Ferguson Technique Research Articles

Is the combination of laser hemorrhoidoplasty and Ferguson hemorrhoidectomy superior to conventional surgical techniques in terms of postoperative pain in hemorrhoid patients? A retrospective comparative analysis

This study aimed to evaluate early and long-term results of three surgical methods (Ferguson hemorrhoidectomy, laser hemorrhoidoplasty, and the combined method), especially for pain management in hemorrhoidal disease. Between January 2018 and January 2020, 154 patients diagnosed with symptomatic grade II–III hemorrhoid disease were treated with three surgical techniques: (1) Ferguson hemorrhoidectomy (FH);(2) laser hemorrhoidoplasty (LHP); (3) combined (Ferguson hemorrhoidectomy + laser hemorrhoidoplasty) method. Patients were retrospectively evaluated for duration of surgery, recovery time of symptoms, postoperative pain, early and late complications, and recurrence. When the postoperative early and mid-term pain levels of the patients were compared, the results showed that patients treated with the Ferguson technique had the most severe pain scores after surgery at postoperative 6th, 12th, 24th hours, and 1st week, compared to the other techniques (LHP and combined method) (p < 0.001). The LHP method had the lowest pain levels when compared to the Ferguson and the combined methods (p < 0.001). The combined method had significantly lower pain scores than the Ferguson method in all periods after surgery (p < 0.001). Upon the development of postoperative perianal thrombosis in two patients in the LHP group, one patient underwent thrombectomy, and the other patient underwent medical treatment. There were two hemorrhoid disease recurrences, with a median follow-up period of 24 (12–36) months in the LHP group. In the FH group, reoperation and hemostasis were done for bleeding on the postoperative sixth day in one patient, and a Foley catheter was applied due to urinary retention in one patient. Two anal fissures were seen postoperatively in one month in the FH group and recovered with medical treatment. In patients with multiple hemorrhoid packages, the combined method can be better used safely and effectively, with significantly lower pain scores than the Ferguson method only.

An actuarial comparison of loss-ratio-Bornhuetter-Ferguson and classical chain ladder techniques in insurance loss reserving: A computational approach

An insurance firm promises to reimburse benefits to the insured when unforeseen events evolve. When such contingencies arise, the underwriter has a liability to pay the claim through loss reserving techniques. The estimation of such loss reserving should be technically performed so the insurance firm will not run into a loss. This study aims to (i) estimate the Bornheutter-Ferguson reserve and the inverse of its development factor λn under the aegis of the loss ratio framework. (ii) numerically estimate the chain ladder reserve and final losses, (iii) estimate the Ratio of cumulative payments in successive development periods, and (iv) demonstrate to professional insurance firms how to use these techniques in practice. These techniques evaluated through some run-off loss matrix can be employed to estimate technical provisions for the outstanding claims. Computational evidence from our results over the periods analyzed confirms that on the assumption of 0.9 the loss ratio, the Bornheutter- Ferguson technique as an actuarial extension of the chain ladder method numerically presents a lower reserve value than the corresponding chain ladder reserve, and hence CLreserve=249,811.708>BFreserve=86,612.58.

Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial

PurposeTo compare short-term and medium-term results of superior rectal artery embolization versus surgical hemorrhoidectomy in the treatment of patients with hemorrhoidal disease. Material and MethodsThis study was a prospective randomized clinical trial following 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups: the superior rectal artery embolization group (n = 15) and Ferguson closed hemorrhoidectomy surgical group (n = 14). Four patients were excluded from the analysis. Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months. ResultsThe mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001). The mean use of pain medication was higher in the surgery group (28.92 doses ± 15.78 vs 2.4 doses ± 5.21; P < .001). In the embolization group, the most prevalent preprocedural symptom was bleeding in 14 patients, with complete improvement in 12 (83.3%) patients. Mucus, skin tag, and pruritus were symptoms that showed little improvement in both groups. The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691). No severe adverse events were observed in both groups. ConclusionsDespite no difference in outcomes, embolization of the superior rectal arteries for the treatment of hemorrhoidal disease showed pain levels lower than those observed after surgical treatment.

