Ligation Treatment Research Articles

S601 Endoscopic Band Ligation in Treatment of Gastric Antral Vascular Ectasia (GAVE): A Systematic Review and Meta-Analysis

S601 Endoscopic Band Ligation in Treatment of Gastric Antral Vascular Ectasia (GAVE): A Systematic Review and Meta-Analysis

Ligation Anopexy vs Doppler Guided Haemorroidal Artery Ligation in Treatment of Grade III Haemorroidal Disease

Ligation Anopexy vs Doppler Guided Haemorroidal Artery Ligation in Treatment of Grade III Haemorroidal Disease

Advanced Approaches to Rubber Band Ligation in Treatment of Hemorrhoidal Disease in the Elderly and Senile Outpatients

Introduction. Currently, rubber band ligation of internal hemorrhoids is performed during surgical treatment of hemorrhoids in 26,8844,0 % of cases. However, this technique can lead to the need for repeated interventions. Moreover, at stage IV hemorrhoids a relapse occurs in almost 40% of cases.The aim of the study was to improve clinical outcomes of the senile and elderly outpatients with stage II-III internal hemorrhoids by optimizing a rubber band ligation technique and indications for its use.Materials and methods. The authors analyzed clinical outcomes of 60 senile and elderly outpatients with stage II-III internal hemorrhoids. Patients were divided into 2 study groups. Patients of the control group received standard treatment including ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal 0.8 atm. Patients of the case group were exposed to ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal to 0,60,7 atm. Ligation in the case group was performed on the following conditions: high and medium degree of compliance in patients, hemorrhoids size less than 1,5 cm, absence of anemia, no antiplatelet drug intake a possibility to discontinue an antiplatelet drug in case it is takenResults. The study results demonstrated that 60 % of patients of the case group required pain relief on Day 1 after the intervention, 13,3% of patients of the case group required pain relief on Day 3 after the intervention. The correspondence to these parameters in the control group was 66,6% and 16,6% of patients respectively. The first defecation in patients of the case group occurred in 1,73 0,48 days on average; in patients of the control group in 1,74 0,47 days. Acute swelling of the external hemorrhoids was reported in 13,3% of patients of the case group and in 16,7% patients of the control group. Thrombosed external hemorrhoids, rectal bleeding, acute urinary retention were reported in 6,7% of patients of the case group and in 10,0% of patients of the control group. Vaso-vagal syndrome and local wound complications were reported in 6,7% of patients of the case group and in 3,3% of patients of the control group. Stricture of the anal canal was noted in 3,3% of patients of the case group and in 3,3% of patients of the control group. Anal sphincter incompetence was not detected in patients of the case group, while it was reported in 3,3% of patients of the control group. The average time of temporary disability was 2,3 0,4 days in patients of the control group and 1,9 0,4 days in patients of the case group. In 6 months after ligation, 60,0% of patients of the control group and 63,3% of patients of the case group manifested good results; 30,0% and 33,3% manifested satisfactory results; and 10,0% and 3,3% manifested unsatisfactory results respectively. After rubber band ligation, the relapse rate of the disease was 13,3% in patients of the control group and 10,0% in patients of the case group.Conclusion. Rubber band ligation is well tolerated by the senile and elderly patients. To reduce pain, tenesmus, vaso-vagal conditions, and urinary retention, the negative pressure created in the device sleeve degressed, which resulted in an improvement of patients general state and decrease in the number of complications.

Clinical Outcome after Doppler-Guided Hemorrhoidal Artery Ligation and Rubber Band Ligation for Treatment of Primary Symptomatic Hemorrhoids

