Hemorrhoidectomy In Patients Research Articles

To assess the effectiveness of intravenous metronidazole as an analgesic in post hemorrhoidectomy patients

To assess the effectiveness of intravenous metronidazole as an analgesic in post hemorrhoidectomy patients

Assessment of quality of life and incontinence in patients of open hemorrhoidectomy

Background: For the most part, symptomatic hemorrhoids are a quality-of-life issue. All patients should initially receive conservative management if this fails to improve symptoms, an office-based or operative procedure may be offered. Aims and Objectives: The present study was conducted to assess quality of life using SF-36 health survey and incontinence by Wexner scoring system in patients of open hemorrhoidectomy. Materials and Methods: The study was conducted on 50 cases of open hemorrhoidectomy in M.L.B. Medical College, Jhansi, between January 2021 and June 2022. Results: Results of health-related quality of life in patients before and after open hemorrhoidectomy are compared out of 8 domains, 5 domains, i.e., physical functioning, role limitation due to physical health, social functioning, pain, and general health have significantly shown that patients after open hemorrhoidectomy are having better quality of life before open hemorrhoidectomy. Out of 8 domains, 3 domains such as emotional well-being, vitality, and role limitation due to emotional problems have shown that there is no significant difference in the quality of life in patients before and after open hemorrhoidectomy. Conclusion: Open hemorrhoidectomy patients after open hemorrhoidectomy improved the quality of life of patients treated for hemorrhoidectomy.

Safety and Efficacy of Oral Nalbuphine on Postoperative Pain in Hemorrhoidectomy Patients: A Randomized, Double-blind, Placebo-controlled, Pivotal Trial.

Severe postoperative pain requiring opioid treatment has been reported in 20-40% of hemorrhoidectomy patients. Compared to morphine, nalbuphine offers better hemodynamic stability, a lower risk of respiratory depression, and a lower potential for addiction. Nalbuphine was developed from intravenous form into an oral form (PHN131) to alleviate moderate-to-severe pain. A randomized, double-blind, placebo-controlled, multiple-dose, parallel-design trial was conducted to evaluate the safety and efficacy of PHN131 in patients undergoing hemorrhoidectomy. Eligible patients were randomly assigned to receive either PHN131 soft capsules containing nalbuphine hydrochloride 60mg or placebo capsules. Intramuscular diclofenac was the rescue analgesic. Pain was measured by the area under the curve of mean Visual Analog Scale (VAS) pain intensity scores. VAS results in patients receiving PHN131 were significantly lower than placebo group scores through 48 hours postoperatively (149.2±75.52 vs. 179.6±65.97; P=0.0301). According to Brief Pain Inventory Short Form scores, the impact of pain on quality of life was significantly smaller for the PHN131 group than for the placebo group. Time to the first use of diclofenac postoperatively was significantly longer in the PHN131 group than in the placebo group. The cumulative dosage of diclofenac in the PHN131 group was only around half of that in the placebo group (P<0.0001). Drug-related adverse events were mild-to-moderate and resolved by treatment end. No drug-related severe adverse events were observed. Our findings demonstrate that PHN131 is effective and well-tolerated in the treatment of moderate-to-severe pain and may provide another option for patients to control their pain.

Combined mucopexy & Milligan-Morgan's technique in circumferential 4th degree haemorrhoids: Prospective observational cohort study

