Degree Hemorrhoids Research Articles

Topical diltiazem ointment in post-hemorrhoidectomy pain relief: A meta-analysis of randomized controlled trials

Hemorrhoidectomy is commonly associated with postoperative pain. Calcium channel blockers are known to cause relaxation of gastrointestinal smooth muscle and oral diltiazem has also been shown to reduce the resting anal pressure. We attempted to analyze efficacy and side effects of topical diltiazem oint. in post-operative pain control. This is a meta-analysis of patients who underwent hemorrhoidectomy using topical diltiazem oint. versus placebo (Vaseline) for pain control. Patients with third or fourth degree hemorrhoids undergoing traditional hemorrhoidectomy were included. Procedures took place in the colorectal division of a hospital in 5 countries. Five randomized control trials (RCTs) published between 2005 and 2016 including 227 patients were included our meta-analysis (Diltiazem (calcium channel block) group=137; Placebo (Vaseline) group=90). Pain assessment was performed using a standardized Visual Analogue Scale. Any side effects of surgery or medication use, which were noted by the patient or the surgeon, also were recorded. A total of 227 patients were included in the meta-analysis. The results revealed that Diltiazem ointment was statistically significant in reducing pain within 48h, at 72h, and more than 96h after operation compared to the placebo group. Regarding overall complications (including headache), there was no statistical significance between diltiazem and placebo group. Topical application of diltiazem effectively relieves pain after hemorrhoidectomy with minimal side effects. Further large studies are needed to substantiate its value in clinical practice.

Randomized Trial of Open Hemorrhoidectomy Versus Stapled Hemorrhoidectomy for Grade II/III Hemorrhoids

Hemorrhoids are one of the most common anorectal disorders. Open hemorrhoidectomy (OH) is the gold standard surgical technique while stapled hemorrhoidopexy (SH) [procedure for prolapsed hemorrhoids (PPH)] is a newly developed method for the surgical management of hemorrhoids. A Medline, PubMed, and Cochrane data base search was performed. Relevant papers, e.g., randomized controlled trials, review, and meta-analysis from different parts of the world have shown stapled hemorrhoidopexy is less painful and it is associated with quicker recovery, but SH is associated with higher rates of skin tags, hemorrhoid recurrence, and prolapse recurrence than conventional hemorrhoidectomy. A randomized trial was conducted from March 2014 to March 2016 at M.Y.H. Hospital Indore tertiary care center. The aim of the study was to compare the early results in 100 patients randomly allocated to undergo either stapled or open hemorrhoidectomy. Patients with grade II and III hemorrhoids were randomly allocated to undergo either stapled (50 patients) or open (50 patients) hemorrhoidectomy. Post-operative pain was assessed by means of a visual analog scale (VAS). Recovery evaluation included return to pain-free defecation and normal activities. A 6-month clinical follow-up was obtained in all patients. Operation time for stapled hemorrhoidectomy was shorter (mean 35.8 mins [range 20 to 50] minutes versus 50.2 mins [range 30 to 60] minutes, p < 0.05). Mean (range) VAS scores in the stapled group were significantly lower (VAS score after 7 days: 2.2 [2 to 5] versus 3.3 [2 to 6], p < 0.05). Resumption of routine work was significantly faster in the stapled group (8.08 days versus 16.2 days, p = 0.001). At follow-up, 4 weeks and 4 months recurrence of symptoms and fecal urgency was present in 6/50 (12%) patients in the stapled group and 2/50 (4%) in the OH group (p < 0.05). Our initial results suggest that stapled hemorrhoidectomy is an effective treatment for symptomatic second and third degree hemorrhoids but with significant complication rates on follow-up in patients compared with traditional hemorrhoidectomy.

PPH AND BIOLOGICAL GLUE IN PATIENTS WITH HIGH RISK OF BLEEDING IN STAPLED HEMORRHOIDOPEXY.

