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PubMedDate not supplied

[Hemorrhoidal desarterialization guided by Doppler. A surgical alternative in hemorrhoidal disease management].

BACKGROUND: Hemorrhoidal disease is a common condition that includes 30% of patients seen for the first time at the Colon and Rectal Unit of the Gastroenterology Service, Hospital General in Mexico City. This study shows experience with hemorrhoidal desarterialization guided by Doppler in patients with internal hemorrhoidal disease stages II or III in the Coloproctology Units of the Hospital General in Mexico City and at the North Medical Unit in Monterrey, Nuevo Leon, Mexico. MATERIALS AND METHODS: A prospective, longitudinal, and descriptive study was performed in 56 patients with diagnosis of internal hemorrhoids stages II or III, not complicated, and treated by hemorrhoidal artery ligation guided by Doppler between July 1, 2002 and April 31, 2003. RESULTS: 49 patients were included, 32 male (66%) and 17 female (34%), aged between 21 and 75 years with mean age of 43.5 years; 40 patients had internal hemorrhoids stage II (82%) and nine, stage III (18%). With a follow-up of 4 months or longer, all patients were symptomless: bleeding and hemorrhoidal prolapse disappeared. CONCLUSIONS: Doppler-Guided hemorrhoidal desarterialization is indicated in patients with internal hemorrhoids stages II or III; it is a simple technique that requires a short learning curve, minimal anesthetic and surgical materials, and pain after the procedure is mild and short-lived in the majority of patients.

Adult↗
PubMed2003

Endoscopic hemorrhoidal ligation of symptomatic internal hemorrhoids.

BACKGROUND: This study assessed the efficacy of endoscopic hemorrhoidal ligation for treatment of patients with symptoms caused by internal hemorrhoids. METHODS: A total of 576 consecutive patients with symptoms caused by internal hemorrhoids were enrolled in the study. Symptoms were rectal bleeding (239 patients) and prolapse (337 patients). The severity of the hemorrhoids was classified by using the grading system of Goligher. RESULTS: All patients were treated by the same operator. Mean follow-up was 17.5 months (range 8 to 24 months). The mean number of band ligations per session was 2.86. The mean number of treatment sessions was 1.24. At least one grade reduction in the severity of the hemorrhoids was achieved in most patients (93.58%). Moreover, rectal bleeding was controlled in 228 patients (95.4%), and rectal prolapse was reduced in 310 patients (91.99%). After treatment, 85 patients experienced anal pain, 37 had mild bleeding, 4 developed external hemorrhoidal thrombosis, and one had a peri-anal abscess. The latter 5 patients were treated surgically and recovered uneventfully. CONCLUSIONS: Endoscopic hemorrhoidal ligation is a simple, safe, and effective treatment for patients with symptoms caused by internal hemorrhoids.

Endoscopy, Gastrointestinal↗
PubMed2005

Hemorrhoidal ablation and fixation: an alternative procedure for prolapsing hemorrhoids.

BACKGROUND: Many new techniques have been evolved to curb the problem of post-operative pain after hemorrhoidectomy. Stapler hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation are the two methods gaining popularity amongst proctologists. The author proposes another technique called radiofrequency ablation and fixation of hemorrhoids to add to this list. PATIENTS AND METHODS: The surgical technique and clinical follow-up of 410 patients operated by this technique are presented. An Ellman radiofrequency generator was used for hemorrhoidal ablation at the output power intensity of 80. Post-defecation pain and pain at rest were assessed using a visual analogue scale. Patient satisfaction score was calculated at the mean follow-up of 60 months (range 48-72). The results in terms of mean hospital stay, post-operative pain, post-operative complications, and period of incapacity for work were compared with the published data of results of stapled hemorrhoidopexy and Doppler-guided hemorrhoidal artery ligation. RESULTS: Pain score at first evacuation was 6. The post-defecation pain score in the first week was 4 (range 3-6) and it was 3 (range 2-5) in the second week. The mean pain score at rest in the first week was 2 (range 1-4) and 1 (range 0-2) in the second post-operative week. In the long-term follow-up at a mean of 60 months, this procedure was found in most of the cases to control prolapse, discharge, and bleeding, with no stenosis or incontinence. The recurrence rate was less than 2%. The patient satisfaction score was high. CONCLUSION: The results of this technique of radiofrequency ablation and fixation of hemorrhoids hold positive promises in terms of less post-operative pain, early discharge from the hospital and faster return to work. The results are comparable to stapled hemorrhoidopexy and are better than Doppler-guided hemorrhoidal artery ligation in terms of effectiveness and symptomatic relief on a long-term basis.