BackgroundIt is well known that a large excisional haemorrhoidectomy could be certain cause of post-operative severe complications like incontinence, ectropion or anal stenosis. ObjectiveOur aim is to reduce post-operative complications avoiding a large haemorrhoidectomy in patients suffering of a circumferential 3-4th degree prolapsed haemorrhoids. DesignThis was a prospective, single institution study with propensity score matching performing a classic stapled mucopexy followed by the excision of the internal mucosae prolapse combining at the same operative time a concomitant classic Milligan and Morgan's technique of the remnant external piles. PatientsThe study population were 54 eligible patients, study included 32, to demonstrate feasibility and safety of our proposals. 20 males, 12 females, mean age 51.9 years (range 21–84) underwent combined mucopexy and haemorrhoidectomy in one single surgical procedure between January 2017 and December 2019. ResultsA total of thirty-two patients were included prospectively and consecutively; 18 patients (33.4% of the universe) presented anatomical variations on the CMHP and variations on the IHED (10), associated anal fissures (2), modified piles with HPV condylomata (2), non-stoppable anticoagulation treatment (2), immunity treated disease (1), no evidence of a haemorrhoidal mucosal prolapse and minor pile's components (1) and they were definitely excluded of the study. There were no significant differences in the postoperative complication rates. The length of the operation was (48, 05 min +/- 5, 30 min). Some special bleeding had required at the end of the procedure a supplementary haemostasis with absorbable single suture in six patients (18, 8%), men (12, 5%) women (6, 3%). The stapled haemorrhoidal mucopexy allowed a faster functional recovery with shorter time off work (weighted mean difference 9.45 days; p < 0.00001), earlier return to normal activities (weighted mean difference, 15.85 days; P = 0.03), and better wound healing (odds ratio, 0.1; P = 0.0006). No stenosis, neither ectropion. LimitationsBecause of a single limited study including a single operative group. ConclusionsOur results confirm the strategy, demonstrating that the combined technique drastically reduces the risk of anal stenosis, ectropion, incontinence or recurrence of the prolapse. By the restoration of the anal canal anatomy under visual control and preservation of the required mucosal and cutaneous bridges results are reproducible and sure.

Pemberian Kompres Dingin Terhadap Penurunan Nyeri Pada Asuhan Keperawatan Pasien Post Hemoroidektomi

Hemorrhoidectomy is a surgical removal of hemorrhoids by excision, which is removing tissue that has varicose veins (widening) that occurs in the anal canal area. This research design is analytical descriptive with case study method. The non-pharmacological implementation of post hemorrhoidectomy is the administration of cold compresses to reduce pain carried out at Bhayangkara M.Hasan Hospital, Palembang from June 15, 2022 to June 18, 2022. The subjects of this study were 2 post hemorrhoidectomy patients. Pain in Nursing Care of Post Hemorrhoidectomy Patients. The research instrument used in this study is the format of Nursing Care and Medical Records as a data collection tool. In this study, the instrument for measuring the pain scale was using the Wong Baker FACES Pain Rating Scale. As for cold compresses, the instruments used are ice packs, ice cribs, kom, perlak or blankets. Stationery and watches. After giving cold compresses for 3 days, both patients experienced a decrease in pain scale. Pain scale Mr. 'A' before giving cold compresses pain scale 4 after giving cold compresses pain scale 1. While the pain scale Mr. 'R' before giving cold compresses pain scale 5 after giving cold compresses pain scale 0. After giving cold compresses to post hemorrhoidectomy patients for 3 days, both patients experienced a decrease in pain scale.

Topical Calcium channel blockers for effective post operative analgesia for hemorrhoidectomy patients; A Randomized Control Trial at a Tertiary Care Hospital.

Objective: To compare the mean pain scores after hemorrhoidectomy in patients given topical calcium channel blocker and patients being given routine post-operative treatment only. Study Design: Randomized Controlled Trial. Setting: Surgical Department of Holy Family Hospital. Period: 7th January 2022 to 7th July 2022. Material &amp; Methods: Patients fulfilling the inclusion criteria were divided into two groups. Group A patients will receive topical calcium channel blockers whole group B will receive conventional analgesic medications. Patients in both groups underwent open hemorrhoidectomy under saddle block anesthesia. At the end of procedure, a lignocaine gel-soaked pack was placed in rectum which was removed after 6 hours. The post-operative treatment of test group was similar in all regards except that they were given 2% diltiazem ointment to apply to perianal region twice a day. Oral stool softeners were started after NPO duration. The patients were advised to start warm sitz bath and application of 2% lignocaine gel to perianal region 12 hourly after removal of pack. The patients in both groups were compared for the degree of pain on the second post-operative day using visual analogue scale. Results: In this study, on comparison of mean pain scores after hemorrhoidectomy in patients given topical calcium channel blocker and patients being given routine post-operative treatment only shows that pain in Group-A was 5.89+0.80 and in Group-B 3.60+0.77, p value was 0.0001. Conclusion: Topical Calcium Channel Blockers are effective in managing post hemorrhoidectomy pain.

