Circular hemorrhoidectomy in advanced hemorrhoidal disease.
ABSTRACT Milligan-Morgan's hemorrhoidectomy has a high recurrence rate (> 10%) in patients with circular IV grade hemorrhoids. In such cases a circular hemorrhoidectomy with complete elimination of residual piles, and anoplasty might be more successful. The aim of this retrospective study was to compare the results of circular hemorrhoidectomy using the Hopital Leopold Bellan (HLB) technique (Paris) with the reported results of other techniques in patients with advanced hemorrhoidal disease.
From January 87 to December 96, 100 consecutive patients with circular IV grade hemorrhoids underwent radical hemorrhoidectomy. Mean hospital stay was 4 days (range 3-7). Patients were strictly controlled in the postoperative period and in cases of early fibrosis anal dilators were used.
Eighty one percent of patients had a complete recovery. The recurrence rate was 4%. The cumulative rate of early and late complications was 34%. Early and late hemorrhages were more frequent than in traditional hemorrhoidectomy, while the incidence of anal stenosis was the same.
The HLB operation is the best choice for patients with advanced circular hemorrhoids because of its radicality and good results. The postoperative morbidity of HLB hemorrhoidectomy is higher than traditional hemorrhoidectomy; nevertheless, all complications are tractable without extension of hospital stay.
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ABSTRACT: Introduction: To evaluate if micronized purified flavonoid fraction (MPFF) (Daflon) ameliorates symptoms after Ligasure hemorrhoidectomy (LH) for prolapsed hemorrhoids. Experimental: Eighty eight patients with prolapsed hemorrhoids who underwent LH were randomly assigned to receive either, analgesics and Metronidazole postoperatively (n=45) or MPFF in addition (n=43). Data on patient demographics, postoperative course and complications were prospectively collected. Post-operative symptoms (pain, bleeding, mucus discharge, pruritis, and tenesmus) were assessed regularly for 8 weeks. Each symptom was allocated a score from 0 to 4. A global score was constructed to compare improvement in symptoms between groups at weeks 1 and 8 postoperatively. Results and Discussion: All symptoms were significantly better relieved in the Daflon group during the first week post-LH. The global score for each symptom was significantly lower in the Daflon group. Conclusions: MPFF (Daflon) can significantly reduce the intensity and duration of postoperative symptoms after LH for prolapsed Grades III and IV hemorrhoids.Global Journal of Surgery. 01/2011; 2(1):37-45.
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ABSTRACT: Circumferential excisional hemorrhoidectomy (CEH) enables the surgeon to remove the encircling hemorrhoids completely. The purpose of this study is to compare the efficacy of CEH with that of Ferguson hemorrhoidectomy (FH) for end-stage hemorrhoids. Between February 1998 and December 2011, a prospective randomized trial was conducted with 688 patients who presented with end-stage hemorrhoids and underwent FH or CEH at our center. The patient demographics, mean operative times, lengths of hospital stay, and cumulative rates of postoperative complications were similar in the study groups. Significant differences were revealed in the incidence of postoperative hemorrhage (9 vs. 0 patients in the FH and CEH groups, respectively; p = 0.002) and in the tendency to form anal stricture (15 vs. 32 patients in the FH and CEH groups, respectively; p = 0.02). However, all cases of anal strictures were easily managed by digital dilatations. At a mean follow-up of 7.4 (range, 1-14) years, accessible patients from the CEH group remained symptom free, whereas 126 of 308 patients in the FH group indicated that they had recurrent hemorrhoidal symptoms. Without increasing postoperative complications, CEH demonstrates an advantage compared with FH, with regard to reducing the rate of recurrence to 0 through complete hemorrhoid removal.Journal of Gastrointestinal Surgery 12/2013; · 2.36 Impact Factor
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ABSTRACT: Recurrence and/or complications after 3-quadrant hemorrhoidectomy or stapled hemorrhoidopexy still remain a challenging problem. This challenge is even greater for massive hemorrhoidal thrombosis leading to edema, ulceration, and/or gangrene. To address this challenge, we developed a further modification of the Whitehead procedure termed circumferential excisional hemorrhoidectomy. The proposed procedure allows access to a submucoanodermal/skin workspace that provides a "view from inside" the hemorrhoidal disease, and therefore facilitates the precise excision of even each hemorrhoidal vein while preserving the overlying normal tissues. This study aimed to describe the circumferential excisional hemorrhoidectomy procedure and to demonstrate its results in patients presenting with total hemorrhoidal thrombosis. DESIGN, SETTINGS, PATIENTS: This prospective, descriptive study was conducted with 294 consecutive patients who underwent urgent circumferential excisional hemorrhoidectomy at our coloproctological center from January 1996 to June 2009. Circumferential excisional hemorrhoidectomy involves the stripping and excision of hemorrhoids from the submucoanodermal space with reconstruction of the anal canal by the use of an undermined irregular/zigzag-shaped mucoanodermal flap and accurately trimmed skin. The main outcome measures were the surgical outcomes and complications. The mean patient age was 41.7 for both sexes. There were 215 men and 79 women. The mean operative time was 26.4 (range, 17-43) minutes. In terms of postoperative complications, there were 39 (13.2%) urinary retentions, 1 (0.3%) fecal impaction, and 3 (1%) delayed complete wound epithelization. The mean hospital stay was 3.1 (range, 2-5) days, and the mean time off from work was 10 (range, 7-18) days. At the fifth week after surgery, digital rectal examination revealed easily dilated mild stricture in 26 (8.8%) patients. At a mean follow-up of 6.8 (range, 2-14) years, 271 (92.2%) accessible patients were actually symptom-free. This study did not have a control group. Circumferential excisional hemorrhoidectomy is an anatomically safe surgical procedure with a low rate of complications and no recurrences, even after a long-term follow-up.Diseases of the Colon & Rectum 09/2011; 54(9):1162-9. · 3.34 Impact Factor