To compare the efficacy and clinical outcome after rubber band ligation (RBL) and Doppler-guided hemorrhoidal artery ligation (DG-HAL) for primary symptomatic (grades II and III) hemorrhoids. Fifty patients with symptomatic grades II and III uncomplicated internal hemorrhoids were randomly assigned to treatment with RBL or DG-HAL. Patients were assessed clinically for postoperative complications and recurrence through 6 months after surgery. Preoperative characteristics were similar between both groups. The main preoperative complaint was protrusion of piles followed by bleeding. The overall rate of complications was 16% after RBL (9.1% of grade II and 21.4% of grade III) and 4% after DG-HAL (6.7% of grade II and 0% of grade III). The overall rate of recurrence was 12% after RBL (9.1% of grade II and 14.3% of grade III) and 4% after DG-HAL (0% of grade II and 10% of grade III). All complications were conservatively controlled with no need for reintervention. At the end of 6 months of follow-up, the overall freedom of symptoms was 88% after RBL (90.9% of grade II and 85.7% of grade III) and 96% after DG-HAL (100% of grade II and 90% of grade III). With respect to grade of hemorrhoids (II or III), there were statistically insignificant differences between both procedures in terms of recurrence and complications. DG-HAL is safer and effective than RBL for treatment of grade III hemorrhoids, however in grade II patients, both procedures had nearly equal rate of complications despite no recurrence with DG-HAL.

Endoscopic ligation in treatment and prevention of bleeding from esophageal varices

To demonstrate the efficacy of endoscopic ligation in treatment and prevention of bleeding from esophageal varices in patients with liver cirrhosis and portal hypertension. We performed a retrospective analysis of 338 patients with liver cirrhosis who underwent ligation for the period 2009 - May 2016. There were 209 (61.8%) men and 129 (38.2%) women. In this group 511 ligations were performed. The total number of ligated nodes was 4086. Ligation was effective in 502 (98.2%) cases. In 9 (1.8%) cases endoscopic ligation was ineffective and Blackmore tube was required. The main cause of failed procedure was pre- or intraoperative active bleeding from esophageal varices. Complications in this group can be considered 3 cases of bleeding during ligation. Endoscopic ligation is highly effective (from an economic and medical points of view) treatment and prevention of bleeding from esophageal varices in patients with liver cirrhosis.

Laparoscopic Ovarian Vein Ligation for Treatment of Pelvic Congestion Syndrome

Laparoscopic Ovarian Vein Ligation for Treatment of Pelvic Congestion Syndrome

Distal radial artery ligation for treatment of steal syndrome in a distal radiocephalic arteriovenous fistula

Distal radial artery ligation for treatment of steal syndrome in a distal radiocephalic arteriovenous fistula

Latex ligation in treatment of chronic hemorrhoids

We analyzed the results of treatment of 432 patients with chronic hemorrhoids using different variants of latex ligation. New technique including ligation of mucosa and submucosa of low-ampullar rectum providing ligation of hemorrhoidalvessels, lifting and recto-anal repair is developed and suggested. This method is advisable to use in case of chronic internal hemorrhoids stages I and II. The authors recommend simultaneous combined ligation of mucosa of low-ampullar rectum and internal hemorrhoids for stages III and IV. Different variants of latex ligation with external hemorrhoids excision were used in 103 patients. Pointed variants of latex ligation preserve important advantages including mini-invasiveness, simplicity and wide availability, low cost. Good remote results were obtained after these procedures in 87.3% of observations. Suggested tactics extends use of latex ligation and increases its effectiveness in treatment of different stages and forms of chronic hemorrhoids.

Clinical effects of endoscopic submucosal dissection combined with variceal ligation in treatment of patients with gastrointestinal stromal tumors

Clinical effects of endoscopic submucosal dissection combined with variceal ligation in treatment of patients with gastrointestinal stromal tumors

What Should Be the Treatment Protocol in Cases of Second and Third Degree Hemorrhoids?