Hemoroidlerin Cerrahi Tedavisinde Ferguson Hemoroidektomi

Aim: To assess the outcome of the conventional Ferguson approach in the surgery of our patients who were operated on for prolapsed internal hemorrhoid.Method: 769 patients who were treated with the Ferguson technique between March 2007 and January 2017 were included in the study. Patients' medical files were assessed and, the complaints at presentation, anorectal comorbidities, operation findings and postoperative early and late complication data were recorded.Results: 65% of the patients were male and the mean age was 39 years (18 -81). The durations of complaints varied between one week and 5 years. In the order of higher to lower frequency the complaints were palpable pakers, bleeding and pain respectively. The pakers were at classical locations (3,5,7,11 o’clock) in 69 % of patients. Most of the cases (65%) were grade 4 hemorroid. 19 % of patients had anal fissures as anorectal comorbidity. All patients were operated on at the lithotomy position under spinal anaesthesia. Operation time for ferguson technique was on average 20 minutes and postoperative stay in hospital was one day on average. During the postoperative period, 55 patients developed early complications. These included severe abdominal pain in 25 patients (3-25%), bleeding in 3 (0,4%) and urine retention in 28 (3.60%). Late complications developed in 7 patients. There developed anal stenosis in one patient, anal fissure in 3 and fistula with an abscess in 2. Incontinence and recurrence were not observed in any patient.Conclusion: Ferguson technique is still employed for hemorrhoid surgery. The results of our study support the Ferguson hemorrhoidectomy as a reliable method of preference.

Comparison Between Ferguson's Technique and Mitchelle Bank Technique for Inguinal Herniotomy in Children

Objective: To assess the safety of the Mitchelle bank technique for herniotomy in children by comparing its recurrence rate with conventional Ferguson's technique.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Paediatric Surgery Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Sep 2019.&#x0D; Methodology: Children below the age of 6 years coming to Paediatric Surgery Outpatient Department with inguinal hernia were included in the study. The patients were divided into two groups. Group-I underwent herniotomy by Mitchelle bank technique (MBT-group) while Group-II by Ferguson's technique (FT-group). The demographic characteristics of the studied population, operative time, and intra-operative and post-operative complications were recorded.&#x0D; Results: The mean age of the patients was 25.94 ± 17.06 months in Ferguson's technique-group and 24.76 ± 16.63 months in the Mitchelle bank technique-group. The mean operative time was less in the Mitchelle bank technique-group (13.17 ± 1.47 minutes) as compared to Ferguson's technique-group (16.23 ± 1.51 minutes) (p&lt;0.05). Early complications such as hydrocele, seroma and hematoma were seen in 5 (2.3%), 6 (2.6%) and 3 (1.3%) cases in Ferguson's technique-group, and 15 (6.9%), 8 (3.7%), and 9 (4.1%) cases in the Mitchelle bank technique group, respectively. Late complications such as orchitis, testicular atrophy, and recurrence were seen in 5 (2.3%), 6 (2.6%), 2 (0.9%) in Ferguson's technique group, and 6 (2.6%), 4 (1.8%), and 3 (1.3%) in the Mitchelle bank technique group (p&gt;0.05).&#x0D; Conclusion: Mitchelle bank technique is safe for herniotomy in children with less operative time and no increase in...

Measurement of Lumbar Lordotic and Lumbosacral Angle in Patients with Chronic Low Back Pain

The investigation intended to quantify lumbar lordotic and lumbosacral Angle (LLA) in patients with lower back pain. The examination was completed on 54 patients with chronic low back pain, in a multispecialty hospital in India, over a period of 6 months for lumbosacral lateral radiographs. The lumbar lordotic angles were measured by Ferguson's technique. The age group ranged from 21-65 years with the weight range of 33 to 88 kg, height range of 133 to 182 cm, and BMI range of 15.2 to 36.6 (Kg/ m2). The mean weight, height, and BMI were 59.8 kg, 159.1 cm, 23.7 kg/m2 respectively. The overall range of peak kilovoltage was 60 to 75 kVp. The mAs range was 53 to 78. The mean lumbar lordotic angle (LLA) of the study population was 50.1 degrees with a range of 23 to 68 degrees.

Emergency surgical treatment for active bleeding and anemia in patients with hemorrhoidal disease.

