moreover there are psychologic and social advantages, not quantifiable but considerable, due to the early physical recovery and to the absence of out-patient dressing cycles peculiar of this surgical technique, with a rapid social and working reinstatement of patients (4-5 days versus 4-5 weeks of conventional intervention).

Adult↗
PubMed2000

Stapling procedure for hemorrhoids versus conventional haemorrhoidectomy.

Forty patients admitted at the Saudi German Hospital were randomly assigned to Milligan-Morgan haemorrhoidectomy (n = 20) or the circular stapled procedure. Under general anesthesia patients underwent standardized haemorrhoidectomy or had a circumferential doughnut of rectal mucosa and submucosa above the dentate line excised and closed with a standard circular end to end stapling device. All patients received the same preoperative and postoperative analgesic and laxative regimens. Patients completed linear analogue pain charts each day and were interviewed at 1, 3, and 12 weeks postoperatively. Summary measures of average pain experience were calculated from 10 cm linear analogue pain scores and were used as the primary outcome measure. The stapled group was found to have shorter anesthesia time (9-25 minutes, median 18) versus (15-35 minutes, median 22). Average pain in the stapled group was significantly lower than it was in the Milligan-Morgan group (0.2-7.6, median 2.1) versus (3.1-8.5, median 6.5). Hospital stay and time to first bowel motion were not significantly different between both groups. Return to normal activity was significantly shorter in the stapled group (3-60 days, median 17) versus (14-90 days, median 34). Early and late complications, patient assessed symptom control, and functional outcome appear to be similar after short term follow up.

Hemorrhoids↗