RESUMEN
BACKGROUND: Postoperative expectations after stapled hemorrhoidopexy are still being clarified. Our purpose was to evaluate how outcome is affected by staple line height (SLH) above the dentate line and specimen histology. METHODS: A prospective database identified demographics, SLH, histology, narcotic use, return to work, and resolution or recurrence of preoperative symptoms data for analysis. RESULTS: One hundred five patients were analyzed; median age was 49 years. Median RTW and narcotic use were 9 and 4 days, respectively. Patients with squamous epithelium-containing specimens had longer narcotic use (P = .038), whereas patients with SLH >20 mm had shorter narcotic use (P = .021). Preoperative pain and bleeding resolved more frequently with SLH >20 mm (P = .036) and less frequently with SLH >40 mm (P = .032). Patients with poor sphincter tone were more likely to have SLH >20 mm (P = .044). Postoperative symptoms recurred more frequently in patients with SLH >40 mm (P = .001). CONCLUSIONS: Hemorrhoidopexy SLH and histology can impact postoperative outcomes. SLH should be >20 mm yet < or =40 mm above the dentate, avoiding squamous epithelium.
Asunto(s)
Hemorroides/cirugía , Grapado Quirúrgico/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Hemorroides/complicaciones , Hemorroides/patología , Humanos , Masculino , Persona de Mediana Edad , Narcóticos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Pronóstico , Estudios Prospectivos , Recuperación de la Función , Grapado Quirúrgico/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: To determine the long-term outcome in patients with filling defects on intraoperative cholangiography. DESIGN: Case series; retrospective review. SETTING: Community teaching hospital. PATIENTS: All patients (n = 872) undergoing cholecystectomy from July 1993 through June 1995. Of 281 intraoperative cholangiograms performed, 89 had abnormal findings. Defects were classified as stone (n = 47), unsure (n = 29), and artifact (n = 13). Medical records were reviewed for immediate and long-term follow-up results. INTERVENTION: Need for common bile duct exploration (CBDE) or endoscopic retrograde cholangiopancreatography (ERCP). OUTCOME: Morbidity and interventions required 1 to 3 years after surgery. RESULTS: Of the 47 patients with suspected stones, 24 underwent successful operative bile duct clearance. One patient required irrigation. Of the 22 patients who left the operating room with unresolved stones, only 2 ERCPs were required. Of the 29 patients with unsure filling defects, operative clearance was successful in 1; irrigation achieved clearance in 4. Only 1 of the 24 patients who left the operating room with unsure filling defects required subsequent ERCP. CONCLUSIONS: Observation of common bile duct defects of 4 mm or smaller is an appropriate clinical alternative. Defects of 5 mm or larger represent a gray area, although few 5- to 8-mm stones will cause subsequent symptoms. In our experience, if stone extraction is clinically important, especially if the patient has jaundice, open CBDE is more effective than transcystic laparoscopic CBDE.