The purpose of the study is to describe the clinical and surgical characteristics of patients with hemorrhoidal disease (HD), anemia, and active bleeding in need of urgent surgery. It is a descriptive, retrospective study of 510 patients between 2015 and 2019. Male and female patients diagnosed with HD. The records of these patients were reviewed, and we identified those who underwent emergency surgery due to active bleeding, anemia, shock, and other clinical problems. Statistical analysis was carried out with the SPSS version 24 software. Fifty-three (10.3%) patients met the criteria for presenting active hemorrhoidal bleeding at the time of review and clinical and biochemical data of anemia. Patients presented a mean hemoglobin of 7.5 g/dl. The most frequent degree of HD was Grade II. The treatment received in 92.5% of the cases was hemorrhoidectomy with the Ferguson technique; in 5.7% (3), a hemorrhoidectomy was performed with an advanced energy device, and 1.9% (1) underwent the Milligan-Morgan technique. Emergency hemorrhoidectomy is the treatment of choice for patients with severe active bleeding from HD.

A Meta-Analysis on the Comparison Between Pediatric Inguinal Herniotomies Performed With and Without Incising the External Oblique Aponeurosis in Terms of Recurrence and Complications

Rationale: There is a diversity of methods in performing pediatric inguinal herniotomy, but no consensus on which is the gold standard. The two most common are the Ferguson technique and the Mitchell Banks technique. The objective of this meta-analysis was to compare the two techniques in terms of hernia recurrence and post-operative complications: namely hematoma, hydrocele, testicular ascent, and testicular atrophy. Methods: Three randomized controlled trials and one multi-center retrospective study were included in this meta-analysis. Using the Cochrane Collaboration tool and Newcastle-Ottawa quality assessment scale, all studies included were deemed to be of good quality and have low risk of bias. Revman 5.3 was used for all statistical analyses. Results: There was no significant difference in terms of hernia recurrence between the two techniques (OR = 0.85, 95% CI = 0.31- 2.36). For post-operative complications, hematoma (OR = 0.64, 95% CI = 0.37-1.13), testicular ascent (OR = 0.28, 95% CI = 0.05- 1.50), and testicular atrophy (OR = 2.02, 95% CI = 0.54-7.52) did not differ between the two techniques. Only the incidence of postoperative hydrocele significantly differed between the two techniques, being higher when the external oblique aponeurosis was opened (OR = 0.44, 95% CI = 0.27-0.70). Conclusion: Performing pediatric inguinal herniotomy without opening the external oblique aponeurosis is a safe procedure and may be recommended as an optimal choice of method for uncomplicated cases. Key words: Pediatric herniotomy, Mitchell-Banks, Ferguson, external oblique aponeurosis

English

BACKGROUND Chronic low back pain (CLBP) is one of the common debilitating condition in middle-age population. Often the pain is "non-specific" or related to mechanical origin; so, often it is termed as chronic mechanical low back pain. Among the various predisposing factors, abnormal lumber lordosis is more often seen. Radiographic assessment of lumbar lordosis can be done by measuring lumbosacral angle (LSA). Therefore, study of variations in LSA among these patients can give important clues in both pathogenesis and management. The aim of the study is to determine different factors leading to the variations of lumbosacral angle amongst the middle-aged patients presenting with chronic mechanical low back pain. METHODS This retrospective study was conducted by analysing records of 105 CLBP patients of both sex (male = 32, female = 73) in the age group of 45 - 65 years. LSA was directly measured digitally by Ferguson technique from the selected patients’ lateral lumbosacral radiographs. Data was collected in Microsoft Excel 2016 and analysis was done with International Business Machines Statistical Package for the Social Sciences (IBM SPSS) Statistics version 23. RESULTS The difference in median of LSA of male [Median (IQR) = 37.00 (10.00)] and female [Median (IQR) = 45.00 (8.50)] patients was statistically significant (p-value 0.000). Significant positive correlation was also found between LSA and BMI for both sexes, but more in case of female (Spearman’s rho 0.806 p = 0.000) than male (Spearman’s rho 0.680 p-value 0.000). CONCLUSIONS Variation of LSA was found to have significant relations with sex and body mass index (BMI), but not with the age. Statistically significant positive correlation between LSA and BMI alongside higher BMI of the females in the study group suggested that they are more prone to develop CLBP. To formulate proper rehabilitation protocol for middle aged CLBP patients, LSA variations and related factors can be kept in mind. KEYWORDS Chronic Low Back Pain (CLBP), Lumbosacral Angle (LSA), Lordosis, Rehabilitation, Body Mass Index, Lordosis, Spine, Radiography, Rehabilitation

