Prevention of Rectal Stenosis After Procedure for Prolapse and Hemorrhoids by Anastomotic Thread-Drawing and Anal Enlargement
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Purpose to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early. Methods A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group. Experimental group: Thread-drawing during operation and anal enlargement after PPH. Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone. The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years. Results The effective rate of mixed hemorrhoid treatment in the 4 groups was 100%. There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C. Conclusion Multipoint thread-drawing and anal enlargement after PPH can avoid postoperative rectal stenosis and can strengthen anastomosis and reduce bleeding, while being a simple procedure that can be easily popularized.Keywords:
Anal stenosis
Objective:To evaluate the efficacy of the procedure for prolapse and hemorrhoids(PPH) in the treatment of patients with prolapsed hemorrhoids.Methods:30 patients with Ⅲ or Ⅳ degree of circular prolapsed hemorrhoids were operated on by PPH and were analysed retrospectively.Results:The mean operation time was 15 minutes and mean postoperative hospital stay was 4 days.Hemorrhoids in 26 of the 30 patients disappeated immediately after operation and 4 days.Hemorrhoids in 26 of the 30 patients disappeared immediately after operation and 4 disappeared on the second day postoperatively.Postoperative bleeding was noted in 3 cases at the first and sixth day after operation,which was cured by conservative methods.3 patients complained local pain and 5 patients suffered from temporary urine retention after operation.Follow-upperiod lasting for 10 months showed no recurrence.Conclusion:PPH is a safe and effective treatment for severely prolapsed circular hemorrhoids at the third or fourth degree with the advantages of shorter hospitalization time and quicker recvery.However,thd long-term outcome remains to be identified.
Conservative Treatment
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Objective Discussion and study of postpartum acute incarcerated hemorrhoid treatment feasibility of early operation. Methods 35 cases of postpartum acute incarcerated hemorrhoid, Early mixed hemorrhoids Milligan-Morgan operation or Procedure prolapse and hemorrhoids, Anti-infection after trentment for 4 to 6 days. Results The group had no postoperative hemorrhage and infection, anal margin without obvious edema. The postoperative healing time of 10~21 days, average 17 days. Healing after defecation without bleeding, anal margin smooth appearance, no anal incontinence and anal stenosis. Conclusion Postpartum acute incarcerated hemorrhoid treatment early operation, can reduce the pregnant complicated with Incarcerated Hemorrhoids caused by pain, accelerate postpartum recovery.
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Abstract Thirty end‐ to‐ end (ETE) and 30 end‐ in‐ end (EIE) microvascular anastomoses were performed in the central arteries of the ear or the saphenous arteries of 30 rabbits (diameters: 0.8– 1.2 mm). The anastomoses were then examined angiographically at varying intervals postoperatively. The ETE anastomoses caused no stenosis in the majority of vessels, while the EIE anastomoses generally resulted in considerable stenosis. This was most marked one hour postoperatively, with the average luminal area in crosssection being 22% of the luminal area of the vessel. With time the stenosis in the EIE anastomoses gradually became less pronounced, but even after 90 days the cross‐ sectional luminal area was only 63% of the luminal area of the vessel. In a second series, EIE anastomoses were performed in five femoral arteries (diameter: 1.7– 2.0 mm) and five renal arteries (diameter: 2.0– 2.7 mm). The EIE technique was found to cause less pronounced stenosis in the larger vessels. In a third series, five EIE anastomoses were performed in the central arteries of the ear according to the technique of Lauritzen and compared with five EIE anastomoses performed according to the technique of Meier. The Meier technique was more difficult to perform but produced less stenosis.
