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British Medical Journal Jul 1902
PubMed: 20760379
DOI: 10.1136/bmj.2.2168.168 -
Techniques in Coloproctology Dec 2017The transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to... (Review)
Review
BACKGROUND
The transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to assess the clinical efficacy and the satisfaction of patients in a large series treated with THD and to review the relevant literature.
METHODS
In this retrospective, single-institution, study consecutive patients with grade 2, 3, or 4 hemorrhoidal disease were treated with the THD Doppler procedure. Dearterialization was performed in all cases and mucopexy in case of prolapse. The dearterialization procedure evolved from "proximal artery ligation" to "distal Doppler-guided dearterialization." Follow-up was scheduled at 15 days, 1, 3, 12 months, and once a year thereafter. Complications were recorded. Clinical efficacy was assessed comparing both frequency of symptoms and disease grading (Goligher's classification) at baseline versus last follow-up. Uni-/multivariate analysis evaluated factors affecting the outcome.
RESULTS
There were 1000 patients (619 men; mean age: 48.6 years, range 19-88 years). Acute postoperative bleeding was observed in 14 patients (1.4%), pain/tenesmus in 31 patients (3.1%), and urinary retention in 23 patients (2.3%). At mean follow-up duration of 44 ± 29 months, the symptomatic recurrence rate was 9.5% (95 patients; bleeding in 12 (1.2%), prolapse in 46 (4.6%), and bleeding and prolapse in 37 (3.7%) patients). The recurrence rate was 8.5, 8.7, and 18.1% in patients with grade 2, 3, and 4 hemorrhoids, respectively. Seventy out of 95 patients with recurrence needed surgery (reoperation rate: 7.0%). At final follow-up and taking into account the reoperations, 95.7% of patients had no hemorrhoidal disease on examination. Younger age, grade 4 disease, and high artery ligation affected the outcome negatively.
CONCLUSIONS
Our results show that the THD Doppler procedure is safe and effective in patients with hemorrhoidal disease and associated with low morbidity and recurrence rates and a high rate percentage of treatment success.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Arteries; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Pain, Postoperative; Patient Satisfaction; Postoperative Hemorrhage; Proctoscopes; Recurrence; Retrospective Studies; Severity of Illness Index; Symptom Assessment; Transanal Endoscopic Surgery; Treatment Outcome; Urinary Retention; Young Adult
PubMed: 29170839
DOI: 10.1007/s10151-017-1726-5 -
La Clinica Terapeutica Jul 2021Haemorrhoids are a very common disease, with a great economic burden. Many treatments have been developed for trying to solve the problem, being the standard not yet... (Comparative Study)
Comparative Study
INTRODUCTION
Haemorrhoids are a very common disease, with a great economic burden. Many treatments have been developed for trying to solve the problem, being the standard not yet found. In 1995, Doppler-guided haemorrhoidal artery ligation was introduced, aiming to reduce postoperative pain and complications. In this work, an evolu-tion of the aforementioned surgical technique was described.
MATERIALS AND METHODS
183 patients treated with standard Doppler-Guided Haemorrhoidal Artery Ligation were statistically compared with 225 patients dealt with Colour Doppler-Guided Haemorrhoidal Artery Ligation. The procedures were performed under local anaes-thesia with patients in lithotomy position. A special proctoscope and a dedicated Colourdoppler US probe were employed in the second group. Superior haemorrhoidal artery terminal branches were con-secutively ligated according to provided technique in the first group and under vision in the second. In all cases, each ligation was followed by mucopexy.
RESULTS
No significant differences between the two groups, in terms of post-operative pain, early complications (bleeding, urinary retention, incontinence) or patient satisfaction, were demonstrated. Recurrence rate was significantly higher in patients treated with stan-dard DG-HAL. No late complications (after one-year follow-up) were registered in both groups.