A Study of normal variation in lumbosacral angle in asymptomatic patients attending orthopaedic out-patient department of a medical college hospital, Telangana

Introduction: The Lumbosacral angle (LSA), is the angle formed between a line across the plane of the superior margin of the sacrum and a horizontal line. Various literature and studies around the world shows wide normal variation in LS angle, ranging from 320 to 440. Abnormal variation in LS angle is commonly associated with low back pain. Hence research involving study of normal variation of LSA in different ethnic population plays a significant role. In Indian scenario very few studies are available, especially from rural population, to know up to what extent, variation in LS angle is normal. Hence, the present study attempts to study the normal variation in LSA in rural population of Telangana. Materials and Methods: A descriptive study of normal LSA variability, involving 100 asymptomatic subjects between the age group of 20-60 years was carried out in orthopedic department of Medical College hospital, Telangana. Ferguson’s technique was employed for calculation of LSA. Results: In this study variation of LSA ranges from 280 to 600. Overall average LSA was 340.Females have greater average LSA as compared to males. Conclusion: Results of the present study show variability when compared to other similar studies, which further strengthen the fact that normal variation in LSA differs among different region and races; hence results of the present study will be a useful tool to health care providers for treating different spinal disorders of rural Telangana population. Keywords: Lumbosacral angle (LSA), Ferguson technique, Lumbar lordosis, LSA Variation, Spinal maturity.

HAEMORRHOIDECTOMY;

Haemorrhoids are one of the most common anorectal disorders. Internalhaemorrhoids are symptomatic anal cushions and characteristically lie in the 3, 7 and 11 o’clockposition whereas external haemorrhoids relate to venous channels of the inferior haemorrhoidalplexus. Objectives: To compare the outcome of haemorrhoidectomy using harmonic scalpelversus conventional closed haemorrhoidectomy. Study Design: Randomized control trial.Setting: Department of Surgical unit II, Jinnah Hospital, Lahore. Period: Six months from 25thDecember 2014 to 24th June 2015. Methodology: A total of 140 patients were included inthis study. Patients were divided in two groups A &amp; B. In Group A, (70 patients) conventionalhaemorrhoidectomy was performed by the Ferguson Technique (closed technique) whereasin Group B, (70 patients) suture less closed haemorrhoidectomy was performed by using theharmonic scalpel. Results: The mean age of the patients in group A was 43.3±8.2 years andin group B was 42.3±7.3 years. The mean time for surgery in group A was 23.8±4.2 minutesand in group B was 8.5±3.6 minutes. The mean pain score in group A was 5.3±1.8 VAS andin group B was 3.9±1.9 VAS. In group A, less than 1 day postoperative hospital stay was in 62(88.6%) patients and in group B, it was in 66 (94.3%) patients. Conclusions: It is concludedfrom this study that haemorrhoidectomy by harmonic scalpel results in decrease in operationtime and less postoperative pain although there is not much significant difference in less than 1day hospital stay as compared to the conventional closed haemorrhidectomy technique.

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study.

Objective:To evaluate the effect of inguinal operations performed with a modified Ferguson technique upon testicular volume and blood flow.Methods:This study involved 23 children receiving surgery for inguinal hernia, hydrocele, and cord cyst. This was a prospective study performed between April 2016 and June 2016 in a medical faculty pediatric surgery unit. The color Doppler ultrasound (CDUS) was used to assess testicular volume and blood flow before and after a modified Ferguson technique surgery. The pre- and post operative testicular volume and blood flow were compared with the contralateral testes. SPSS software was used to statistically analyze the data arising; the Mann-Whitney U test and Friedman test were used to compare samples, and P<0.05 was accepted as statistically significant.Results:Preoperative and postoperative testicular volumes were not statistically different when compared to contralateral testes. In patients with right sided inguinal pathology, testicular blood flow on the right side was significantly lower than that on the left side (P=0.023). The testicular blood flow was not statistically different compared with the contralateral testes during the first week evaluation and first month evaluation. The blood flow, probably reduced due to the pressure caused by inguinal pathology, was normalized through surgery.Conclusions:The modified Ferguson technique do not change the testes volume and blood flow.