Laser hemorrhoidoplasty combined with blind hemorrhoidal artery ligation compared to Milligan–Morgan hemorrhoidectomy in patients with second and third degree piles; a prospective randomized study

Background Laser hemorrhoidoplasty is a relatively new management option for symptomatic hemorrhoids. Although its advantages over the Milligan–Morgan approach were highlighted in previous trials, the combination of laser and mucopexy (hemorrhoidal artery ligation) is scarcely discussed in the literature. Herein, the author compared the outcomes of the previous combination with the traditional Milligan–Morgan procedure in cases with second and third-degree piles. Methods The 66 included patients were randomly divided into two groups; group A underwent the combined approach, while group B underwent the Milligan–Morgan procedure. Postoperative pain, satisfaction, and complications were assessed. Results Preoperative data, including patient presentation and the degree of piles, were comparable between the two groups. Nonetheless, operative time and hospitalization period showed a significant increase in group B (P = 0.004 and &lt; 0.001). Group A patients expressed significantly lower pain scores during rest and defection, as well as a better satisfaction level, compared with group B patients. The incidence of postoperative complication did not differ between the two interventions, except for urine retention, which was more frequently encountered in group B cases. An earlier return to normal daily activities was noted in group A. 1-month Wexner scores did not differ between the two groups, and no cases developed recurrence during the 1-year follow-up. Conclusion The combination of laser with hemorrhoidal artery ligation is associated with multiple advantages over surgical hemorroidectomy manifested in a better analgesic profile, better satisfaction, and an early restoration to daily activities.

Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II-III hemorrhoidal disease: a retrospective analysis.

Hemorrhoidal disease is a common ailment that presents a challenge in terms of standard treatment methods. Although surgical hemorrhoidectomy is often considered the gold standard, new surgical techniques have emerged, such as laser hemorrhoidoplasty and LigaSure hemorrhoidectomy, to address postoperative pain, bleeding, and extended return-to-work times. This study aims to compare the outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in patients with grade II-III hemorrhoidal disease. A retrospective analysis was conducted on a cohort of patients who underwent laser hemorrhoidoplasty or LigaSure hemorrhoidectomy. Data were collected on postoperative pain, complications, recurrence rates, and return-to-work times. The primary outcome was the difference in postoperative pain between the two groups, as assessed using the Visual Analog Scale (VAS). Patients in the laser hemorrhoidoplasty group experienced significantly lower postoperative pain compared to those in the LigaSure hemorrhoidectomy group. Bleeding amounts during the operation were also significantly lower in the laser group. However, the recurrence rate was higher in the laser group compared to the LigaSure group (9.4% versus 2.5%). Return to work and normal activities time after laser hemorrhoidoplasty was shorter than after LigaSure hemorrhoidectomy. Laser hemorrhoidoplasty is a minimally invasive technique that can be safely applied in suitable grade II-III patients, offering lower postoperative pain rates, fewer complications, and shorter return to work and normal activity times compared to LigaSure hemorrhoidectomy. However, recurrence rates are still higher for laser hemorrhoidoplasty. Future studies should explore the potential of combining laser hemorrhoidoplasty with other surgical treatments.

A Prospective Randomized Study of Laser Hemorrhoidectomy and Open Hemorrhoidectomy in Patients with Grade III and Grade IV Hemorrhoids

A Prospective Randomized Study of Laser Hemorrhoidectomy and Open Hemorrhoidectomy in Patients with Grade III and Grade IV Hemorrhoids

Psychological states could affect postsurgical pain after hemorrhoidectomy: A prospective cohort study.

