Document Detail


Stapled hemorrhoidectomy: surgical notes and results.
MedLine Citation:
PMID:  14696423     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Recently the surgical treatment of hemorrhoids using a circular stapler device has gained increasing approval. The Longo's procedure reduces the rectal mucosal and hemorrhoid prolapse using a circular stapler to resect transversally a mucosal-submucosal rectal ring in order to restore the correct anatomical relationships of the anal canal structures. The recent availability of a dedicated instrument kit (PPH01 Ethicon Endo-Surgery) allowed an easy diffusion of this technique. From March 1999 to September 2001, 198 patients with III-IV degree hemorrhoids were treated by a single expert surgeon using the dedicated kit instrumentation (PPH01) according to the Longo's technique, adopting some variations from the original procedure: 1) The anal dilator is not fixed to the perianal skin with forceps or stitches but is kept by the assistant. 2) In performing the purse-string suture particular care must be given to the apposition of the stitches at the same level also in the posterolateral side where there is a natural trend to apply the stitches at a lower level; furthermore the last stitch of the purse-string suture must be overlapped to the first one in order to allow a better hemostasis when the knot is tightened. 3) After having performed the purse-string and having resected the mucosa and submucosa, an accurate hemostasis with U-shaped 3/0 vicryl stitches firmly reduces the postoperative bleeding. We recorded pain scores, short- and long-term complications (included moderate-severe pain, persistent pain), recurrences and postoperative hospital stay. The data of the last 40 consecutive patients who underwent stapled hemorrhoidectomy were compared with the data obtained by 40 consecutive patients who underwent Milligan-Morgan diathermic hemorrhoidectomy for III-IV degree non-circumferential hemorrhoids by the same surgeon. In the 198 stapled hemorrhoidectomy cases the rate of postoperative moderate-severe pain and persistent pain were 6% and 2.5% respectively, the rate of short-term and long-term bleeding were 4.5% and 3.5%, the recurrence rate was 2.5%. The mean postoperative stay was 1.6 days. The stapled group had significantly lower postoperative moderate-severe pain, bleeding and soiling than the Milligan-Morgan group.
Authors:
Domenico Mascagni; Kenneth Paul Zeri; Filippo Maria Di Matteo; Nadia Peparini; Alessandro Maturo; Alberto Berni
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Hepato-gastroenterology     Volume:  50     ISSN:  0172-6390     ISO Abbreviation:  Hepatogastroenterology     Publication Date:    2003 Nov-Dec
Date Detail:
Created Date:  2003-12-30     Completed Date:  2004-06-15     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8007849     Medline TA:  Hepatogastroenterology     Country:  Greece    
Other Details:
Languages:  eng     Pagination:  1878-82     Citation Subset:  IM    
Affiliation:
Department of Surgical, Sciences, La Sapienza University, Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Electrocoagulation
Equipment Design
Fecal Incontinence / etiology
Follow-Up Studies
Hemorrhoids / surgery*
Hemostasis, Surgical / instrumentation
Humans
Length of Stay
Outcome and Process Assessment (Health Care)
Pain Measurement
Pain, Postoperative / etiology
Postoperative Complications / etiology
Postoperative Hemorrhage / etiology
Recurrence
Surgical Staplers*
Suture Techniques / instrumentation

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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