Modified Marcy repair for indirect inguinal hernia in children: a 24-year single-center experience of 6826 pediatric patients.

To evaluate the management and outcomes of modified Marcy repair for inguinal hernia in a large series of children. We analyzed the case records of 6826 pediatric patients who underwent surgery for inguinal hernia between January, 1991 and January, 2015 at Split University Hospital in Croatia. The following parameters were examined: sex, age, location of the hernia, intraoperative or postoperative complications, recurrence, and surgical method. The 6826 patients included 4751 boys and 2075 girls operated on for inguinal hernia. The mean age was 3.5years, and mean followup was 14years. Right-side predominance was noted with 59.50% right hernia repairs, 33.72% left hernia repairs, and 6.78% bilateral hernia repairs. There were 6410 (93.90%) elective procedures and 416 (6.10%) emergency procedures for incarceration. The mean duration of surgery was 26min (14-90min), and the mean hospital stay was 1day. Marcy repair was the most commonly performed operation (95.76%), whereas Ferguson's technique was performed in only 3.98% of the children. The overall recurrence rate was 0.43%, with a recurrence rate of 0.36% for Marcy repair and 1.83% for Ferguson repair (p=0.0003). Modified Marcy hernia repair is a safe and effective procedure for inguinal hernia in children with excellent outcomes and a low incidence of recurrence.

Measurement of lumbosacral angle in normal radiographs: a retrospective study in southeast Nigeria.

Background:A retrospective study of lumbosacral angle (LSA) in normal lateral supine lumbosacral radiographs of 274 Nigerians (aged 15-74 years) of Southeast region. A supine lateral lumbar spine radiograph is a very accurate means of measuring lordotic angles. The LSA is one of such angles, and can be used in the investigation, treatment and follow-up of low back disorders. Little is known about what the normal value for our population is and therefore, what constitutes hypo-/hyper-lordosis; most of the data in use in medical practice are based on studies on other races.Aim:To quantify the normal LSA in our population.Materials and Methods:LSA was measured by the Ferguson's technique and the data analyzed with SPSS Statistics version 17.0 (Chicago IL, USA).Results:LSA varied between 18° and 71°. With a 95.0 confidence interval of 43.3-45.6°, the mean (standard deviation) was 44.5 (9.9)° and showed no significant variation with sex and between various age groups; it compared favorably (though with small difference) with some of the literature values currently in use.Conclusion:This study had established the normal lordosis and the possible values at which to consider hypo-lordosis (below 15°), and hyper-lordosis (above 75°) in our population. Also established is that the development of lumbar lordosis ceases at spinal maturity, and that in normal lumbar lordosis measurement, the retrospective approach is a credible alternative to the prospective method.

Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques

The analysis of 2,840 cases of hemorrhoidectomy by open techniques of Milligan-Morgan (2,189 cases), Ferguson (341 cases) and mixed (310 cases) in 11,043 patients with hemorrhoidal disease (HD) allowed the following conclusions. The patients' acceptance of surgical indication for hemorrhoidectomy was 25.7%. Hemorrhoidectomy was more common among women (53.8%) than men (46.2%), and more accepted by women (26.5%) than men (24.8%). Hemorrhoidectomy was more common in patients of the fourth (27.7%), fifth (21.9%) and third (21.0%) decades of age. Most patients who agreed to undergo hemorrhoidectomy were those of the second (38.2%), eighth (35.9%) and ninth (34.5%) decades of age. The overall incidence of surgical complications was 3.0% (87 cases): anal stenosis (1.8%), bleeding (0.8%), worsening of anal hypotonia (0.2%), sepsis (0.1%) and systemic complications (0.1%), with no difference among the techniques used. The incidence of surgical complications by Milligan-Morgan technique was 3.0% - stenosis (1.9%), bleeding (1.9%), worsening of anal hypotonia (0.2%) and systemic complications (0.04%). The incidence of surgical complications by Ferguson's technique was 3.5% - stenosis (1.7%), bleeding (0.6%), worsening of anal hypotonia (0.6%) and sepsis (0.6%). And the incidence of surgical complications by mixed techniques was 2.5% - stenosis (1.0%), bleeding (0.3%), worsening of anal hypotonia (0.3%), sepsis (0.3%) and systemic complications (0.3%). The incidence of surgical complications according to gender was 3.0% among women and 3.2% among men, with higher incidence of stenosis in women (2.0%) and hemorrhage in men (1.1%). Surgical complications were more observed in the eighth (5.1%) and seventh (3.8%) decades of age. The incidence of anal stenosis was 1.8%, being 64.0% without hypotonia and 66.0% without anal fissure (66.0%), with annular stenosis as the most common anatomical shape (70.0%). Anal stenosis was more common among women (2.0%) presenting mean age of 38.2 years, with no relation to age decades. The most common technique for anal stenosis was single anotomy without sphincterotomy (46.0%). All cases of anal bleeding had surgical ligation of all hemorrhoidal pedicles, no matter if the bleeding site was found or not.

Ferguson hemorrhoidectomy: is still the gold standard treatment?

Hemorrhoidectomy remains the most definitive procedure to treat symptomatic grades III and IV hemorrhoids. However, over the years, several modifications have been made to the original operation to improve the outcomes. A total of 693 consecutive patients with grade III and IV hemorrhoids underwent Ferguson hemorrhoidectomy. Our results serve as a standard for comparison conventional hemorrhoidectomy (Ferguson's technique) with recent methods such as stapled hemorrhoidopexy and LigaSure hemorrhoidectomy. We have obtained a very low rate of post-operative pain after Ferguson hemorrhoidectomy (VAS pain score was 2.47 ± 1.1 after a day, 1.34 ± 0.7 after 7 days and 0.51 ± 0.1 after 2 weeks) as to for stapler and LigaSure procedure in the literature. Moreover, long-term results demonstrate high levels of patient satisfaction (the satisfaction was good in 624 patients after 2 weeks and in 658 patients after 1 year) with a low recurrence rates (7 patients had recurrence after 1 year and 21 patients after 2 years). We believe that Ferguson-closed hemorrhoidectomy could still be, at the moment, the gold standard to which other techniques are compared.

Ferguson Hemorrhoidectomy with Radiofrequency versus Classic Diathermy

ABSTRACTBackground: This randomized study compared results obtained with the Ferguson's technique for the treatment of hemorrhoids performed with a radiofrequency (RF) scalpel and traditional diathermy. Methods: 28 patients affected by grade IV hemorrhoids were randomized to receive either the Ferguson operation with the RF scalpel (group A) or traditional diathermy (group B). The operating time, intra- and postoperative bleeding, postoperative pain, and overall patient satisfaction were all recorded. Results: Six patients (three for each group) did not attend follow-up controls. Group A showed a significant reduction of the surgical time (23 vs. 33 min; p < .01), pain at first postoperative day (Visual Analog Scale [VAS] score 3.4 vs. 4.8; p < .05), and at the first evacuation (3.4 vs. 5.0; p < .05). No significant differences were observed for the pain score at the seventh postoperative day, or overall satisfaction scores at the 7th postoperative day, and six months postoperatively (p = NS). No severe complications were recorded. Two patients in group A (18.2%) and four patients in group B (36.4%) reported transitory gas incontinence that spontaneously resolved within one month (p = NS). Three patients in group A (27.3%) and four patients in group B (36.4%) required postoperative catheterization due to urinary retention (p = NS). Conclusions: RF scalpel shortens the operating time of the Ferguson operation and is less painful in the early postoperative period.