CONCLUSIONS
Colour Doppler-Guided Haemorrhoidal Artery Li-gation represents an ideal management for 1-day surgery, and fulfils the requirements of minimally invasive surgery in patients with III-IV grade haemorrhoids. The absence of complications and the evidence of significant wellness of patients are the best advantages. Colour Doppler-Guided Haemorrhoidal Artery Ligation is a safe and easy procedure with good results and a very short-time training. It could be considered an easy and reliable method to treat symptomatic haemorrhoids.
Topics: Adult; Echocardiography, Doppler, Color; Female; Hemorrhoidectomy; Hemorrhoids; Humans; Ligation; Male; Mesenteric Artery, Inferior; Middle Aged; Ultrasonography, Doppler
PubMed: 34247216
DOI: 10.7417/CT.2021.2337 -
Journal of Visceral Surgery Jun 2010
Topics: Equipment Design; Humans; Intestinal Mucosa; Microsurgery; Proctoscopes; Proctoscopy; Rectal Neoplasms; Suture Techniques
PubMed: 20801733
DOI: 10.1016/j.jviscsurg.2010.07.006 -
Journal of Gynecologic Oncology Nov 2018We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic...
OBJECTIVE
We aimed to propose a set of quality indicators (QIs) based on the clinical guidelines for cervical cancer treatment published by The Japan Society of Gynecologic Oncology, and to assess adherence to standard-of-care as an index of the quality of care for cervical cancer in Japan.
METHODS
A panel of clinical experts devised the QIs using a modified Delphi method. Adherence to each QI was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2013, and linked with insurance claims data, between October 1, 2012, and December 31, 2014. All patients who received first-line treatment at the participating facility were included. The QI scores were communicated to participating hospitals, and additional data about the reasons for non-adherence were collected.
RESULTS
In total, 297 hospitals participated, and the care provided to 15,163 cervical cancer patients was examined using 10 measurable QIs. The adherence rate ranged from 50.0% for 'cystoscope or proctoscope for stage IVA' to 98.8% for 'chemotherapy using platinum for stage IVB'. Despite the variation in care, hospitals reported clinically valid reasons for more than half of the non-adherent cases. Clinically valid reasons accounted for 75%, 90.9%, 73.4%, 44.5%, and 88.1% of presented non-adherent cases respectively.
CONCLUSION
Our study revealed variations in pattern of care as well as an adherence to standards-of-care across Japan. Further assessment of the causes of variation and non-adherence can help identify areas where improvements are needed in patient care.
Topics: Adenocarcinoma; Adult; Aged; Carcinoma, Squamous Cell; Female; Guideline Adherence; Hospitals; Humans; Japan; Middle Aged; Practice Guidelines as Topic; Quality of Health Care; Registries; Uterine Cervical Neoplasms
PubMed: 30207093
DOI: 10.3802/jgo.2018.29.e83 -
Journal of Medicine and Life Sep 2013To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. (Clinical Trial)
Clinical Trial
OBJECTIVE
To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure.
PLACE AND DURATION OF STUDY
Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments.
MATERIALS AND METHODS
This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and < 50% in 14 cases. Twenty-eight cases did not come for follow-up. In the 2nd sitting, out of 84/127; 58 patients got a total relief, >75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits.
CONCLUSION
IRC is a safe, simple and effective procedure for early hemorrhoids without any complications. IRC is nowadays the world's leading office treatment for hemorrhoids. IRC is a better option than the surgical treatment as it is easy, well tolerated, and remarkably complication-free. In our study, we have not used any course of antibiotics. In the management of early hemorrhoids, IRC should be considered as a simple trouble-free and painless option.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Coagulation; Hemorrhage; Hemorrhoids; Hospitals; Humans; Infrared Rays; Middle Aged; Proctoscopy; Young Adult
PubMed: 24146691
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Nov 2007Rectal tumors up to 25 cm from the anal verge may be resected by transanal endoscopic microsurgery (TEM). TEM is suitable for resection of benign adenomas, but can also... (Review)
Review
BACKGROUND
Rectal tumors up to 25 cm from the anal verge may be resected by transanal endoscopic microsurgery (TEM). TEM is suitable for resection of benign adenomas, but can also be used for selected malignant tumours.
