RESUMEN
BACKGROUND: The aim of this study was to evaluate and compare transanal haemorrhoidal dearterialisation (THD) and stapled haemorrhoidopexy [also called procedure for prolapsed haemorrhoids (PPH)] in the management of haemorrhoidal disease, in terms of short-term outcomes and efficacy. METHODS: Patients presenting with symptomatic haemorrhoids were treated with THD. Patient demographics, pre-operative data, post-operative pain scores, complications, recurrence, and patient satisfaction scores were evaluated and recorded. Patients with acute thrombosed haemorrhoids, external haemorrhoids only, or other concomitant anal diseases were excluded. These data were compared with the historical data of PPH. RESULTS: Forty consecutive patients underwent THD from February 2012 to July 2013 and were compared to 37 patients who underwent PPH taken from a medical records database. There were no significant differences in terms of demographic data, type of anaesthesia, operative time, and blood loss. Length of hospital stay, time to first post-operative bowel movement, and complications were similar between the two groups. The median pain score after THD and PPH was 1.71 and 5.00, respectively, on a scale of 0-10 (10 = worst possible pain) (p = 0.000). There was a significant improvement in bleeding and prolapse scores after THD. THD patients had an earlier return to normal daily activities (3.13 vs. 6.78 days, p = 0.001) when compared with the PPH group. Upon follow-up, patients in both groups had similar satisfaction scores, and complication and recurrence rates. CONCLUSIONS: Both THD and PPH appear to be safe procedures for haemorrhoidal disease, and they appear to have similar short-term outcomes. In particular, THD seems to be associated with a lower pain score than PPH, an earlier return to normal daily activities, and similar rates of complication and recurrence.
Asunto(s)
Arterias/cirugía , Hemorroides/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Recto/irrigación sanguínea , Técnicas de Sutura/instrumentación , Suturas , Canal Anal , Humanos , Ligadura/métodos , Recto/cirugía , Estudios RetrospectivosRESUMEN
Coloduodenal fistula is an uncommon disease entity. It can be caused by either a malignant or benign disease. We report the fifth case of coloduodenal fistula secondary to colonic diverticulosis. Our patient, a 60-year-old man, presented with severe diarrhoea and recurrent severe hypokalaemia. A partial colectomy with en bloc excision of the fistula was performed, and the duodenal defect was closed primarily. A literature review was carried out on the aetiology, presentation, diagnosis and management of coloduodenal fistula.