Randomized trial comparing LigaSure to closed Ferguson hemorrhoidectomy

Performing hemorrhoidectomy with LigaSure vessel sealing system is a relatively new technique. The aim of the study was to evaluate LigaSure hemorrhoidectomy by comparing its results to closed Ferguson technique. Eighty patients with grades III and IV hemorrhoids were prospectively randomized to either LigaSure or Ferguson hemorrhoidectomy. Primary end point was postoperative pain. Secondary end points were operative time, blood loss, morbidity, manometric assessment, need for analgesics, hospital stay, time to achieve complete wound healing, and patient satisfaction. The LigaSure group achieved a significant reduction in operative time (P < 0.001), blood loss (P < 0.001), first postoperative day pain score (P < 0.006), seventh day pain score (P < 0.012), second week pain score (P < 0.001). Less patients in the LigaSure group required pethidine analgesia on the first postoperative day (P < 0.006). Hospital stay (P < 0.001), time to achieve complete wound healing (P = 0.001) were shorter in the LigaSure group, and third month satisfaction score was higher (P = 0.03). There was no difference in postoperative complications. Postoperative manometric resting (P = 0.0001) and squeeze (P = 0.001) pressures were significantly decreased in the Ferguson group. LigaSure hemorrhoidectomy provides a valid alternative to closed hemorrhoidectomy. LigaSure patients gain short-term benefits in terms of reduced postoperative pain, wound healing, and better satisfaction. Based on our preliminary results, future studies addressing long-term functional results are needed to prove that LigaSure hemorrhoidectomy may be safer for the patients.

Cirurgias proctológicas em 3 anos de serviço de coloproctologia: série histórica

Em 2007, 72,5% do movimento cirúrgico do Serviço de Coloproctologia do HU/UFS foi de procedimentos proctológicos. A experiência desse Serviço, em 3 anos, foi compilada e analisada retrospectivamente. Foram 455 pacientes submetidos a hemorroidectomias(40%), fistulectomias (20%) e fissurectomias (13%), sendo os demais, cisto pilonidal, fístula retovaginal, etc. As doenças orificiais prevaleceram em mulheres (54%) e na faixa etária dos 30 a 50 anos. Hemorróidas e fissuras acometeram mais mulheres, enquanto as fístulas, homens. Hemorroidectomia a Milligan e Morgan foi realizada em 53,7% dos casos, com níveis de dor e sangramento comparáveis aos de Ferguson. Ela proporcionou maior número de fissuras residuais e incontinência fecal transitória. Estenose foi igual para as duas técnicas.A técnica de Ferguson tem o tempo de cicatrização inferior, mesmo com elevada taxa de deiscência. A fístula acometeu 4 vezes mais homens. Em 65% dos casos, a fistulectomia foi a técnica de escolha, com melhores resultados em termos de dor e sangramento, e piores índices de incontinência. Houve colocação de sedenho em 14% dos casos, mantidos em média por 20 semanas, e após sua retirada, 36% relataram sinais de incontinência minor. A fissura anal demonstrou uma preferência de cerca de 3 vezes maior pela comissura posterior. As fissuras anteriores ocorreram mais em homens.

Stapled Haemorrhoidopexy versus Ferguson Haemorrhoidectomy: A Prospective Study with 2-Year Postoperative Follow-up

Patients with grade III or IV haemorrhoids underwent stapled haemorrhoidopexy or Ferguson haemorrhoidectomy (50 patients in each group) between June 2000 and April 2003. Six patients (12.0%) receiving stapled haemorrhoidopexy experienced complications: bleeding (2.0%) and haematoma (4.0%); late complications were anal fissure (4.0%) and recurrence of haemorrhoidal disease (2.0%). Bleeding was treated during the operation by suture ligation and fissures by sphincterotomy; haematomas resolved spontaneously with conservative medical treatment. Of those undergoing Ferguson haemorrhoidectomy, no bleeding occurred postoperatively, however urinary retention was seen in three patients (6.0%) We conclude that Ferguson haemorrhoidectomy was safer than stapled haemorrhoidopexy for bleeding complications, but stapled haemorrhoidopexy was superior to the Ferguson technique in terms of postoperative pain (4.2 versus 7.4 on day 1 after operation, decreasing to 2.2 versus 4.2 at 1 week for stapled haemorrhoidopexy compared with Ferguson haemorrhoidectomy, respectively), duration of hospital stay (92% undergoing stapled haemorrhoidopexy discharged on postoperative day 1) and time to return to normal activities (10.0+/-1 versus 28.0+/-2 days, respectively).