ABSTRACTBackground: Stapled hemorrhoidopexy is a common treatment for grade 3 hemorrhoids. Patients with conditions that increase the risk of bleeding, as cardiac stents usage with clopidogrel bissulfate and liver cirrhosis, should receive an extra care in surgical procedures due to the high risk of bleeding. For this reason and for patients with third degree hemorrhoids we propose the use of stapled hemorrhoidopexy followed by the use of biological glue. Aim: Assess surgical outcomes in patients with hemorrhoids and high risk of bleeding submitted to stapled hemorrhoidopexy followed by biological glue. Methods: Between 2005 and 2015, 22 patients were analyzed, in a retrospective cohort study. Results: From 22 patients submitted to stapled hemorrhoidopexy followed by the use of biological glue, only one (4.5%) presented bleeding in the surgical postoperative. Patients do not have any other complications and pain in the postoperative period. The median (IQR) operation duration was 55 (12) min and the median (IQR) length of hospital stay after surgery was 3 (2) days. Conclusion: Patients with high risk of bleeding submitted to stapled hemorrhoidopexy followed by the use of biological glue presented very low rates of bleeding in the postoperative period.

Comparative Study of Outcome of Open Vs Closed Hemorrhoidectomy Vs Rubber Band Ligation in Third Degree Haemorrhoids

Comparative Study of Outcome of Open Vs Closed Hemorrhoidectomy Vs Rubber Band Ligation in Third Degree Haemorrhoids

A prospective study on suture ligation of internal hemorrhoids without Doppler guidance for the treatment of symptomatic hemorrhoid disease

Background: Hemorrhoids or piles are one of the most common afflictions of human being, affecting both sexes &amp; can occur at any age. The aim of the study was to study the effectiveness of suture ligation of hemorrhoids and mucopexy as an outpatient treatment for symptomatic hemorrhoids.Methods: This prospective observational study was carried out in the department of surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India on 64 adult patients of hemorrhoids treated by suture ligation of hemorrhoid pedicle without Doppler guidance and mucopexy from July 2012 to December 2014. The patients were managed as outpatient or day care cases. The observations and follow up data were recorded and descriptive analysis was done to study the clinical presentation of hemorrhoid disease and effectiveness of hemorrhoid ligation and mucopexy in an ambulatory, outpatient or day care setting.Results: Total 64 patients of hemorrhoids who underwent suture ligation of hemorrhoids and mucopexy were studied. Most of the patients were between 31- 60 years of age (74.28%) with males predominance (64.06%). All the patients in this study had bleeding per rectum as the main symptom. All patients had hemorrhoids in primary 3, 7 or 11 ‘o clock positions and 21 patients (32.8%) had secondary hemorrhoids as well. Majority the patients had 1-3 degree hemorrhoids. However hemorrhoid ligation was also done in 7 patients with fourth degree hemorrhoid who were severely anemic and unfit for surgery due to co morbidities. Over all 82.81% patients were free from symptoms at 1 year follow up after the procedure and only 7.81% of the patients had recurrence of bleeding or prolapse.Conclusions: Hemorrhoid suture ligation with mucopexy is a simple, safe &amp; cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains.

Evaluation of Office Ligation in the Treatment of Hemorrhoids at Nepalgunj Medical College Teaching Hospital

Introduction: Rubber band ligation, an outpatient procedure for treatment of 2nd and 3rd degree hemorrhoids is an effective mode of management.Aims and objectives: To evaluate the effectiveness of rubber band ligation as an office procedure in the treatment of 2nd and 3rd degree hemorrhoids.Material and Methods: This is a cross sectional hospital based study of 30 cases that underwent rubber band ligation as an outpatient procedure for 2nd and 3rd degree hemorrhoids done in Nepalgunj Medical College Teaching Hospital from the period of August 2014 to June 2015. The patients were followed up for six months for the development of procedure related complications, relief of symptoms, and requirement of any further interventions. The total cost of treatment was calculated and the time off work was noted. Patients were requested to assess the forms of treatment as excellent, moderately successful or of little help based on their results post treatment. Statistical analysis using SPSS software (version 20) was done and p value less than 0.05 was taken as significant.Results: Post procedure complications were milder and self-limiting, with discomfort in 57.5% (2nd degree) and 60% (3rd degree), pain in 5% (2nd degree) 40% (3rd degree), bleeding in 22.5% (2nd degree) and 30% (3rd degree) of patients with absence of any major complications (sepsis or death). Majority (77.5% in 2nd degree, 70% in 3rd degree) of the patients significantly improved after initial treatment with band ligation. Some of the patients treated by band ligation required further intervention i.e. 16.66% in 2nd and 16.66% in 3rd degree as repeat ligation in the immediate post-op period and were managed subsequently. But none of them required any surgical procedures. Majority of the patients treated by band ligation were able to resume their normal work within three day i.e. 95% in 2nd and 90% in 3rd degree hemorrhoids. Most of the patients spent Rs 2000- 2500 (52.5% in 2nd and 40% in 3rd degree) which most was on routine checkups and follow-ups but it was very cheaper as compared to others modalities. Most of the patients (77.5% in 2nd and 70% in 3rd degree) treated by band ligation assessed the treatment as excellent.Conclusion: Rubber band ligation is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an outpatient procedure with significant improvement in quality of life. Immediate relief of symptoms can be obtained in the post-operative period and therefore be considered as the treatment of choice for second and third degree hemorrhoid. Though the complications are slightly higher and improvement in symptoms were delayed than in second degree but still Rubber Band Ligation proved to be effective even in 3rd degree hemorrhoid.Journal of Nepalgunj Medical College Vol.13(1) 2015: 17-20