MATERIAL AND METHODS
Based on review of the literature and our own experience with 150 procedures, we present a review of the method and indications for TEM.
RESULTS
TEM is a safe and suitable method for resection of rectal adenomas that cannot be radically removed by endoscopic methods. TEM offers lower recurrence rates and less morbidity than traditional treatment. Large tumours and involvement of the microscopical resection margin disposes for recurrence. Selected malignant tumours (like small carcinoid tumours and early stage [Tis, T1] adencarcinomas) with higer moderate differentiation may be resected by TEM with the same oncological result as open surgery.
INTERPRETATION
Tumours can be resected in the entire rectum with TEM. TEM is especially suitable to resect benign adenomas, and may also have a place as primary treatment of selected malignant tumours in Norway. Depending on selection criteria and combination with radiotherapy, the method may be suitable for 30 - 110 patients/year with rectal cancer in Norway.
Topics: Adenocarcinoma; Adenoma; Humans; Microsurgery; Neoplasm Recurrence, Local; Postoperative Complications; Proctoscopes; Proctoscopy; Rectal Neoplasms
PubMed: 18026244
DOI: No ID Found -
Cureus May 2020Background Haemorrhoid is the most common anal canal disease. Treatments may vary from non-invasive to invasive depending on the symptoms. Haemorrhoidectomy has been...
Background Haemorrhoid is the most common anal canal disease. Treatments may vary from non-invasive to invasive depending on the symptoms. Haemorrhoidectomy has been widely used. However, it has some drawbacks like severe postoperative pain, longer time to return to daily activities and complications such as anal stenosis. To overcome these, various new treatment methods have been introduced. Doppler-guided hemorrhoidal artery ligation operations (HALO) are becoming popular among surgeons. HALO has been reported to have a lower recurrence rate of less than 10% and higher patient satisfaction of approximately 90% with minimal postoperative pain. It achieves very good postoperative outcomes in the treatment of early haemorrhoids where per rectal bleeding and/or perianal discomfort are main symptoms. Nevertheless, it has a limitation in the treatment of prolapsing haemorrhoids. To tackle this, simultaneous recto-anal repair (RAR) has been recently introduced. HALO, in combination with RAR, has been reported to achieve good postoperative outcomes and excellent patient satisfaction. This is a two-stage open operation. The stages are: - Doppler-guided HALO and - RAR (recto-anal repair) Methods We are presenting a single-centre one-year experience of Doppler-guided haemorrhoidal artery ligation operation and recto-anal repair (DG-HALO and RAR) conducted on haemorrhoidal patients to evaluate the outcomes and effectiveness of the procedure. Retrospective data were collected for the patients who underwent HALO over one year period from June 2018 to August 2019. A total of 10 patients were treated with the HALO-RAR procedure. Results The male to female ratio was 7:3, median age was 47.98 (28.38 - 61.7) years, median body mass index (BMI) was 30.23 (23.8 - 39.1). Eight patients were American Society of Anesthesiologists (ASA) Grade II, one patient was ASA I and one was ASA III. Time from initial consultation to the HALO procedure was 9.90 (3.5 - 19.8) months. All patients complained of preoperative bleeding and six of them complained of pain or discomfort. Nine patients underwent previous bandings in the clinic and one patient declined banding. The average time of the procedure was 57 mins. The average number of ligations was 10 (0-21). In one case, the proctoscope did not pair with the speaker. The average number of plications was three (2-4). Postoperatively, nine patients had no immediate complications; one patient had acute urinary retention. Seven patients were discharged on the same day. One patient had to stay overnight for monitoring prior to restarting apixaban, one patient for his learning difficulties and one patient had an unplanned overnight stay due to acute urinary retention requiring catheterization. Eight patients had their first follow-up; improvement of symptoms was found in 100% patients on the first follow-up. Conclusion HALO-RAR should be considered as a treatment option for recurrent symptoms after banding for haemorrhoids. The study showed good overall results with no immediate surgical complications. Excellent patient satisfaction was found even in long-term follow-up.
