RESUMO
Introducción: En el tramo distal del conducto anal es normal la presencia de unas estructuras a modo de cojines, constituidas por tejido vascular, denominadas plexos hemorroidales. Objetivo: Comparar las técnicas quirúrgicas abiertas y cerrada en la enfermedad hemorroidal en la provincia Camagüey, en el periodo comprendido desde enero de 2021 a enero de 2023. Métodos: Se realizó un estudio observacional, analítico de corte transversal. El universo lo conformaron 135 pacientes que acudieron a consulta con el diagnóstico de enfermedad hemorroidal. Se le realizó un muestreo aleatorio simple, donde se tomaron 15 pacientes de cada uno de los grupos para conformar una muestra total de 45, cada grupo fue tratado con una técnica quirúrgica diferente. Resultados: En relación al sexo predominó el femenino, el tiempo quirúrgico fue dado a los 30 minutos en las técnicas abiertas. El dolor postoperatorio como complicación inmediata fue significativo con la utilización de la técnica abierta Whitehead clásico, no existieron complicaciones mediatas en el estudio; mientras que en las tardías la estenosis anal fue la que más se manifestó. Conclusiones: Existió predomino del sexo femenino, el tiempo de quirúrgico de mayor frecuencia fue de 30 minutos en los pacientes operados con la técnica abiertas, en la mayor parte de los pacientes se constató dolor excesivo como complicación inmediata con las técnicas de Milligan-Morgan y Whitehead clásico abiertas no así con la cerrada de Ferguson. La estenosis anal fue la complicación quirúrgica tardía más frecuente asociada a la técnica de Whitehead clásico.
Introduction: In the distal section of the anal canal, the presence of "cushion"-like structures, mainly made up of vascular tissue, called hemorrhoid plexuses. Objective: To compare the open and closed surgical techniques in hemorrhoid disease in Camagüey province, in the period from January 2021 to January 2023. Methods: An observational, analytical, cross-sectional study was carried out. The universe was made up of 135 patients who attended the consultation with the diagnosis of hemorrhoid disease. A simple random sampling was carried out, where 15 patients from each of the groups were taken to form a total sample of 45 patients, each group was treated with a surgical technique. Results: In relation to sex, the female sex predominated, the surgical time was given at 30 minutes in the open techniques. Postoperative pain as an immediate complication was significant with the use of the classic Whitehead open technique; there were no mediate complications in this study; while in the late ones, anal stenosis was the one that manifested itself the most. Conclusions: There was a predominance of the female sex, the most frequent surgical time was 30 minutes in patients operated with the open technique, in most patients excessive pain was found as an immediate complication with the Milligan-Morgan and classic Whitehead open techniques, but not so with the closed technique of Ferguson. Anal stenosis was the most frequent late surgical complication associated with the classic Whitehead technique.
RESUMO
The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective: To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method: A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with highmucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence. Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion: Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD. (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hemorroidas/terapia , Resultado do Tratamento , Ultrassonografia Doppler , Hemorroidectomia/métodosRESUMO
ABSTRACT Introduction: The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective: To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods: This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results: The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion: The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.
RESUMO Introdução: O tratamento da doença hemorroidária pelas técnicas convencionais cursa com significante redução da qualidade de vida do doente, principalmente relacionada à dor pós-operatória e ao considerável tempo de afastamento do trabalho. A técnica de desarterialização hemorroidária associada à mucopexia retal é uma opção cirúrgica pouco invasiva, a qual é utilizada com o objetivo de tratar a doença hemorroidária e reduzir seus inconvenientes. Objetivo: Analisar os resultados encontrados após sete anos de seguimento em doentes submetidos à técnica da desarterialização hemorroidária associada à mucopexia para o tratamento da doença hemorroidária. Método: Foram estudados 407 portadores de doença hemorroidária de graus II, III e IV, submetidos à técnica da desarterialização hemorroidária no Hospital das Clínicas Luzia de Pinho Melo de Mogi das Cruzes, durante o período de Dezembro de 2010 a Dezembro de 2017. Vinte e sete doentes (6,6%) apresentavam doença hemorroidária de grau II, 240 (59,0%) do grau III e 117 (28,8%) do grau IV. Em 23 doentes (5,7%) não foram encontradas a classificação nos prontuários. Todos os doentes foram operados pelo mesmo cirurgião e sob anestesia raquidiana. Os 407 doentes foram submetidos à desarterialização, variando de um até seis ramos arteriais seguidos de mucopexia por sutura contínua. Oitenta e dois (20,14%) necessitaram ressecções associadas por plicomas ou hemorroidas externas. No pós-operatório foram avaliados os seguintes parâmetros: dor, tenesmo, sangramento, prolapso, trombose e recidiva. Resultados: O tenesmo foi a queixa pós-operatória referida por 93,36% dos doentes. Quarenta e três (10,5%) apresentaram tenesmo intenso e 44 (22%) de moderado a intenso. Quatro (0,98%) doentes apresentaram sangramento de maior intensidade no pós-operatório e em 1 (0,5%) houve necessidade de hemostasia cirúrgica, em nenhum deles houve necessidade de reposição sanguínea. O prolapso ocorreu em 18 (4,42%) doentes, trombose em 11 (2,7%) e houve 19 (4,67%) recidivas reoperados durante o período. Conclusão: A desarterialização hemorroidária apresenta bons resultados, complicações leves e de fácil resolução e pouca dor pós-operatória.