Recently, we were going through one of the very interesting articles published in Indian Journal of Surgery, titled “Comparative study of hemorrhoidectomy and rubber band ligation in treatment of second and third degree hemorrhoids in Kashmir” by Gagloo et al. [1]. In our routine academic review of reputed journal articles, we found it very promising as the incidence of hemorrhoid patients comprises a significant portion of OPD and IPD. This article drew our attention because of its simple study design and thorough review of literature. Though there were minor flaws without which this study would have been more impressive. Like,

Avaliação da ocorrência do refluxo venoso da safena magna pela ultrassonografia com doppler colorido após tratamento cirúrgico da insuficiência da junção safeno-femoral

To evaluate the occurrence of reflux from the great saphenous vein by color Doppler ultrasonography in subjects undergoing treatment of insufficiency of the saphenofemoral junction by simple ligation or ligation with section of the saphenous arch. We performed 60 operations (in 45 subjects) of varicose insufficiency of the saphenofemoral junction (SFJ), belonging to the CEAP clinical classification of 2-5, who were randomly divided into two groups. A group called C, with ligature and section of the saphenous arch, and a group called L, with simple ligation of the saphenous vein and no sectioning of its arch. We then investigated the occurrence of reflux from the great saphenous vein in groups C and L through postoperative color Doppler ultrasonography at intervals of six months to one year. Of the 60 members submitted to the approach of the saphenous arch, 57 were evaluated by postoperative doppler ultrasound, since two subjects (three limbs) did not return and were excluded from the study. The mean age was 54 years, with 93% females and predominance of CEAP classification 2 in 60.5%. Of the 57 operations for the treatment of reflux of the saphenous arch, 43.9% had reflux postoperatively,14.1% in group C and 29.8% in group L (p < 0,05). The relative risk of reflux of the saphenous arch in group L was 2.03 times higher compared with group C. the section of the arch of the great saphenous vein causes less postoperative reflux than simple ligation in treatment of insufficiency of the great saphenous vein.

Comparative Study of Staging Rubber Band Ligation (RBL) and Hemorrhoidectomy in Treatment of Forth Degree Hemorrhoids

Background: Rubber band ligation is one of the most worldwide used treatments of hemorrhoids because of its effectiveness and low complication rate. Hemorrhoidectomy is the procedure of choice for treatment of grade four hemorrhoids which is a painful method for a relatively benign disease. There are a few studies available analyzing the effectiveness of RBL as an initial treatment for grade four symptomatic internal hemorrhoids. Objective: This study aimed to analyze the efficacy of the staging rubber band ligation in treatment of grade four hemorrhoids and comparing to hemorrhoidectomy. Patients and Methods: A prospective randomized clinical trial was performed on all patients diagnosed with grade four symptomatic internal hemorrhoids from August 2011 to March 2013. Sixty four patients with grade four hemorrhoids were divided into two groups and underwent hemorrhoidectomy (H group) and rubber band ligation (R group).These patients were compared for any complications and recurrence in a six month period. Results: Pain existed in 100% of the H group and 67.7% of the R group in the first visit one week postoperation (P < 0.05). There was a statistically significant difference between the two groups regarding the days off work. Patients’ satisfaction and recurrence were similar in both groups after a period of six months. Conclusions: This study showed that staging rubber band ligation is effective for treating grade four hemorrhoids. Few complication and low recurrence rate were noted which enable us to recommend this modality as the procedure of choice for the management of selected patients with grade four symptomatic hemorrhoids.

Comparative Study of Hemorrhoidectomy and Rubber Band Ligation in Treatment of Second and Third Degree Hemorrhoids in Kashmir

The diagnosis of hemorrhoids is primarily based on the proctoscopic examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1½ year from Jan 2003 to June 2004. It includes 100 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of SMHS Hospital Srinagar, Kashmir. These 100 patients were selected randomly and divided into two groups of 50 patients each (hemorrhoidectomy group and RBL group). Each patient was subjected to sigmoidoscopy to exclude other lesion higher up in rectosigmoid. Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed. The statistical analysis of the study was done using SPSS statistical package in which we used descriptive statistics and correlation analysis for the final evaluation. Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many a hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery or have concurrent disease that contraindicates anesthesia. RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia.