The non-surgical management for hemorrhoidal disease. A systematic review.

The non-surgical treatments for hemorrhoids are cost and time-saving techniques usually performed in patients suffering early hemorrhoidal disease. The most used are rubber band ligation (RBL), injection sclerotherapy (IS), and infrared coagulation (IRC). We performed a systematic review in order to evaluate: do these procedures really help to avoid further more aggressive treatments? What are the common harms? What are the rare harms? How many recurrences there are? A total of 21 RCTs were included in this review: 12 on RBL, 4 on IRC and 5 on IS. In RBL bleeding stops in up to 90% and III degree hemorrhoids improves in 78%-83.8%. IV degree prolapse should have a more invasive treatment. The commonest complications are bleeding and pain (8-80%). IRC related improvement is 78%, 51% and 22% for I, II and III degree. Post-operative pain occurs in 15-100% and post-operative bleeding ranges from 15% to 44%. Recurrence rate is 13% at a three months follow-up. IS brings to the resolution of prolapse in 90%-100% of II degree and allows good results for III degree even if reported only by case series. The post-procedural pain is 36%-49%. Bleeding is a very rare harm. Even if not definitive, these treatments could be an alternative for mild symptomatic patients after a clear explanation of recurrence rates and possible complications.

Comparative clinical study of Apamarga Kshara application, infrared coagulation and Arshohara Vati in the management of Arsha (1st and 2nd degree hemorrhoids).

Introduction:In anorectal disorders, incidences of piles and fissures are increasing in Indian population due to western lifestyle. Many surgical methods are available to cure anorectal disorders, but now a days, demand for Ayurveda and herbal preparation is increasing in society.Materials and Methods:In this study, Apamarga Kshara application, infrared coagulation (IRC) procedure and Arshohara Vati (AV) tablet were administered for the management of internal hemorrhoid (Arsha). This study was an open labelled, prospective, interventional study, in which patients of piles [n = 30 (10 each group)] were selected from OPD of Institutional hospital. Apamarga Kshara application (AKA) was done on the internal piles for 1–3 sittings as per requirement, IRC was applied at the base of piles for one sitting and two tablets (500 mg each tablet) of AV were given orally thrice a day for 15 days. In all the three groups, the patients were assessed every week for 1 month and were followed up for another 1 month for relief in signs and symptoms.Results:Obtained results were analyzed and encouraging results were observed after completion of the treatment.Conclusion:The study concluded that Apamarga Kshara application is the most effective treatment for the management of internal hemorrhoid of 1st and 2nd degree in comparison to IRC procedure and administration of Arshohara Vati.