Open hemorrhoidectomy is one of the standard procedures for grade IV hemorrhoids. Postsurgical pain is a common problem for patients. We aim to prospectively evaluate potential factors affecting postoperative pain among hemorrhoidectomy patients. An observational study was conducted on 360 patients who had undergone Milligan-Morgan open hemorrhoidectomy. Details of the surgery and baseline information were recorded. Preoperative anxiety and depression were analyzed via the self-rating anxiety scale 20 (SAS-20) and self-rating depression scales 20 (SDS-20), respectively. Postoperative pain score was performed daily after surgery until the patient was discharged. The numerical pain score was evaluated by the visual analogue scale (VAS). The association between preoperative psychological states (anxiety or depression) and postoperative pain was analyzed using a generalized additive mixed model. A total of 340 patients eventually provided complete data and were included in our study. The average age was 43.3 ± 14.4 years, and 62.1% of patients were women. In total, 14.9% of patients had presurgical anxiety and 47.1% had presurgical depression. Postsurgical pain reached a peak point 1-2 days after surgery and went down to a very low level around 4-5 days after surgery. More excision of hemorrhoids could lead to more pain experience after surgery. Presurgical depression was associated with postsurgical pain. Patients who had presurgical depression had higher pain scores after surgery (2.3 ± 1.9 vs. 3.3 ± 1.9, p = 0.025). Preoperative depression and the amount of excisional hemorrhoids are positively related to postsurgical pain.

A Comparative Study on Post-operative Outcomes of Stapled Haemorrhoidopexy versus Milligan–Morgan Haemorrhoidectomy in Patients above 60 Years

Abstract Background: Haemorrhoidal disease is one of the most common benign anorectal pathologies worldwide. Plethora of treatment options available for haemorrhoids. Stapled haemorrhoidopexy and Milligan–Morgan haemorrhoidectomy were commonly done surgeries. Aim: we compared the short-term post-operative outcomes of stapled haemorrhoidopexy with Milligan–Morgan haemorrhoidectomy in patients aged above 60 years. Materials and Methods: It was a prospective, observational, comparative study from August 2020 to May 2022 on 100 patients above 60 years admitted to the general surgery departments with a diagnosis of third- and fourth-degree haemorrhoids and underwent stapled haemorrhoidopexy and Milligan–Morgan haemorrhoidectomy were included in the study after applying inclusion and exclusion criteria. Results: In stapled haemorrhoidopexy, mild pain is experienced in 44 (88%) patients and moderate pain in only 6 (12%) patients compared to 38 (76%) patients in Milligan–Morgan haemorrhoidectomy experience mild pain and 12 patients (24%) had moderate pain in 1st post-operative day. Anal incontinence is present in 12 (24%) patients of Milligan–Morgan surgical candidates and 3 (6%) patients of stapled haemorrhoidectomy patients on 1st post-operative day. First post-operative day 11 patients (22%) of Milligan–Morgan surgery developed urinary retention, whereas 6 patients (12%) of stapled surgery showed urinary retention. Forty-five (90%) patients resumed to normal activities within 1 week following Milligan–Morgan haemorrhoidectomy. Forty-six (92%) patients resumed to normal activities within 1 week following stapled haemorrhoidopexy. The average operating time for stapled haemorrhoidopexy was 33.0 min and Milligan–Morgan haemorrhoidectomy was 45.6 min. Thirty-nine (78%) patients were discharged 2 days after Milligan–Morgan haemorrhoidectomy and 3 (6%) patients were discharged 2 days after stapled haemorrhiodopexy. Eleven (22%) patients were discharged 2 days after Milligan–Morgan haemorrhoidectomy and 47 (94%) patients were discharged 2 days after stapled haemorrhiodopexy. Conclusion: We found that stapled haemorrhoidopexy is a better alternative compared to Milligan–Morgan haemorrhoidectomy as it outweighs the latter in terms of short-term post-operative outcomes included in the study.

ENSEAL® Hemorrhoidectomy, a Novel Technique, Versus Conventional Open Method for the Management of Grade III and IV Hemorrhoids.