Modified laparoscopic high ligation in treatment of inguinal hernial sac in infants: a report of 183 cases

Objective To study the clinical effectiveness of a modified laparoscopic high ligation in treatment of inguinal hernial sac in infants.Methods The high ligation of hernial sac was conducted using a modified method:the laparoscopic suture of hernia sac was performed with No.4 thread in two semi-circles,facilitated by a No.8 syringe needle holding outside of the body.Two thread ends were knotted outside by supporting trocar and then put back into the abdomen.The thread end was tightened and knotted subcutaneously at the groin.A total of 183 infants received the modified ligation.The average operation time,postoperative hospitalization stay,and the rates of postoperative reoccurrence and complication were observed and the operative efficacy was evaluated.Results The modified laparoscopic high ligation was successfully conducted in all the 183 infants(142 males and 41 females,278 sides in total) without transitional opening.Unilateral operation time lasted from 6.8-15.2 min(with a mean of [13.1±1.2] min).Bilateral operation time lasted from 22.7-33.3 min(with a mean of [28.4±4.7] min).Postoperative hospitalization stay varied from 1 day to 3 days(with a mean of [2.3±0.6] days).The postoperative reoccurrence rate was 0.7%.Delitescence hernia was identified in 48 cases(35.2%) and was treated by high ligation.Conclusion Our modified laparoscopic high ligation for treatment of inguinal hernia sac is effective,easy-to-perform and easy-to-learn,making it worth popularizing in clinic.

Assessment of four types of endoscopic ligation in treatment of submucosal tumors in upper gastrointestinal tract

Objective To evaluate the clinical efficacy and safety of 4 types of endoscopic nylon ligation in the treatment of submucosal tumors in upper gastrointestinal tract. Methods Those with submu- cosal tumors located in esophagus, stomach or duodenum were enrolled in the study. All patients were trea- ted with endoscopic nylon ligation, which included direct ligation, ligation with a transparent cap, ligation with dual-channel endoscope, and ligation in combination with endoscopic submucosal dissection （ESD）. The patients were followed up endoscopically for evaluation of efficacy and safety of the procedures. Results A total of 128 patients were recruited into the present study from June 2006 to December 2008. The tumors were in esophagus in 28 patients, in stomach in 82 and in duodenum in 18. Direct ligation was applied in 3 patients, ligation with a transparent cap in 105, ligation with a dual-channel endoscope in 8, and ligation plus ESD in 12. Endoscopic follow-up was completed in 111 patients. Reduced lesion size was observed in 16 patients （ I4.4% ） , residue nylon in 16 （ 14. 4% ） and no lesion in 71 others （63.9%）. The overall ef- fective rate was 92.8%. No delayed perforation or bleeding occurred. Conclusion Endoscopic ligation with nylon thread in combination with other assistant approaches is effective and safe for the treatment of submuco- sal tumors in upper gastrointestinal tract. Key words: Gastrointestinal neoplasms; Nylon thread ligation; Endoscopic submucosal dissection

Uterine Artery Ligation for Treatment of Pregnant Women with Uterine Leiomyomas who are Undergoing Cesarean Section

The proper management of uterine leiomyomas found during cesarean section remains uncertain. Some obstetricians believe that myomectomy is safe in carefully selected cases, but others continue to discourage the practice because of the risk of intractable bleeding. Uterine artery occlusion may provide an alternative. This prospective nonrandomized study evaluated ligation in 48 women with uterine leiomyomas, including at least one larger than 5 cm, who underwent cesarean section for obstetrical reasons. Approximately 60% of patients had multiple myomas. Twenty-six women (group I) had ligation of both uterine arteries immediately after closing the uterine incision, while 22 (group II) served as a control group. In study cases the uterine arteries were double-ligated with silks. Women in the study and control groups were similar with respect to age, parity, gestational age, myoma size, position of the dominant myoma, indications for cesarean delivery, and preoperative hemoglobin values. The average postoperative follow-up was 38.5 months. Surgery was technically successful in all cases. Blood loss during surgery averaged 254 ml and 278 ml for groups I and II, respectively. One group II patient required blood transfusion because of hemorrhage. In group I women the decrease in myoma volume averaged 45%. In group II women, average myoma volume increased 34%. During follow-up, two group I women (8%) and nine group II women (41%) underwent myomectomy or hysterectomy. All three group II women who had repeat cesarean deliveries requested uterine artery ligation. The investigators believe that uterine artery ligation may be a promising means of lessening postpartum bleeding in women found during cesarean section to have uterine leiomyomas. The procedure may reduce the need for future myomectomy or hysterectomy, and does not appear to compromise fertility.

