RESUMEN
BACKGROUND: Rubber band ligation (RBL) is probably the most commonly performed nonsurgical therapy for hemorrhoidal disease. Infrared coagulation (IRC) is one of the most recent advances based on the use of "heat". Recent studies have demonstrated similar efficacy for both modalities. This prospective randomized crossover trial compared IRC and RBL for pain, complications, effectiveness, and patient satisfaction and preference in the treatment of internal hemorrhoids (IH). METHODS: Patients were randomized to receive either RBL (Group A) or IRC (Group B) for treatment of the first hemorrhoid; in a second procedure two weeks later, patients underwent the other procedure on the second hemorrhoid, thereby serving as their own control. The procedure preferred by the patient was employed two weeks later for the third hemorrhoid. Post-treatment pain was evaluated on a visual analog scale and on the basis of the percentage of patients requiring analgesics. Bleeding and early outcome of treatment were also recorded, together with the patient's satisfaction. RESULTS: A total of 94 patients were included in this study (47 patients in each group). At 30 minutes and 6 hours after treatment, pain scores were significantly higher in patients treated with RBL than in those treated with IRC (p<0.01). There was no significant difference in pain scores between the two procedures immediately and 24 hours after the procedures (p<0.05). After 72 hours and one week, the pain scores for RBL and IRC were similar. The percentage of patients using analgesics was significantly higher in RBL group than in IRC group at 6 hours (29.6% vs. 19.2%, respectively; p<0.05) and 24 hours (22.5% vs. 13.5%, respectively; p<0.05) after treatment. However, significant differences were not noted at 72 hours (12.7% vs. 6.4%; p<0.05) and one week (5.6% vs. 7.1%; p>0.05) after the procedures. There were significantly higher incidences of bleeding immediately, 6 hours, and 24 hours after RBL compared to IRC (immediate: 32.4% vs. 4.3%; 6 hours: 13.4% vs. 3.6%, 24 hours: 26.8% vs. 10.2%, respectively; p<0.01). However, there were no significant differences noted regarding the incidence of bleeding between the two groups at 72 hours. Complications were more likely after RBL than IRC, however this difference was not significant (p>0.05). Overall, 91 patients (96.8%) were successfully treated and 93 patients (99%) were very satisfied with the treatment. In the third treatment session, 50% of patients selected RBL and 50% chose IRC. CONCLUSIONS: Both RBL and IRC were well-accepted and highly efficacious methods for the treatment of IH; in addition, both procedures were associated with relatively minor complications. However, RBL was associated with more pain than IRC in the 24-hour postoperative period.
Asunto(s)
Hemorroides/cirugía , Fotocoagulación , Adulto , Estudios Cruzados , Femenino , Humanos , Ligadura/efectos adversos , Fotocoagulación/efectos adversos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Satisfacción del Paciente , Estudios Prospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To prospectively compare immediate postoperative results of the surgical treatment of haemorrhoidal disease (HD) by Milligan-Morgan technique using either the CO(2) laser or cold scalpel. METHODS: Forty patients with grade III/IV HD were prospectively randomized to undergo surgical treatment (Milligan-Morgan) using either the CO(2) laser (group A) or the cold scalpel method (group B). Data were compared regarding postoperative pain, complications, healing time, return to normal activity and patient satisfaction. Patients were blinded to treatment method until the completion of the study. Postoperative outcomes were assessed by patient questionnaire and outpatient follow-up visits. Pain was assessed by Visual Analogue Scale and analgesic consumption. RESULTS: Twenty patients were randomized into each group and were comparable relative to mean age, gender and grade of HD. There were no statistically significant differences regarding postoperative pain measured (P =0.17) or consumption of oral (P = 0.741) and parenteral analgesics (P = 0.18) between the two groups. Mean pain score at the first bowel movement was significantly higher in group A (P = 0.035), although the use of analgesics was similar in both the groups. There were no differences regarding complications, mean healing time, return to normal activities and patient satisfaction. CONCLUSION: There were no differences in the immediate results after Milligan-Morgan haemorrhoidectomy using either the CO(2) laser or cold scalpel regarding postoperative pain, complications, healing time, return to normal activities or patient satisfaction.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Hemorroides/cirugía , Dolor Postoperatorio/etiología , Femenino , Hemorroides/patología , Humanos , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico , Satisfacción del Paciente , Estudios Prospectivos , Instrumentos QuirúrgicosRESUMEN
We report a case of a highly recurrent giant perianal condyloma, or Buschke-Lowenstein tumor, which was successfully treated by telecobalt therapy. We conclude that radiation therapy is an optional treatment modality for the management of giant perianal condylomata in selected cases.
Asunto(s)
Enfermedades del Ano/radioterapia , Condiloma Acuminado/radioterapia , Adulto , Enfermedades del Ano/patología , Biopsia , Condiloma Acuminado/patología , Humanos , Masculino , RecurrenciaRESUMEN
Rectovaginal fistulas are difficult to manage and cause significant morbidity. A new technique for large rectovaginal fistula repair is presented; it is based on the creation of a neovagina associated with an established abdominal pull-through operation. This technique has been used since 1970 in selected cases, with very little morbidity and no operative mortality.
Asunto(s)
Procedimientos de Cirugía Plástica/métodos , Fístula Rectovaginal/cirugía , Femenino , HumanosRESUMEN
The management of anal incontinence varies. It can be treated either clinically or surgically depending on its etiology and the intensity of the signs and symptoms. The variety of procedures and techniques employed in its treatment is proof of the incomprehension of the pathophysiological mechanisms involved as well as their diversity. Sphincteroplasties are indicated for those patients with well-defined muscle injury, usually resulting from obstetrical trauma, iatrogenic surgery or vehicular accidents. In cases of persistent anal incontinence after previous sphincteroplasty or those in which extensive destruction of the sphincteric musculature is confirmed, muscle-aponeurotic transpositions are an attractive option. A detailed survey of the literature of the chief techniques utilized and their results is presented.