Outcome of Injection Sclerotherapy for First Degree and Second Degree Haemorrhoids– A Study of 50 Cases

Introduction: Haemorrhoid is the frequent problem in clinical practice of general surgery. Haemorrhoids are dilatation and tortuosity of rectal veins affecting almost 4.5% of the population. Various operative and non operative therapeutic options are in practice to treat haemorrhoids, yet none has been proven cent percent effective. Sclerotherapy is a simple, safe and cost effective procedure that is widely practiced globally to treat haemorrhoids. Many sclerosants are being used with variable efficacies.&#x0D; Objective: To evaluate the outcome of injection Sclerotherapy in first degree and second degree haemorrhoids.&#x0D; Materials and Methods: Fifty patients of both gender having haemorrhoids who attended Outpatient Department (OPD) at BNS Patenga from September 2013 to August 2014 were included in this study. On the basis of history, patients were selected for Digital Rectal Examination (DRE) and proctoscopic examination to confirm the diagnosis. Sclerotherapy was repeated at interval of 6 weeks till symptomatic relief was achieved. Maximum 3 sittings of sclerotherapy were given. Patients were followed up at 3 months interval for 1 year.&#x0D; Results: This prospective study was conducted on 50 cases of first degree and second degree Haemorrhoids. The highest number of patients 21(42%) were in the age group of 21-30 years with majority 38(76%) being male. Male female ratio was 3.16: 1. All the patients presented with painless per-rectal bleeding. Satisfactory results were observed in 29(58%) patients of whom 20(40%) patients were having first degree haemorrhoids and 9(18%) patients were having second degree haemorrhoids. Sclerotherapy was more effective in first degree compared to second degree haemorrhoids patients.&#x0D; Conclusion: Injecting Sclerotherapy is a suitable office procedure for treatment of haemorrhoids. The method is easy, convenient, cheap, well accepted and comfortable for patient. More or less there are no complications and the result is also satisfactory.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 98-101

May radiofrequency be the best choice for III-IV degree hemorrhoids?

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. 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. 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. Radiofrequency hemorrhoidectomyis a valid alternative to the conventional diathermy technique, due to the reduction of operative time, postoperative pain, early and late complication rate.

LigasureTM hemorrhoidectomy: how we do.

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. 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. 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. 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.

DIATHERMY HAEMORRHOIDECTOMY

Objectives: Hemorrhoids is a common ano-rectal disorder, and heamorridectomyis universally accepted procedure. Haemorrhoidectomy can be carried out under severalmodes of anesthesia. Local anesthetic produce a loss of sensation and muscle paralysis ina circumscribed area of body by localized effect on peripheral nerve endings. The aim ofthis study is determine long term and short term outcome of diathermy haemorrhoidectomyunder local anesthesia, in term of early recovery, hospital stay, postoperative pain, bleedingand recurrence. Study Design: Cross sectional, descriptive case series study. Period: 24-02-2014 to 24-02-2015. Setting: Department of General Surgery, Liaquat University of Medicaland Health Sciences Jamshoro / Hyderabad. Method: 50 patients of haemorrhoidectomy. Allpatients of III and IV degree hemorrhoids, which are fit for surgery were included whereasthose patients who had previous anal surgery, co-existing disease i.e. Crohn’s disease, chronicdiarrhea illness, malignancy of anal region, hyper sensitivity to local anesthetics were excludedfrom the study. Data was collected and analyzed in SPSS version 20.0. Results: A total of 50patients of haemorrhoidectomy were included. The mean operative time was 15.04 minutes (n= 50). 9(18.0%, n = 50) patients had the complaint of pain, 15(30.0%, n = 50) patients haditching around anus. Postoperatively 9(18.0%, n = 50) patients got pain relief within one week,no post operative bleeding was observed within the one week. Two patients (4.0%, n = 50) hadtemporary incontinences infection. Only 1(2.0%, n = 50) patient developed anal stenosis withinthe long term period of one month to 1 year. Conclusion: Diathermy hemorrhoidectomy underlocal anesthesia feasible, safe and well tolerated by our environment and population.