Background Surgical removal of hemorrhoids is the gold-standard treatment for symptomatic grade III and IV hemorrhoid disease.There are numerous ways the hemorrhoidectomy surgical procedure is done but the most effective and least painful way is still to be elucidated. Objective To compare the outcomes of ENSEAL® (Ethicon, Inc., Raritan, USA) versus gold standard Milligan-Morgan hemorrhoidectomy in patients presenting with grade-III and IV hemorrhoids Materials and methods After ethical approval, the Randomized Controlled Trial was conducted at the Department of Surgery, Unit III, Lahore General Hospital, Lahore, Pakistan, between January 2020 and January 2022. In this study, 140 patients who met the inclusion criteria were recruited after informed consent. Patients were split randomly into two equal groups using a lottery technique. In group A, hemorrhoidectomy was carried out with ENSEAL®, whereas in group B, open hemorrhoidectomy was performed by the Milligan-Morgan method. the surgery duration and blood loss werenoted. After the operation, patients were transferred to and discharged from the post-anesthesiarecovery room. Patients were further followed up for pain scores after 24 hours. Data was analyzed by using Statistical Package for Social Sciences (SPSS) v25 (IBM Corp., Armonk, USA). Data was categorized for age, gender, body mass index (BMI), degree of hemorrhoids, and duration of hemorrhoids. A p-value <0.05 was considered significant. Results 140 patients were included in this study. Group A patients underwent ENSEAL® hemorrhoidectomy, and group B was formed from those who underwent the Milligan-Morgan procedure. In group A, there were 41 (58.5%) males and 29 (41.4%) females, while in group B, there were 43 (61.4%) males and 27 (38.5%) females. The mean age of group A patients was 49.97 ± 7.36 years and 43.2 ± 8.01 years in group B. In group A, the mean operative time was 20.87 ± 3.05 min, while 27.10 ± 3.42 minin group B, which is statistically significant with a p-value of <0.001. In group A, mean blood loss was 9.79 ± 2.87 ml, while 13.36 ± 3.73 ml in group B, which is statistically significant with a p-value of <0.001. In group A, the mean pain score was 2.7 ± 1.08, while 3.34 ± 1.16 in group B, which is statistically significant with a p-value of <0.001. Conclusion When considering the length of the procedure and blood loss, ENSEAL® hemorrhoidectomy has been determined to be an effective treatment that the patients tolerated well. Therefore, ENSEAL® hemorrhoidectomy can be a safe and efficient alternative to conventional treatment for hemorrhoids that are causing symptoms.

A STUDY OF COMPARISON OF TRANSANAL SUTURE RECTOPEXY WITH OPEN HEMORRHOIDECTOMY IN PATIENTS OF HEMORRHOID'S: A RANDOMIZED CONTROL TRIAL

Aim: To compare Transanal suture rectopexy with Open hemorrhoidectomy in patients of hemorrhoids. MATERIALS AND METHOD: After obtaining institutional ethics committee clearance, a prospective comparative study was done involving 60 patients with hemorrhoids undergoing either Transanal suture rectopexy [TR] or Open hemorrhoidectomy [OH]. With simple random sampling, the patients who t into the criteria was randomized in to two groups A for Transanal suture rectopexy and group B Open hemorrhoidectomy Both the procedures were compared RESULTS: with respect to mean operating time, intra-operative &amp; post-operative bleeding, postoperative pain &amp; use of analgesia, duration of hospital stay along with six months of post operative complications in which we observed that Transanal suture rectopexy is better in terms of intraoperative bleeding, postoperative pain, duration of hospital stay and postoperative recurrence as compared to Open hemorrhoidectomy. Suture hemorrhoidopexy can be considered as a safe alternative CONCLUSIONS: approach for surgical treatment of hemorrhoids than open hemorrhoidectomy after adequate training. More studies are needed to declare it as a standard procedure for the cure of the disease of hemorrhoids

Bleeding After Hemorrhoidectomy in Patients on Anticoagulation Medications.

