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Diseases of the Colon and Rectum May 2022Core factors involved in the treatment of hemorrhoids include the engorgement of hemorrhoids, prolapse, recurrence, and pain.
BACKGROUND
Core factors involved in the treatment of hemorrhoids include the engorgement of hemorrhoids, prolapse, recurrence, and pain.
OBJECTIVE
The goal of this study was to assess the safety, pain, and efficacy of the transanal suture mucopexy for the treatment of hemorrhoids.
DESIGN
This was a retrospective study over a 13-year period.
SETTING
This procedure was performed, and data collected, from medical records at six centers in India.
PATIENTS
This study includes 5634 patients who had grade II to IV symptomatic hemorrhoids. Patients suffering from thrombosed hemorrhoids, inflammatory bowel disease, anal strictures, and anorectal carcinoma were excluded.
INTERVENTIONS
Hemorrhoidal swelling was reduced by manual massage and a steep Trendelenburg position under saddle block. The reduced hemorrhoids were fixed to the muscles of the rectal wall using sutures. Each suture measured 0.5 to 1.0 cm in length; double-locking continuous sutures were used, along the complete circumference of the rectum, at 2 and 4 cm proximal to the dentate line.
MAIN OUTCOME MEASURES
Pain assessed using the visual analog scale and hemorrhoid recurrence served as outcome measures.
RESULTS
The transanal suture mucopexy procedure was performed for 5634 patients with symptomatic hemorrhoids. A dull pain compatible with a visual analog score of 2 to 3 was reported in 126 (2.2%) patients; in the remaining 5508 (97.8%) patients, the visual analog score was 1 to 2. Effective treatment without complications occurred for 5541 patients (98.65%). A recurrence rate of 1.3% was recorded in 5634 cases with a mean follow-up of 7 ± 6 years.
LIMITATIONS
Utilization of a self-illuminating proctoscope or Brinckerhoff or anal speculum is essential.
CONCLUSION
Transanal suture mucopexy, designed with 2 suture rows, is a safe procedure with a short learning curve. It is associated with minimal pain, low recurrence rate, and fewer complications. See Video Abstract at http://links.lww.com/DCR/B841.
MUCOPEXIA TRANSANAL CON SUTURA PARA ENFERMEDAD HEMORROIDAL
ANTECEDENTES:Los factores centrales involucrados en el tratamiento de la enfermedad hemorroidal incluyen congestión de hemorroides, prolapso, recurrencia y dolor.OBJETIVO:Evaluar la seguridad, el dolor y la eficacia de la mucopexia transanal con sutura para el tratamiento de la enfermedad hemorroidal.DISEÑO:Estudio retrospectivo durante un período de 13 años.ESCENARIO:Este procedimiento se realizó y se recopilaron datos de expedientes médicos en seis centros en India.PACIENTES:Este estudio incluye 5634 pacientes con enfermedad hemorroidal sintomática grado II a IV. Se excluyeron pacientes que padecían hemorroides trombosadas, enfermedad inflamatoria intestinal, estenosis anales y carcinoma anorrectal.INTERVENCIONES:La inflamación hemorroidal se redujo mediante masaje manual y posición Trendelenburg profundo bajo bloqueo caudal. Las hemorroides reducidas se fijaron a los músculos de la pared rectal mediante suturas. Cada sutura midió 0.5 a 1.0 cm de longitud, se utilizaron suturas en surgete continuo de doble anclado, a lo largo de la circunferencia completa del recto, a dos y cuatro cm proximales a la línea dentada.PRINCIPALES MEDIDAS DE RESULTADO:El dolor se evaluó mediante la escala de puntuación analógica visual y se evaluó la presencia de recurrencia.RESULTADOS:El procedimiento de mucopexia transanal con sutura se realizó en 5634 pacientes con hemorroides sintomáticas. Se informó un dolor sordo compatible con una puntuación analógica visual de 2-3 en 126 (2.2%) pacientes; en los 5508 (97.8%) pacientes restantes, la puntuación analógica visual fue de 1-2. La mayoría (5541 pacientes [98.65%]) tuvo un tratamiento eficaz sin complicaciones. Se registró una tasa de recurrencia del 1.3% en 5634 casos con un seguimiento medio de 7 ± 6 años.LIMITACIONES:La utilización de un proctoscopio autoiluminado o de Brinckerhoff o espéculo anal es esencial.CONCLUSIÓN:La mucopexia transanal con sutura es un procedimiento seguro diseñado con dos filas de suturas asociadas con dolor mínimo y baja tasa de recurrencia con menos complicaciones. Tiene una curva de aprendizaje corta. Consulte Video Resumen en http://links.lww.com/DCR/B841. (Traducción-Dr. Jorge Silva Velazco).
Topics: Carcinoma; Hemorrhoids; Humans; Pain; Retrospective Studies; Sutures
PubMed: 34958048
DOI: 10.1097/DCR.0000000000002191 -
Journal of Laparoendoscopic & Advanced... Dec 2007Retrieval of polyps during colonoscopic procedures can be technically difficult and time consuming. This is particularly the case when attempting to retrieve large...
Retrieval of polyps during colonoscopic procedures can be technically difficult and time consuming. This is particularly the case when attempting to retrieve large polyps intact through the anal canal of an anxious patient with a hypertonic sphincter. In this paper, we describe a simple technique that permits the complete removal of a large polyp intact by using a readily available theater instrument. The success rate of this procedure can be improved with the aid of simple instrument like a proctoscope.