Asunto(s)
Incontinencia Fecal/cirugía , Músculo Esquelético/trasplante , Colgajos Quirúrgicos , Canal Anal/lesiones , Canal Anal/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Humanos , Técnicas de Sutura/normasRESUMEN
Three hundred and twenty-eight patients with anorectal diseases were submitted ambulatory surgery, under local anesthesia, in a three-year period. Three hundred and fifty one operations were performed in outpatient service. Local anesthesia by Hook-Needle Puncture technique was used in 37 operations and the rest of them by classical technique through infiltration of both lateral anal quadrants. Hemorrhoids, fistulas, fissures and pilonidal cysts were the most frequent diseases treated (71.6%). The incidence of early and late complications was 19.6% and 4.8%, respectively. The most common complication was severe pain (16.1%). Five patients (1.5%) required hospitalization due postoperative complications. The surgery on an outpatient basis was a well-accepted procedure for two hundred eighty-eight patients (88%). The main benefit reported by patients was the possibility of recovery at home, which is more comfortable. The ambulatory anorectal surgery under local anesthesia is a safe and effective method, with the additional advantage of the costs saved and increase of available beds for more complex surgery.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Anestesia Local , Enfermedades del Recto/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Rectal procidentia is an uncommon but debilitating condition that often affects elderly patients with significant medical problems. Fecal incontinence is usually frequent. Abdominal rectopexy with or without sigmoid resection repeatedly demonstrate lower recurrence rates (2-4%) but in high-risk patients, morbidity and mortality may be significant. Perineal or transacral approaches may be used in these patients to avoid the complications of abdominal procedures and general anesthesia. The lack of experience with transacral approach has limited your utilization by colon and rectal surgeons. We describe a case of rectal procidentia in patient with severe liver disease (Child C) sucssefull treated with transacral rectopexy, detailing the technique used.
Asunto(s)
Hepatopatías/complicaciones , Prolapso Rectal/cirugía , Recto/cirugía , Incontinencia Fecal/etiología , Incontinencia Fecal/cirugía , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Prolapso Rectal/complicacionesRESUMEN
True non-parasitic splenic cysts are uncommon, their real incidence is difficult to determine since over 30% are asymptomatic. Preoperatively these cysts are rarely diagnosed correctly and they are often findings on examinations. Partial or total splenectomy is the treatment of choice after ruling out splenic hydatidosis, since it is responsible for two thirds of global incidence. Currently, with the technological advances of surgery, especially of videolaparoscopy, some authors have proposed its use for partial cystectomy or splenectomy. The authors present the case of a true splenic cyst (epidermoid) which was resected videolaparoscopically and they discuss aspects of diagnosis and management.
Asunto(s)
Quistes/cirugía , Laparoscopía , Enfermedades del Bazo/cirugía , Grabación en Video , Adulto , Quistes/diagnóstico , Femenino , Humanos , Enfermedades del Bazo/diagnósticoRESUMEN
PURPOSE: Anorectal surgery has been increasingly performed as an ambulatory procedure using general, regional, and local anesthesia. Local anesthesia is classically performed through infiltration of four quadrants around the anal verge, which renders the procedure painful and uncomfortable for most surgeons and patients. We present a new, painless technique of local anesthesia for anorectal surgery. METHODS: Patients with surgical risk Classes I and II (American Society of Anesthesiologists) bearing anorectal pathologies were sedated and placed on the operating table in the prone jackknife position. After local antisepsis, the anal canal was lubricated with 2 percent lidocaine gel, and the mucosa was punctured by a hook-shaped, curved, 22-gauge needle just above the pectinate line. A solution of local anesthetics was slowly infused in all four quadrants to the submucosal level. If needed, more anesthetics were infused during the operation. RESULTS: This technique was easily and painlessly applied in more than 60 patients and permitted execution of several ambulatory anorectal procedures with comfort and safety. CONCLUSIONS: The hook-needle puncture for local anesthesia is an effective and safe procedure and may be routinely used for ambulatory anorectal surgery in selected patients.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Anestesia Local/métodos , Enfermedades del Recto/cirugía , Recto/cirugía , Canal Anal/cirugía , HumanosRESUMEN
PURPOSE: Retrorectal tumors are rare entities often found in females during reproductive age. Reports of retrorectal tumors complicating pregnancy are scant. This study presents two cases of retrorectal tumors complicating pregnancy and a literature review. METHODS: Two patients bearing retrorectal tumors diagnosed during pregnancy were referred to our care at the postpartum period. Both then underwent exploratory laparotomy. RESULTS: One patient had premature delivery by cesarean section because of hemorrhage from abruptio placentae followed by fetal mortality. Attempts to resect the tumor immediately after delivery had been unfruitful. The tumor was also unresectable on exploratory laparotomy. Biopsy studies of the tumor were consistent with low-grade myosarcoma. Another patient had a benign cystic mass that had been conservatively monitored throughout pregnancy. A healthy baby was delivered at term by cesarean section. The cyst was later resected via Kraske's incision and was diagnosed as cystic teratoma. CONCLUSIONS: Retrorectal tumors may cause significant local effects such as complicated pregnancy. Early detection in the population at risk is needed, as correct diagnosis and treatment may be done only on surgical exploration. During pregnancy, careful monitoring of advanced tumors is mandatory and may be sufficient to prevent maternal and fetal complications.