English

Objectives: Hemorrhoids is a common ano-rectal disorder, and heamorridectomyis universally accepted procedure. Haemorrhoidectomy can be carried out under severalmodes of anesthesia. Local anesthetic produce a loss of sensation and muscle paralysis ina circumscribed area of body by localized effect on peripheral nerve endings. The aim ofthis study is determine long term and short term outcome of diathermy haemorrhoidectomyunder local anesthesia, in term of early recovery, hospital stay, postoperative pain, bleedingand recurrence. Study Design: Cross sectional, descriptive case series study. Period: 24-02-2014 to 24-02-2015. Setting: Department of General Surgery, Liaquat University of Medicaland Health Sciences Jamshoro / Hyderabad. Method: 50 patients of haemorrhoidectomy. Allpatients of III and IV degree hemorrhoids, which are fit for surgery were included whereasthose patients who had previous anal surgery, co-existing disease i.e. Crohn’s disease, chronicdiarrhea illness, malignancy of anal region, hyper sensitivity to local anesthetics were excludedfrom the study. Data was collected and analyzed in SPSS version 20.0. Results: A total of 50patients of haemorrhoidectomy were included. The mean operative time was 15.04 minutes (n= 50). 9(18.0%, n = 50) patients had the complaint of pain, 15(30.0%, n = 50) patients haditching around anus. Postoperatively 9(18.0%, n = 50) patients got pain relief within one week,no post operative bleeding was observed within the one week. Two patients (4.0%, n = 50) hadtemporary incontinences infection. Only 1(2.0%, n = 50) patient developed anal stenosis withinthe long term period of one month to 1 year. Conclusion: Diathermy hemorrhoidectomy underlocal anesthesia feasible, safe and well tolerated by our environment and population.

Strengths and limitations of Close vs Open Haemorrhoidectomy in Patients of 2nd and 3rd Degree Hemorrhoids

Fifty patients were randomly selected who presented with symptoms of hemorrhoids at out patient of surgical-I Jinnah Hospital, Lahore between Jan 01-June 02. Eligibility criteria were laid down and half of our study population was subjected to open haemorrhoidectomy and half to close. Post operatively all the study participants were evaluated for the healing time and stenosis. The results showed that hemorrhage less. healing time rapid with rare incidence of anal stenosis in closed as compared to open haemorrhoidectomy. The results were statistically significant when Fisher`s exact probability was applied. Based on results it was concluded that closed haemorrhoidectomy is a far superior procedure than open.

Open versus Closed Hemorrhoidectomy - An Experience at Mayo Hospital

Hemorrhoids are a common problem that affects a larger group of population. It affects both sexes and is more common in the more prosperous societies, perhaps related to exercise, diet and bowel habits. The objective of the study was to compare the outcome of the two conventional methods of haemorrhoidectomy, open and closed techniques for 3rd degree prolapsing and complicated haemorrhoids. This would be a non-interventional type of study comparing the two methods conducted at surgical unit-1 Mayo Hospital, Lahore comprising of fifty patients selected randomly and equally divided in two groups. No statistically significant differences were found between the two methods regarding complications and postoperative hospital stay (P&gt;0.05). Pain and the analgesic requirement on the day of surgery and the first postoperative day was significantly lower (P&lt;0.05) in open haemorrhoidectomy group. Complete wound healing took longer in open haemorrhoidectomy as compared to closed technique, 3 patients suffered wound dehiscence after closed haemorrhoidectomy. Only 4% in each group develop recurrence after one year. Open haemorrhoidectomy leads to more reliable wound healing with lesser complications, though heeling time is more as compared to the closed technique. Both techniques are fairly efficient for treating third degree haemorrhoids.

Stapled Hemorrhoidectomy: hope or hype!

This study was carried out to assess the feasibility of Stapled haemorrhoidectomy. This included 45 patients of which twenty nine were males and sixteen females. Age ranged from 23 to 84 years. The severity of the disease ranged from 3rd to 4th degree haemorrhoids. Place of study was Sir Ganga Ram, Masood and Wishaw Hospital Scotland. Period of study was two years from October 2002 to October 2004.

Ambulatory management of Hemorrhoids by Rubber Band Ligation

Objective: To evaluate the efficacy of rubber band ligation for the management of internal haemorrhoids. Study design: A prospective randomized study. Place and duration of study: Department of Surgery Lahore General Hospital conducted from April 1999 to June 2002. Subject/Methods: One hundred and eighty patients with II &amp; III degree Hemorrhoids were treated with rubber band application. Results: About 562 band applications in 255 sessions were made. Follow up ranged from 3 to 50 months with a median follow up of 19 months. The common post procedural complaints were anal discomfort (78 patients), proctalgia (24 patients) and soiling (12 patients). The overall success rate of RBL was 91.7%. Conclusion: Ambulatory RBL should be considered as a safe and effective treatment for 2nd and 3rd degree symptomatic haemorrhoids and is associated with low morbidity.