Adult↗
PubMed2005

Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids.

OBJECTIVE: The aim of this study is to clinically test the efficacy of a new approach for patients having symptomatic grade III and IV hemorrhoids. MATERIAL AND METHOD: 32 patients (17 females) complaining of grade III or IV hemorrhoids were included in the study. A specially designed proctoscope coupled with a Doppler transducer on its tip was used to identify the hemorrhoidal arteries, which were afterwards suture ligated. Operating time as well as per- and post-operative complications were analyzed. Follow-up was planned following discharge after 1 week, 1 month, 6 months and 1 year. RESULTS: Mean operation time was 27 (range 18-43) minutes, and 5 (range 4-7) arteries were located on average. No patient had severe or moderate postoperative pain, with anal discomfort being the main complaint. Rectal bleeding and tenesmus were the commonest post-operative complications. After one year of follow-up, 19 patients were free of symptoms and 6 of them had significant symptom relief. According to grade, the technique failed in just 3 grade III patients, but in as many as 4 grade IV hemorrhoid cases. CONCLUSIONS: Doppler-guided hemorrhoid artery ligation is an easy-to-perform technique that is well accepted by patients and has good results for grade III hemorrhoids.

Adult↗
PubMed2006

Radioablation and suture fixation of advance grades of hemorrhoids. An effective alternative to staplers and Doppler guided ligation of hemorrhoids.

BACKGROUND: for advance grades of symptomatic hemorrhoids (grade III and IV) the author has innovated a procedure called radiofrequency ablation and fixation of hemorrhoids. The procedure is performed as a day care surgery. PATIENTS AND METHODS: the surgical technique and clinical follow-up of patients operated by this technique are presented. An Ellman dual frequency radiofrequency generator was used for ablation, which was followed by suture fixation of the hemorrhoids. Patient satisfaction score was assessed using a visual analogue scale. The results of this procedure are presented and are compared with the results of published data of stapled hemorrhoidopexy and Doppler guided hemorrhoidal artery ligation procedures. RESULTS: between 1998 and 2005, 2,376 patients were operated with this technique. Patient s mean age was 34 years and 1,438 patients were males. The postoperative complication rate was 3.5%, which included secondary bleeding, retention of urine and perianal thrombosis. The recurrence rate was less than 1.5%. The satisfaction score was 9.2 on VAS. CONCLUSIONS: radiofrequency ablation and fixation of hemorrhoids is a technique that results in less postoperative pain, shorter hospital stay, and early return to normal activity. It seems to be a better alternative to stapled hemorrhoidopexy or Doppler guided hemorrhoidal artery ligation with regard to effectiveness and symptomatic relief on long term.

Adult↗
PubMed2005

[Analysis of the relationship between stoma position and postoperative effects of procedure for prolapse and hemorrhoids in the treatment of hemorrhoids].

OBJECTIVE: To explore the relationship between stoma position and postoperative effects of procedure for prolapse and hemorrhoids (PPH) in the treatment of hemorrhoids. METHODS: Four hundred and one hemorrhoid patients were treated with circular stapler. II hemorrhoids, 45 cases; III-IV hemorrhoids, 356 cases. The position of stoma located 1 cm up dentate line, 219 cases; 1-2 cm up dentate line, 87 cases; 2-3 cm up dentate line, 60 cases; 3-4 cm up dentate line, 25 cases; > 4 cm up dentate line, 10 cases. The patients were followed from one week to two years postoperatively. RESULTS: Postoperative effects and procidentia rates have significant association with the position of stoma. If the distance between position of stoma and dentate line is < or = 2 cm, the postoperative procidentia rate was 1.1%, lower than that of the distance > or = 4 cm. CONCLUSIONS: The complication and procidentia rate of PPH is associated with the stoma position. The stoma position should be no more than 2 cm to dentate line.

Female↗
PubMed1995

A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter.