Post-hemorrhoidectomy bleeding is a serious complication after hemorrhoidectomy. In the setting of a new wave of anticoagulants, we aimed to investigate the relationship of post-operative anticoagulation timing and delayed bleeding. We performed a retrospective analysis of all patients undergoing hemorrhoidectomy at a single institution over a 10-year period. Fisher's exact and Wilcoxon Rank Sum tests were utilized to test for association between delayed bleeding and anticoagulation use. Between January 2011 and October 2020, 1469 hemorrhoidectomies were performed. A total of 216 (14.7%) were taking platelet inhibitors and 56 (3.8%) other anticoagulants. Delayed bleeding occurred in 5.2% (n = 76) of which 47% (n = 36) required operative intervention. Mean time to bleeding was 8.7days (SD ±5.9). Time to bleeding was longer in those taking antiplatelet inhibitors vs. non-platelet inhibitors vs. none (11 vs. 8 vs. 7 days, P = .05). Among anticoagulants (n = 56), novel oral anticoagulants were more common than warfarin (57% vs 43%) and had a nonsignificant increase in delayed bleeding (31% vs 16%, P = .21). Later restart (>3days) of novel anticoagulants after surgery was associated with increased bleeding (10.5% vs 61.5%, P=.005). On multivariable analysis, only anticoagulation use (OR 4.5, 95% CI: 2.1-10.0), male sex (OR 1.8, 95% CI: 1.1-2.9), and operative oversewing (OR 3.5, 95% CI: 1.8-6.9) were associated with delayed bleeding. Post-hemorrhoidectomy bleeding is more likely to occur with patients on anticoagulation. Later restart times within the first week after surgery was not associated with a decrease in bleeding.

Comparison of Milligan Morgan Versus Stapled Hemorrhoidectomy in Patients Attending Tertiary Care Hospital

Background and Aim: Hemorrhoids are common anorectal problems that cause fear by bleeding, pruritus burden, and thrombosis pain. Prolapse and hemorrhoids are managed by stapled hemorrhoidectomy (SH). Initially, Stapled hemorrhoidectomy seemed to be a good alternative for Milligan Morgan (MM) hemorrhoidectomy verified by various studies. However, recent studies found that long-term assessment of stapled hemorrhoidectomy gives poor outcomes in terms of postoperative complications and patient’s satisfaction. Therefore, the present study aimed to compare the Milligan Morgan versus stapled Hemorrhoidectomy in patients attending Tertiary Care Hospital. Methodology: This prospective study was carried out on 120 patients at the Department of Surgery Unit-I Sheikh Zayed Medical College Rahim Yar Khan from 1st May 2021 to 31th April 2022. All the patients of either gender with an age range from 18 years to 60 years after 2nd degree hemorrhoids failure of multiple rubber band ligations and 3rd and 4th degree hemorrhoids were enrolled. Concomitant anal disease patients such as ano-rectal cancer, fissure, fistula, and abscess were excluded. Patients were divided into two categories: Group-I Stapled Hemorrhoidectomy and Group-II Milligan Morgan. Post-operative complications such as stenosis and urinary retention during hospitalization were recorded. All the data were entered and analyzed using SPSS version 25. Results: The overall mean age of Group-I and Group-II was 46.78±12.66 years and 48.91±14.82 years respectively. Each group comprised 60 patients. Out of the SH group, 35 (58.3%) were males and 25 (41.7%) were females. Of the MM Group-II, male and females were 44 (73.3%) and 16 (26.7%) respectively. About 53 (88.3%) patients in Group-I and 32 (53.3%) patients in Group-II had relief from bleeding and other symptoms. The surgical duration in Group-I and Group-II was 22.9 ± 12.9 minutes and 34.8 ± 9 minutes with statistical significance (p=0.000) respectively. The vessel spurting ligation and postoperative hemorrhage was developed in 5 (8.3%) in SH group patients. Post-operative bleeding and intervention was found in 26 (43.3%) patients in Group-II. The prevalence of postoperative pain requiring analgesia was found in 20 (33.3%) in Group-I and34 (56.7%) in Group-II respectively. After treatment, fecal incontinence was developed in none of the patients in both groups. The postoperative complications such as anal tag, tenderness, bleeding, urinary retention, and wound discharge were higher in Group-II as compared to Group-I with statistical insignificance (p&lt; 0.05). Conclusion: The present study found that hemorrhoids could be effectively treated by Stapled hemorrhoidectomy compared to Milligan-Morgan procedure in terms of postoperative pain, hospital stay, and usage of analgesics, reduced postoperative complications, patient’s satisfaction, and time taken for operation. Beside lesser complications, fecal incontinent, severe pain, and other complications could result from stapling technique. Post-operative pain and complete pain relief was significantly lower in MM group. Hospitalization in the SH group was shorter than the MM group. Hemorrhoid recurrence was null in both SH and MM group. Keywords: Hemorrhoid Surgery, Stapled Hemorrhoidectomy, Milligan-Morgan

