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G Milito - One of the best experts on this subject based on the ideXlab platform.
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ligasure precise vs conventional diathermy for milligan morgan Hemorrhoidectomy a prospective randomized multicenter trial
Diseases of The Colon & Rectum, 2008Co-Authors: D F Altomare, G Milito, R Andreoli, F Arcana, N Tricomi, C Salafia, D Segre, G Pecorella, Pulvirenti A Durso, N CraccoAbstract:Purpose Milligan-Morgan Hemorrhoidectomy using radiofrequency dissection (Ligasure™) has been proposed instead of conventional diathermy in view of its potential benefits in terms of postoperative anal pain and better hemostatic control, but the medical literature is still controversial. This multicenter, randomized, controlled trial was designed to compare the outcomes between Ligasure™ and conventional diathermy Hemorrhoidectomy in the Milligan-Morgan procedures in a sufficient number of patients.
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randomized clinical trial of ligasure and conventional diathermy haemorrhoidectomy
British Journal of Surgery, 2007Co-Authors: Marco Gallinella Muzi, G Milito, C Nigro, F Cadeddu, F Andreoli, D Amabile, A M FarinonAbstract:Background: The aim of this randomized prospective trial was to compare LigaSure™ and conventional diathermy haemorrhoidectomy. Methods: Two hundred and eighty-four patients with grade III or IV haemorrhoids were randomized to LigaSure™ or diathermy (Milligan–Morgan) haemorrhoidectomy as a day-case procedure. Operating time, postoperative pain score, hospital stay, postoperative complications, wound healing time and time to return to normal activities were assessed. Thirty-four patients were lost to follow-up. Results: The mean operating time for LigaSure™ haemorrhoidectomy was significantly shorter than that for diathermy (P = 0·011). Patients treated with LigaSure™ had significantly less postoperative pain (measured on a visual analogue scale; P = 0·010), a shorter wound healing time (defined as time to absence of swelling; P = 0·012) and less time off work (P = 0·010) than patients who had diathermy. Neither postoperative complications nor mean hospital stay (day-case surgery) were significantly different. Conclusion: LigaSure™ haemorrhoidectomy demonstrates simplicity, reproducibility, a low complication rate, fast wound healing, a quick return to work and reduced postoperative pain. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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randomised trial comparing ligasure haemorrhoidectomy with the diathermy dissection operation
Techniques in Coloproctology, 2002Co-Authors: G Milito, M Gargiani, F CorteseAbstract:The study was designed to compare LigaSure haemorrhoidectomy with open haemorrhoidectomy performed by means of diathermy excision. Fifty-sixty consecutive patients with third- and fourth-degree haemorrhoids were randomly allocated to undergo either LigaSure haemorrhoidectomy (29 patients) or diathermy haemorrhoidectomy (27 patients). All patients were evaluated for operative time, pain, post-operative analgesic requirements, time to first bowel movement, length of hospital stay, wound healing period, time to return to work, and occurrence of early postoperative complications (such as urinary dysfunction, bleeding, soiling, seepage, continence disorders) and late complications (such as stenosis). A statisticallysignificant advantage was observed in the patients who received the LigaSure technique as far as concerns length of operative time (9.2 vs. 12.2 min, p<0.001), post-operative analgesic requirements (14.1 vs. 16.8 administrations, p<0.001), wound healing period (16.3 vs. 37.5 days, p< 0.0001), and time to return to work (8.3 vs. 18.3 days, p<0.01). No significant difference was seen in the postoperative pain score, complications rate, first bowel motion or hospital stay. No recurrence was observed at the 6-month follow-up. In conclusion, our experience shows that the LigaSure haemorrhoidectomy offers definite advantages over the classic diathermy technique. This procedure is easier, safer, and more rapid to perform and is followed by a faster wound healing time, a significantly shorter hospital stay, less postoperative pain and faster wound healing.
F Seowchoen - One of the best experts on this subject based on the ideXlab platform.