OBJECTIVES: To assess the usefulness of hemorrhoidal artery ligation (HAL) for internal hemorrhoids with a newly devised instrument (the Moricorn). METHODS: We devised a new instrument (the Moricorn) that is used in conjunction with a Doppler flowmeter. This instrument allows for easy and safe ligation of the hemorrhoidal artery. HAL with the Moricorn was performed on 116 patients with internal hemorrhoids who had episodes of anal pain, bleeding, and prolapse. One month after treatment, the effect was evaluated on the basis of improvement of symptoms and the shrinkage of hemorrhoidal tissue. RESULTS: The treatment's effect was observed in 50 of 52 patients (96%) with pain, 50 of 64 (78%) with prolapse, and 92 of 96 (95%) with bleeding. No patient required anesthesia throughout the entire procedure. No major complications were encountered with this treatment. CONCLUSIONS: HAL with the Moricorn is a simple, safe, and effective method. However, further observations predicated on a longer follow-up, a larger number of patients, and comparisons with other conventional treatments are called for.

Arteries↗
PubMed2002

[Doppler ultrasound assisted hemorrhoid artery ligation. A new therapy in symptomatic hemorrhoids].

In 1995, Morinaga et al. (Japan) reported on a new technique in the treatment of hemorrhoids. We report the results of our first 105 patients thus treated. By a specially designed proctoscope coupled with a Doppler transducer, the hemorrhoidal arteries are looked for and ligated. All stages of hemorrhoid were treated. This method is painless, successful, and has a low rate of complications. It is for outpatients and is an alternative to all other methods in the treatment of hemorrhoids.

Adult↗
PubMed1992

[Effects of administration of 50 mg heparan sulfate tablets to patients with varicose dilatation of the hemorrhoid plexus (hemorrhoids)].

An experimental clinical study was performed using heparan sulfate in order to ascertain the effects of the drug in the treatment of 2nd or 3rd degree varicose dilatation of the hemorrhoid plexus. Forty female patients, mean age 37 years and suffering from varicose dilatation of the hemorrhoid plexus, were enrolled in the study. The study was carried out in an open comparison with oxerutin using parallel groups with random access. After a run-in period of 3 days, 20 patients commenced treatment with 1 50 mg tablet of heparin sulfate 3 times daily, whereas the other 20 patients were given 1,500 mg oxerutin tablet again 3 times daily. Subsequently, treatment was continued at the following doses: 1 50 mg tablet of heparin sulfate twice a day, and 1,500 mg tablet of oxerutin twice a day, for a duration of two weeks. At pre-established times (before treatment, after 1 week, after 2 weeks), a standard questionnaire was filled in relating to each patient in order to evaluate the efficacy and tolerability of treatment. No adverse or undesirable effects were reported. Each participant was also put on a personalized and computerised diet with the same fibre intake. 55% of patients treated with oxerutin reported persistent moderate or intense pain caused by defecation compared to 45% of the group treated with heparan sulfate. Both drugs induced the remission of skin rash and itching. Compared to the control drug, heparan sulfate was more efficacious in relation to the normalisation of hyperemia and mucoid secretion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

[Hemorrhoid Therapy with Doppler Guided Hemorrhoidal Artery Ligation via Proctoscope KM-25. A New Alternative to Hemorrhoidectomy and Rubber Band Ligation?].

The aim of treating patients suffering from hemorrhoids is to eliminate or to relieve their complaints. The method should be performed on an out-patient basis, and should be painless and low rated concerning complications. The Morinaga technique fulfills these conditions, its feasibility and the results in 281 patients are presented.

Adult↗
PubMedDate not supplied

[Macroscopic and microscopic pathological anatomy of the hemorrhoidal vascular network in hemorrhoidal disease].

In this study, the writers have taken as the basis of their investigation the anatomic and pathological analysis of samples studied as a matter of course after hemorrhoidal operations performed regularly at St Mark's Hospital. They describe their macro- and microscopic findings and, in the discussion, they summarise the development of our knowledge in this field, note the inconsistency between anatomical conclusions and clinical variations, stress the importance of the slipped vascular pad phenomenon, and reject the oft-cited concept of the existence of a corpus cavernosum in the rectum.

Anal Canal↗