Sitz bath for pain reliever in patient with hemoroidectomy

Hemorrhoids are diseases affecting the rectum and anus caused by damage to the hemorrhoidal plexus or blood vessels around the rectum and anus. If hemorrhoids are large lumps, then one of the steps is hemorrhoid surgery. One of the effects of post hemorrhoidectomy is pain felt in post hemorrhoidectomy patients. This study aims to apply the application of sitz bath hydrotherapy to decrease pain intensity in post hemorrhoidectomy patients. The method used for this application is a case study. The length of pain felt was measured using the VAS and NRS pain scales. The results of this study indicate that the application of sitz bath hydrotherapy with the main ingredient of warm water at a temperature of 40-45OC can be applied to post hemorrhoidectomy patients who experience moderate to severe pain.&#x0D;

Stapled and open haemorrhoidectomy; A comperative study of early outcome

Background: Stapled Hemorroidectomy is more popular alternative, has higher safety profile, and quickly established than the open Hemorroidectomy procedure. Objective:The study aimed to compare between the early post-operative outcomes of open haemorrhoidectomy and stapled. Methods:A total of 50 patients between the age group 20 to 70years who were diagnosed with grade 3 and grade 4 hemorrhoids, were divided into two groups equally. Stapled haemorrhoidectomy contains 25 Patients undergoing and Open haemorrhoidectomy contains 25 Patients. Comparative analysis between the two groups were done based on student’s T test using SPSS 24 software version. The level of significance was set to 5% (p &lt; 0.05). Results: There were 52% males and 48% females in Stapled haemorrhoidectomy groups and 64% males and 36% females in open haemorrhoidectomy group. 48% patients had grade 3 and 52% had grade 4 haemorrhoids in Stapled haemorrhoidectomy groups, and 44% had grade 3 and 56% had grade 4 haemorrhoids in open haemorrhoidectomy groups. In 16% of patients in stapled haemorrhoidectomy group and 24% of patients in open haemorrhoidectomy group blood loss was seen. In 12% of patients with staple haemorrhoidectomy and in 20% of patients with open haemorrhoidectomy was necessary supportive stitching. 52% of patients in open haemorrhoidectomy was observed residential prolapse but not in stapled haemorrhoidectomy patients. In the stapled group the duration of hospital stay (in days) was 1.96±0.82 days as compared to 3.98±0.78 days in the open group. Comparing to only 4% in the open group, 80% patients were discharged within 2 days in stapled group. In the open group at the end of 4 days 72% were discharged. Conclusions: Open haemorrhoidectomy at Milligan-Morgan is not easy as stapled haemorrhoidectomyinvolves shorter operation, fewer postoperative pain and an analgesic need, shorter hospital stays and a faster rehabilitation, earlier work back, the study confirms. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 438-443

The relationship between perceptions of shared decision-making and patient-reported outcomes in a cross-sectional cohort of haemorrhoidectomy patients.