Topics: Colonic Polyps; Humans; Proctoscopes; Treatment Outcome
PubMed: 18158813
DOI: 10.1089/lap.2006.0158 -
Ugeskrift For Laeger Dec 1969
Topics: Electronics, Medical; Humans; Lighting; Photography; Proctoscopes; Sigmoidoscopy
PubMed: 5376320
DOI: No ID Found -
Diseases of the Colon and Rectum Mar 1983
Topics: Foreign Bodies; Humans; Proctoscopes; Rectum
PubMed: 6825530
DOI: 10.1007/BF02560171 -
American Journal of Proctology Dec 1965
Topics: Aged; Anesthesia, General; Anesthesia, Spinal; Humans; Male; Rectal Neoplasms; Sigmoidoscopy
PubMed: 5839644
DOI: No ID Found -
Colorectal Disease : the Official... Nov 2004Per-anal excision can be an effective method for treating large rectal adenomas and selected rectal cancers. This procedure is suitable for adenomas that are too large... (Comparative Study)
Comparative Study
BACKGROUND
Per-anal excision can be an effective method for treating large rectal adenomas and selected rectal cancers. This procedure is suitable for adenomas that are too large for colonoscopic excision and for early rectal cancers in patients that are unfit for major resection.
PATIENTS AND METHODS
We retrospectively reviewed 37 patients (16 male, 21 female) that had a local resection using a Salvati operating proctoscope. Fifteen had rectal cancer and 22 had rectal adenoma and all have been followed-up for a median of 14 months (range 2-65). Most cancers were staged pre-operatively with endorectal ultrasound and 6 cancer patients received adjuvant therapy.
RESULTS
There were no intra-operative complications, 6 minor postoperative complications, none requiring re-intervention (1 peri-anal haematoma, 2 postoperative anaemia, 2 chest complications, 1 secondary haemorrhage) and no peri-operative deaths. Lesions were histologically completely excised in 33 (89%). Thirty-four (92%) did not have any recurrence, 2 (5%) adenomas recurred (both successfully treated with further local resection) and 1 (3%) failed to attend for follow-up. Six have since died, all from comorbid conditions.
CONCLUSION
Local resection of rectal tumours using the operating proctoscope is a low cost technique with a low complication rate. Outcome of this treatment is good, and similar to other surgical modalities. Local tumour recurrences are uncommon and can be successfully treated with further local treatment.
Topics: Aged; Aged, 80 and over; Equipment Design; Equipment Safety; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Staging; Proctoscopes; Proctoscopy; Rectal Neoplasms; Retrospective Studies; Risk Assessment; Sampling Studies; Survival Rate; Treatment Outcome
PubMed: 15521934
DOI: 10.1111/j.1463-1318.2004.00691.x -
Zentralblatt Fur Chirurgie Jun 2004The aim of treating patients suffering from hemorrhoids is to eliminate or to relieve their complaints. The method should be performed on an out-patient basis, and... (Comparative Study)
Comparative Study
The aim of treating patients suffering from hemorrhoids is to eliminate or to relieve their complaints. The method should be performed on an out-patient basis, and should be painless and low rated concerning complications. The Morinaga technique fulfills these conditions, its feasibility and the results in 281 patients are presented.
Topics: Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Arteries; Endosonography; Female; Follow-Up Studies; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Outcome and Process Assessment, Health Care; Pain Measurement; Pain, Postoperative; Postoperative Complications; Proctoscopes; Rectum; Sclerotherapy
PubMed: 15237328
DOI: 10.1055/s-2004-744 -
International Journal of Colorectal... Nov 1991A disposable torch-lit anoscope is described. Its bevelled end facilitates therapeutic procedures, while the fact that it does not need an external light source makes...
A disposable torch-lit anoscope is described. Its bevelled end facilitates therapeutic procedures, while the fact that it does not need an external light source makes its use on the ward or in the patient's home more straight-forward.
Topics: Anal Canal; Disposable Equipment; Equipment Design; Humans; Lighting; Plastics; Polymers; Proctoscopes; Surface Properties
PubMed: 1770283
DOI: 10.1007/BF00341387 -
Pediatrics Jan 1962
Topics: Colorectal Surgery; Equipment and Supplies; Humans; Pediatrics; Proctoscopes
PubMed: 14481122
DOI: No ID Found -
Cirugia Espanola Sep 2006Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims... (Review)
Review
Transanal endoscopic microsurgery (TEM) uses specific equipment that allows resection of large rectal adenomas and incipient malignancies in the rectal ampulla. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Application of the technique of endoanal excision is limited by the height and extension of the lesions. In this review, the authors present their own experience with this technique and that described in the literature. The protocol for selecting candidates for TEM, their preoperative preparation, equipment, characteristics of the surgical technique, postoperative complications, and follow-up are described. The collaboration of a multidisciplinary team is essential when developing this technique. TEM-associated morbidity is low and mortality is practically nil. TEM is the technique of choice in large rectal adenomas and malignant rectal tumors in stages pT1 localized in the rectal ampulla. The frequency of recurrence is similar to that in abdominal surgery. The technique does not cause complications of urinary or sexual dysfunction and fecal incontinence is minimal. In more advances stages of rectal cancer, the results of better patient selection and future studies on the possible application of neoadjuvant therapy associated with TEM are required.
Topics: Adenoma; Equipment Design; Forecasting; Humans; Microsurgery; Proctoscopes; Proctoscopy; Rectal Neoplasms
PubMed: 16956547
DOI: 10.1016/s0009-739x(06)70940-x