Venous Ligation for Treatment of Cosmetically Unwanted Periorbital Facial Veins

Introduction: Treatment of unwanted periorbital facial veins is a challenge. Common modalities used to treat facial veins include electrocautery, radioelectrosurgery, laser, and microsclerotherapy. Periorbital veins resistant to electrocautery, difficult to safely target with laser, or at risk for sclerosant flow to ophthalmo-cranial anastomotic circulation may be treated with a vein ligation technique in properly selected patients. Methods: Patient selection, preoperative evaluation, exclusion criteria, and anatomic considerations are described in detail. The surgical technique is described in conjunction with intraoperative photos. Discussion: Patient selection and characteristics of ideal target vessels are reviewed to optimize results. Less than ideal patient and target vessel characteristics are reviewed in relation to inclusion and exclusion criteria for periorbital vein ligation technique. Results: This ligation technique provides a useful approach for treatment of cosmetically unwanted 1.5- to 3.0-mm facial veins in properly selected patients. Partial to full resolution may be expected for individual veins. Postoperative photographic documentation shows the typical improvement obtained. Conclusion: Periorbital facial vein ligation is a useful technique for addressing the problem of cosmetically unwanted periorbital facial veins in properly selected patients.

3551 Evaluation of the multiple band ligator in endoscopic injection sclerotherapy with simultaneous ligation for treatment of esophageal varices.

Background:We developed endoscopic injection sclerotherapy with ligation (EISL), which involves EVL of the area including the injection site immediately after injection of the sclerosant into varices, and have used this method since 1993. The usefulness of this method has been documented in our previous reports, but the pneumatic EVL device with a channel for puncture needle, which is commercially available only in Japan, has been required for the method. Recently, a multiple band ligator, with which insertion of puncture needles is possible, has become available internationally. Therefore, we examined the usefulness of the multiple band ligator. Method: The EVL device used was the Injection Speedband Superview(8-band ligator). EISL was performed by the following procedures. A balloon inserted with the EVL device was inflated, EOI was injected into a varix using a needle, and EVL was performed in the area including the injection site, while the needle was kept in place in the varix. The balloon was kept in an inflated state up to the end of operation. The subjects were patients with esophageal varices who were classified as being an F2 (enlarged tortuous varices) red color sign (+1) or more advanced stages, with and without bleeding. Results: Sixteen EISL sessions were performed on 9 patients. The mean EISL session per patient was 1.9±0.3 in this study, while it was 2.1±0.7 in 99 patients who were treated by EISL using the single-band EVL device. The mean time per EISL session was 9.3±2.1 min in this study, which was significantly shorter than that in the 99 patients treated with the single-band EVL device (11.5±3.4). The number of O-ring used per session was 7 at the maximum and 2.8 on average. Therefore, the 8-band ligator was sufficient for treatment. None of the patients had complications. Conclusions: The device used in this study, Injection Speedband Superview, gave visual fields sufficient for the EIS procedure while the device was inserted. The session time was shortened because the procedure can be continuously performed. Furthermore, because the inserted balloon can be kept inflated up to the end of the procedure, outflow of EOI via other varices due to deflation could be prevented. Therefore, this device was proved to be ideal for EISL.

Preoperative Assessment of the Efficacy of Distal Radial Artery Ligation in Treatment of Steal Syndrome Complicating Access for Hemodialysis

Hand ischemic steal syndrome due to a forearm arteriovenous fistula is a rare occurrence. We report here a case in which we applied a new diagnostic method to assess the efficacy of distal radial ligation to treat this syndrome. A favorable comparison of distal radial artery pressure measurements before and after temporary occlusion of the artery with a balloon catheter indicated that perfusion of the hand would be dramatically improved after surgical artery ligation.

Fate of Carotid Artery Following Ligation for Treatment of Cerebral Aneurysms

Fate of Carotid Artery Following Ligation for Treatment of Cerebral Aneurysms