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prospective randomized trial comparing diathermy and harmonic scalpel Hemorrhoidectomy
Diseases of The Colon & Rectum, 2001Co-Authors: F SeowchoenAbstract:PURPOSE: The aim of this study was to compare diathermy and Harmonic Scalpel® Hemorrhoidectomy. METHODS: Fifty consecutive patients were randomly assigned to 2 groups: Group 1 (diathermy) and Group 2 (Harmonic Scalpel®). RESULTS: The median duration of surgery was 10 minutes for both groups. The median number of pethidine injections used for both groups was zero. The median number of oral analgesic tablets taken was 13 by Group 1 and 14 by Group 2 patients. The median number of tubes of lidocaine jelly used was two by Group 1 and three by Group 2. There was no statistical difference between pain scores recorded by both groups. Five patients in Group 1 developed postHemorrhoidectomy bleedvs. one patient in Group 2 (P=NS). CONCLUSION: Hemorrhoidectomy by Harmonic Scalpel® is comparable to diathermy Hemorrhoidectomy in terms of postoperative pain and complications.
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stapled Hemorrhoidectomy cost and effectiveness randomized controlled trial including incontinence scoring anorectal manometry and endoanal ultrasound assessments at up to three months
Diseases of The Colon & Rectum, 2000Co-Authors: Waikit Cheong, C Tsang, Choongleong Tang, F SeowchoenAbstract:PURPOSE: Stapled Hemorrhoidectomy is performed without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared with a conventional open diathermy technique. METHODS: A total of 119 consecutive patients with prolapsed irreducible hemorrhoids were randomly assigned (conventional open diathermy technique=62; stapled Hemorrhoidectomy=57). Preoperative fecal incontinence scoring, anorectal manometry, and endoanal ultrasound were performed. Postoperatively, these were repeated at up to three months with pain scores, analgesic requirements, quality of life assessment, and total related medical costs. RESULTS: Conventional open diathermy technique was quicker to perform (mean, 11.4 (standard error of the mean, 0.9)vs. 17.6 (3.1) minutes). Hospitalization was similar, but conventional open diathermy technique patients felt more pain during defecation (5.1 (0.4)vs. 2.6 (0.4);P<0.005) at two weeks, and analgesic requirements were more for up to six weeks (P<0.05). Up to the latter, 85.5 percent conventional open diathermy technique wounds remained unhealed, with more bleeding (33 (53.2 percent)vs. 19 (33.3 percent);P<0.05) and pruritus (27 (43.5 percent)vs. 9 (15.8 percent);P<0.05). Total complication rates were similar (conventional open diathermy technique 16 (25.8 percent)vs. stapled Hemorrhoidectomy 10 (17.5 percent)), including mild strictures and bleeding in both groups. Minor incontinence occurred postoperatively in two conventional open diathermy technique and two stapled Hemorrhoidectomy patients at six weeks. Endoanal ultrasound internal anal sphincter defects were found in the incontinent conventional open diathermy technique patients, but were asymptomatic in another one conventional open diathermy technique and one stapled Hemorrhoidectomy. Only one patient (conventional open diathermy technique with internal sphincter defect) remained incontinent at three months. Changes between preoperative and postoperative anorectal manometry were similar in the two groups. Patients' satisfaction scores and quality of life assessments were also similar. Conventional open diathermy technique patients resumed work later (mean 22.9 (1.8)vs. 17.1 (1.9) days;P<0.05), but the total costs incurred were less ($921.17 (16.85)vs. $1,283.09 (31.59);P<0.005). CONCLUSIONS: Stapled Hemorrhoidectomy is a safe and effective option in treating irreducible prolapsed piles. It is more expensive but less painful, with less time needed off work. Nonetheless, long-term results are still awaited.