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Objective:To summarize the stapled hemorrhoid on the mucousmembrane circumcision(PPH)is the treatment of hemorrhoids of their experiences and explore issues related to the surgical in order to improve efficacy.Methods:A retrospective summary of 75 cases in August 2006 ～2009 years,in April between the application of PPH treatment of hemorrhoids in patients with clinical data.Results:The operative time was 20～45 minutes(average 29 minutes),hospital stay 3～7 days(average 4.9 days)post-operative urinary retention in 32 cases(43%),severe postoperative pain compared with 18 cases(24%),75 patients without bleeding and anal stenosis,postoperative symptom improvement were satisfied with 70 cases(93%),the remaining effective,follow-up in June-2 years without recurrence.Conclusion:(1)PPH is simple,pain,light,short hospital stay and effective(.1)attention to all aspects of PPH should be effective factors in order to improve surgical treatment of PPH.(3)with severe PPH Hemorrhoid surgery may be the main line with other conventional surgery,for improving the results of operations of great help.
Anal stenosis
Urinary retention
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Abstract Anastomotic stenosis after esophagectomy is a major cause of long-term morbidity because it leads to poor dietary intake and malnutrition that markedly reduces quality of life. The aim of this study was to test the hypothesis that the risk of anastomotic stenosis is higher when the anastomosis is located behind the sternoclavicular joint than when it deviates from the sternoclavicular joint. Methods Among 226 patients who underwent esophagectomy between April 2010 and March 2019, we selected 114 patients who underwent retrosternal reconstruction using a gastric conduit for this study. They were classified into two groups according to the location of the anastomosis as determined by postoperative computed tomography scans: anastomosis located behind the sternoclavicular joint (group B; n = 71) and anastomosis deviated from the joint (group D; n = 43). The primary endpoint was the difference in the incidence of anastomotic stenosis between the two groups. Whether the occurrence of anastomotic leak affected the likelihood of anastomotic stenosis was also investigated. Results The incidence of anastomotic stenosis was significantly higher in group B than in group D (71.8% [n = 51] vs 18.6% [n = 8]; p < 0.0001). The incidence of stenosis in patients who developed an anastomotic leak was significantly higher in group B than in group D (88.0% vs 41.7%; p = 0.0057), although the findings were similar in patients who did not develop an anastomotic leak (63.0% and 9.7%, respectively; p < 0.0001). Conclusion There is an increased risk of anastomotic stenosis independent of anastomotic leak when the anastomosis is located behind the sternoclavicular joint in patients who undergo retrosternal reconstruction with a gastric conduit after esophagectomy.
Esophagectomy
Sternoclavicular joint
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Objective To evaluate the efficacy of tissue-selecting therapy(TST) for hemorrhoids. Methods This study consisted of 100 patients with hemorrhoids,who were evenly randomized to TST(treatment group) and procedure for prolapse and hemorrhoids(PPH,control group).A comparison was done between the two groups in terms of the following items: operation time,blood loss at surgery,post-operative cure rate of prolapse and bleeding,significant postoperative anal pain,incontinence,anal stenosis,and length of stay. Results The differences between the TST and PPH groups were significant in terms of hospital stay,operation time,blood loss at surgery,the incidence of anal stenosis(t=8.86-10.41,χ2=3.37,P0.05),and no significant differences were noted in terms of the other items(P005). Conclusion The therapeutic efficacy of TST and PPH for degree Ⅱ-Ⅳ bleeding hemorrhoids is similar,but TST has more advantages than PPH of shorter operation time and hospital stay,less blood loss at surgery and trauma,and lower incidence of anal stricture.TST is safe,effective,and mini-invasive,which is a new technique that consistent with recto-anal physiology.
Anal stenosis
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To compare the efficacy and complication of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in the treatment of severe hemorrhoids.Clinical data of 542 cases of severe hemorrhoids undergoing TST (258 cases) or PPH (284 cases) in The First Affiliated Hospital of Fujian Medical University from November 2010 to January 2012 were analyzed retrospectively. Operative parameters, efficacy and complication 3 months after operation were assessed and compared.No significant difference in cure rate between TST and PPH (96.5% vs. 95.4%) was found, while the operation time and hospital stay after operation in TST group were significantly shorter urgency [(20.6±4.7) vs. (26.4±6.3) min, (2.9±0.5) vs. (3.5±0.7) d, both P<0.05]. Incidences of postoperative pain, bleeding, anal urgency and urinary retention in TST group were significantly lower than those in PPH group (all P<0.01). No anal stenosis was observed in TST group, and 5 cases developed anal stenosis in PPH group (P<0.05). Hemorrhoid recurrence did not differ significantly between the two groups.The efficacy of TST and PPH is comparable for severe hemorrhoids patients, while TST is associated with faster postoperative recovery and less complications.