Transanal Hemorrhoid Dearterialization and mucopexy: a minimal invasive approach for prolapsed hemorrhoids. Four cases report.

Hemorrhoidal disease is one of the most frequent causes of anal pathology. Surgical therapy is reserved for patients who do not respond to non-operative management and for advanced third and fourth degree hemorrhoids. Milligan-Morgan and Ferguson hemorrhoidectomies are considered the first-choice therapy, but these procedures are associated with postoperative complications including infection, stenosis, pelvic floor dysfunction, rectal bleeding and postoperative pain. In order to minimize postoperative complications, less invasive procedures have been described and two of them are reported with promising results: Stapled hemorrhoidopexy (PPH) and Transanal Hemorrhoid Dearterialization (THD). THD involves ligation of the hemorrhoidal arteries under Doppler guidance resulting reduced inflow that facilitates reduction in size of hemorrhoids, while suture mucopexy addresses the prolapsed mucosa. THD is proven as a reliable technique for third degree hemorrhoids, but its role in fourth degree hemorrhoids is not generally accepted. Herein we report four cases of prolapsed hemorrhoids which were treated with THD and mucopexy. The procedure was successful in all patients. Photographs taken, before and after the procedure, show an impressive reduction of the prolapsed hemorrhoids. THD and mucopexy appears to be an effective technique with the potential of treating not only third degree, but advanced hemorrhoids as a safe one-day procedure with immediate visible results.

A Comparative Study of Open (Milligan-Morgan) Versus Closed (Ferguson) Hemorrhoidectomy

&lt;strong&gt;Introduction&lt;/strong&gt;: Hemorrhoidectomy is an operation for third and fourth degree haemorrhoids. There are two methods by which hemorrhoidectomy can be done -open (Milligan-Morgan) in which the wound is left open and allowed to heal by secondary intension and closed (Ferguson) methods in which the wound is closed with absorbale sutures. &lt;strong&gt;Aim:&lt;/strong&gt; To compare post operative pain and recovery in open (Milligan-Morgan) and closed (Ferguson) methods and evaluate optimum choice of the procedure for third or fourth degree hemorrhoids. Study Design: Prospective randomized study. &lt;strong&gt;Settings:&lt;/strong&gt; Department of Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Center. &lt;strong&gt;Duration:&lt;/strong&gt; Two year (August 2010 to August 2012). Sample Size: 70 cases (35 cases in each group). Inclusion Criteria: Patients with third/four degree hemorrhoids. Exclusion Criteria: Patients with associated anal and perianal conditions like fissure in ano, inflammatory bowel diseases and rectal malignancy, portal hypertension were excluded from the study. &lt;strong&gt;Results:&lt;/strong&gt; Mean hospital stay for open group was 5 days and closed group was 3 days. Post operative pain was seen in 77% in open group and 48 % in closed group. Pain was relieved earlier in closed group. 71% patients had completely healed wounds at 3 weeks in closed group in comparision to only 42% in open group. Anal stenosis was seen in 2 patients of open hemorrhoidectomy. &lt;strong&gt;Conclusion:&lt;/strong&gt; Closed hemorrhoidectomy is the procedure of choice for three/four degree hemorrhoids.

Conventional versus diathermy coagulation haemorrhoidectomy - a prospective study

Background: Haemorrhoids is one of the most frequently encountered anorectal disorders in clinical practice of surgeon. The main aim of the study was to compare conventional haemorrhoidectomy to diathermy coagulation. Methods: 60 patients irrespective of their age and sex suffering from the late second and third degree hemorrhoids were divided into 2 groups of 30 patients each. Group A patients were subjected to conventional closed haemorrhoidectomy. Group B patients were subjected to diathermy coagulation of the pedicle. Results: The results were compared by comparing complications and relief of symptoms after each surgery. The follow up was done for 3 months. Conclusions: The traditional method of mass ligature of haemorrhoidal pedicle is not necessary and electrocoagulation of haemorrhoidal pedical is safe, economical and less time consuming.