Shared decision-making between patients and clinicians is important to surgical practice and patients' perceptions of their healthcare experience. This study aims to measure associations between patients' perceptions of their shared decision-making (SDM) process and health-related quality of life among a cohort of patients choosing surgical management of an elective surgical procedure, haemorrhoidectomy. This study is a single-site study based in Vancouver, Canada. Consecutive patients of five colorectal surgeons registered for elective haemorrhoidectomy between September 2016 and June 2020 were eligible to participate. Participants completed the CollaboRATE instrument which measures patients' perceptions of their SDM after the surgical consultation, along with a number of other patient-reported outcomes. The participation rate was 45.3%, with 157 patients scheduled for haemorrhoidectomy providing complete information. Unadjusted results found that participants having the most comorbidities reported better communication with their surgeon. The adjusted results show that socioeconomic status and depression were associated with lower CollaboRATE scores. There was no effect of sex, pain interference, anxiety or perceived health status on participants' CollaboRATE scores. This study found evidence that participants with lower economic status or those reporting depressive symptoms had worse perceptions of their SDM process with their surgeon. These findings suggest that special attention should be paid to the surgical decision-making process for these patient populations.

Harmonic scalpel assisted hemorrhoidectomy versus conventional Milligan Morgan hemorrhoidectomy in patients with Grade III and IV hemorrhoids: A prospective, randomized, controlled study

Introduction: Harmonic scalpel Hemorrhoidectomy (HSH) is reported to have superior outcomes than Milligan-Morgan hemorrhoidectomy (MMH). However, there is considerable variability in time to return to daily activities, post-operative pain, operating time, and hospital stay. Aims and Objectives: To compare MMH and HSH in terms of various outcomes. Materials and Methods: This prospective randomized controlled study was performed over a period of 12-months (December 2019 to November 2020) in the Department of General Surgery of a tertiary care hospital and included 60 adult patients with grade III and IV hemorrhoids. The patients were randomly and equally divided into either of the two groups i.e., MMH (n=30) or HSH (n=30). Post-operatively patients were evaluated and follow-up to compare the outcomes, including operative time, intra-operative bleeding, post-operative pain, duration of hospitalization, time required to return to daily activities, and intra- and post-operative complications. Results: The time required to return to daily activity was significantly less in the HSH group (p-value=0.0004). The operative time, intra-operative bleeding, and duration of hospitalization were significantly less in the HSH group (all p-values&lt;0.0001). The mean VAS score for post-operative static and post-defecation pain was significantly reduced in the HSH group at all the time intervals (all p-values&lt;0.0001). Moreover, significantly higher proportion of patients in the MMH group had post-operative discharge (p-value=0.02). Conclusion: HSH is superior to MMH in terms of significantly reduced time to return to daily activities, operating time, intra-operative blood loss, post-operative static and post-defecation pain, hospitalization, and intra- and post-operative complications.

The Profiles and Clinical Outcome of Stapled Hemorrhoidopexy and Open Hemorrhoidectomy Patients: A Five-Year Study in Dr. Soetomo General Hospital, Indonesia

Background: There are various surgical methods for hemorrhoid. Currently, there is no data regarding the profile and clinical outcome of surgery on internal hemorrhoids, especially between open hemorrhoidectomy and stapled hemorhoidopexy at Dr. Soetomo General Hospital. We aimed to describe the profile and outcome of internal hemorrhoidal patients. Methods: We collected samples from all patients with internal hemorrhoid who visited the emergency department and outpatient from January 2018 – to April 2022. The data are secondary data taken from medical records. We collected patients’ demographic data (e.g., age and sex), disease severity, comorbidities, therapies, length of stay, and complications. Results: We recruited a total of 615 patients, consisted of 47 cases (7.6%) undergoing hospitalization and 568 (92.4%) outpatient treatment. Male patients dominate the distribution by sex, either in inpatient or outpatient settings. The mean age of patients is 46.6 years for outpatients and 44.6 years for inpatients. The majority of internal hemorrhoid grading is grade 2 for outpatient and grade 3 for inpatient. Most of the patients who came with comorbidities had metabolic disorders (48.1%). The stapled hemorrhoidopexy procedure has a fairly low level of pain than open hemorrhoidectomy. In this study, it was found that the average length of stay of patients after stapled hemorhoidopexy was shorter than open hemorrhoidectomy. Conclusion: Internal hemorrhoid patients who underwent the most surgeries at Dr. Soetomo General Hospital Surabaya is a male aged &gt; 50 years with grade 3. Stapled hemorrhoidopexy has fewer pain complications than open hemorrhoidectomy and shorter length of stay.