Anal stenosis
Urinary retention
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Objective To explore a new method Surgical therapies to eliminate the symptoms and to recover nor- real structure in the treatment of Mixed Hemorrhoids.Methods In this randomized,double-blind study,40 patients were allocated to one of two groups,the control group (n=20) are received Milligan-Morgan haemorrhoidectomy. Treatment group (n=20) are received ligations and hanging internal hemorrhoidal and excision external hemorrhoid. To compare with Pain,anal edema,anal stenosis and fecal incontinence.Results Pain relief and anal edema in treat- ment group were better than those in control group (P0.01 or P0.05).No patient developed anal stenosis and fe- cal incontinence,Found no recurrence in 1 year follow up in tretment group.Conclusions Ligations and hanging inter- hal hemorrhoidal and excision external hemorrhoid has many advantages such as simple operation,little injury and less complications.It is a ideal operative method for mixed hemorrhoids.
Anal stenosis
Fecal Incontinence
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Abstract Anastomotic stenosis after esophagectomy is a major cause of long-term morbidity because it leads to poor dietary intake and malnutrition that markedly reduces the quality of life. The aim of this study was to test the hypothesis that anastomosis behind the sternoclavicular (SC) joint in retrosternal reconstruction is associated with an increased risk of anastomotic stenosis compared with anastomosis deviated from the joint. Among 226 patients who underwent esophagectomy for esophageal cancer between April 2010 and March 2019, we selected 114 patients who underwent retrosternal reconstruction using a gastric conduit for this study. They were classified into two groups according to the location of the anastomosis as determined by axial sections on postoperative computed tomography scans: anastomosis located behind the SC joint (Group B; n = 71) and anastomosis deviated from the joint (Group D; n = 43). The primary endpoint was the difference in the incidence of anastomotic stenosis between the two groups. Whether the occurrence of anastomotic leak affected the likelihood of anastomotic stenosis was also investigated. The incidence of anastomotic stenosis was significantly higher in Group B than in Group D (71.8% [n = 51] vs. 18.6% [n = 8]; P < 0.0001). The incidence of stenosis in patients who developed an anastomotic leak was significantly higher in Group B than in Group D (88.0% vs. 41.7%; P = 0.0057), although the findings were similar in patients who did not develop anastomotic leak (63.0% and 9.7%, respectively; P < 0.0001). We conclude that anastomosis located behind the SC joint in retrosternal reconstruction with a gastric conduit after esophagectomy is associated with an increased risk of anastomotic stenosis regardless of the development of anastomotic leak.
Esophagectomy
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Introduction– Open hemorrhoidectomy described by Milligan and Morgan is one of the common procedures done for hemorrhoids till date. Now a day’s rubber band ligations, radiofrequency ablation with plication, stapled hemorrhoidectomy are also being used. But these methods are not available in all centers. Some are costly too. There is also another method known as anal stretching and ligation originally described by Farag in1978 is a simple method used in our Medical institute with some modification. Methods – The study of 250 patients with hemorrhoids was done in R. D. Gardi medical college from March 2008 to September 2011. The patients were randomly divided into two groups- group A for patients undergoing anal stretching and ligation and group B for patients undergoing open hemorrhoidectomy [125 patients in each group]. Results – The time for first bowel clearance was less in group A [1 to 1.5 days] as compare to group B [2 to 2.5 days]. The post operative stay was shorter in group A [2-4 days] than group B [3-5 days]. In “group A”, the postoperative complications like incontinence, anal stenosis and anal fissures were less than “group B”. Conclusion– The procedures like open hemorrhoidectomy are more destructive and there is again a need of much easier procedures like Anal stretching and ligation of hemorrhoids.
Anal stenosis
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