PubMed: 32499984
DOI: 10.7759/cureus.7944 -
Il Giornale Di Chirurgia 2017The best treatment of early stage anal squamous cell carcinoma (SCC) is under debated. Wide local excision (WLE) may be considered adequate for stage 1 anal margin...
OBJECTIVES
The best treatment of early stage anal squamous cell carcinoma (SCC) is under debated. Wide local excision (WLE) may be considered adequate for stage 1 anal margin cancer. This study demonstrates our experience in treatment of patients with SCC over 5 years.
PATIENTS AND METHODS
We conducted a retrospective study of patients who had undergone anal screening or anal cancer surveillance between October 2010 and 2015 in our department. Each patient underwent anal Pap test, HPV test PCR HPV DNA and cytology by Thin Prep. The examinations were performed by Proctostation THD©. Data were collected and analysed.
RESULTS
We included 25 patients, 16 male (64%) and 9 female (36%). Twenty-four patients had SCC and 1 patient had adenocarcinoma. Of this cohort: 10 underwent chemoradiotherapy (CRT) because T3-4 N1-2 M0, 13 underwent only surgery because T1/T2 and 2 patients had CRT and surgery because they already have had anal cancer treated in the past with CRT. Seventeen patients (68%) of this cohort, including 5 with micro-invasive SCCs, had regular follow-up without recurrences. Four patients (17%) died from metastatic disease and 4 patients (17%) had recurrent disease.
CONCLUSIONS
In this small cohort we demonstrated satisfactory results in treatment of SCCs, underlining the effective role of surgery in early stages of SCC. Screening program and follow up were fundamental to identify early stage and recurrent disease. Also we found the High-resolution video-proctoscopy a valid diagnostic tool.
Topics: Adolescent; Adult; Aged; Anus Neoplasms; Carcinoma, Squamous Cell; Equipment Design; Female; Humans; Male; Middle Aged; Proctoscopes; Proctoscopy; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
PubMed: 29182899
DOI: 10.11138/gchir/2017.38.4.176 -
World Journal of Gastroenterology Apr 2013To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter.
AIM
To assess the therapeutic value of endoscopic mucosal resection (EMR) under micro-probe ultrasound guidance for rectal carcinoids less than 1 cm in diameter.
METHODS
Twenty-one patients pathologically diagnosed with rectal carcinoids following colonoscopy in our hospital from January 2007 to November 2012 were included in this study. The patients consisted of 14 men and 7 women, with a mean age of 52.3 ± 12.2 years (range: 36-72 years). The patients with submucosal tumors less than 1 cm in diameter arising from the rectal and muscularis mucosa detected by micro-probe ultrasound were treated with EMR and followed up with conventional endoscopy and micro-probe ultrasound.
RESULTS
All of the 21 tumors were confirmed by micro-probe ultrasound as uniform hypoechoic masses originating from the rectal and muscularis mucosa, without invasion of muscularis propria and vessels, and less than 1 cm in diameter. EMR was successfully completed without bleeding, perforation or other complications. The resected specimens were immunohistochemically confirmed to be carcinoids. Patients were followed up for one to two years, and no tumor recurrence was reported.
CONCLUSION
EMR is a safe and effective treatment for rectal carcinoids less than 1 cm in diameter.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Carcinoid Tumor; Colonoscopy; Equipment Design; Female; Humans; Intestinal Mucosa; Intestinal Neoplasms; Male; Middle Aged; Miniaturization; Proctoscopes; Proctoscopy; Rectal Neoplasms; Time Factors; Treatment Outcome; Tumor Burden; Ultrasonography, Interventional
PubMed: 23674859
DOI: 10.3748/wjg.v19.i16.2555