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anal stricture following haemorrhoidectomy early diagnosis and treatment
Australian and New Zealand Journal of Surgery, 1995Co-Authors: T A Teoh, F Seowchoen, H S GohAbstract:Anal stricture is an uncommon but well recognized complication following haemorrhoidectomy. Twenty-seven (3.8%) out of 704 (500 elective and 204 emergency) cases of haemorrhoidectomy performed at the Singapore General Hospital over a 24 month period had clinical evidence of anal stricture post-haemorrhoidectomy. Of the 27 cases, 15 had haemorrhoidectomy as an elective procedure while 12 had it performed as an emergency procedure (chi 2 = 3.26, 1 d.f., P > 0.05, not significant). The mean interval between surgery and presentation of anal stricture was 6 weeks (range 3-12 weeks). Eighteen of the patients were managed by anal dilatation in the outpatient clinic combined with bulk laxatives and a local anaesthetic agent. The other nine patients required a minor surgical procedure comprising either a lateral internal sphincterotomy (five) or an anoplasty (four) procedure. All patients were well, following treatment. None of these patients developed a recurrent stricture at follow up 3 months after treatment. It was concluded that although anal stricture following haemorrhoidectomy is rare, it should be detected and treated early in order to avoid pain and suffering, and treatment is usually successful.
Kokyang Tan - One of the best experts on this subject based on the ideXlab platform.
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randomized single blind clinical trial of intradermal methylene blue on pain reduction after open diathermy haemorrhoidectomy
Colorectal Disease, 2014Co-Authors: H L Sim, Kokyang TanAbstract:Background Open haemorrhoidectomy has been associated with considerable postoperative pain and discomfort. Perianal intradermal injection of methylene blue has been shown to ablate perianal nerve endings and may bring about temporary pain relief after haemorrhoidectomy. We hypothesized that the administration of intradermal methylene blue would reduce postoperative pain during the initial period after surgery. Method A randomized, prospective, single-blind placebo-controlled trial was conducted. Patients were randomized to intradermal injection at haemorrhoidectomy of either 4 ml 1% methylene blue and 16 ml 0.5% marcaine or of 16 ml 0.5% marcaine and 4 ml saline prior to surgical dissection. Patients were asked to fill in a pain diary with a visual analogue scale. The primary outcome measure was pain score and analgesic use. Secondary outcomes were complications. Results There were 37 patients in the methylene blue arm and 30 patients in the placebo arm. There were no statistically significant differences in the sex, type of haemorrhoid, number of haemorrhoids excised, duration of surgery or hospital stay. The mean pain scores were significantly lower and the use of paracetamol was also significantly less in the methylene blue group during the first three postoperative days. The risk ratio of acute urinary retention occurring when methylene blue was not used was 2.320 (95% CI 1.754–3.067). Other complication rates were not significantly different. Conclusion Perianal intradermal injection of methylene blue was useful in reducing the initial postoperative pain of open haemorrhoidectomy.
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randomized clinical trial comparing ligasure haemorrhoidectomy with open diathermy haemorrhoidectomy
Techniques in Coloproctology, 2008Co-Authors: Kokyang Tan, H L Sim, T. Zin, A. Cheng, P L Poon, K. MakAbstract:Background Milligan-Morgan excision haem-orrhoidectomy remains a very popular treatment modality for third and fourth degree haemorrhoids due to its cost effectiveness and good long-term results. The LigaSure tissue-sealing device is an alternative technique used in haemorrhoidectomy that has been shown to produce favourable results. The aim of this study was to assess the effectiveness of the LigaSure tissue sealing device in comparison with conventional diathermy haemorrhoidectomy
K. Mak - One of the best experts on this subject based on the ideXlab platform.
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ORIGINAL ARTICLE Randomized clinical trial comparing LigaSure haemorrhoidectomy with open diathermy haemorrhoidectomy
2013Co-Authors: -y. K. Tan, T. Zin, -l. H. Sim, -l. P. Poon, A. Cheng, K. MakAbstract:Abstract Background Milligan-Morgan excision haemorrhoidectomy remains a very popular treatment modality for third and fourth degree haemorrhoids due to its cost effectiveness and good long-term results. The LigaSure tissue-sealing device is an alternative technique used in haemorrhoidectomy that has been shown to produce favourable results. The aim of this study was to assess the effectiveness of the LigaSure tissue sealing device in comparison with conventional diathermy haemorrhoidectomy. Methods A prospective clinical trial was conducted. Patients with newly diagnosed haemorrhoids requiring haemorrhoidectomy were randomized to either LigaSure haemorrhoidectomy or diathermy haemorrhoidectomy. Surgical technique and postoperative care was standardized. Outcome measures were operative time and bleeding, postoperative pain (measured on a visual analogue scale) and rate of wound healing. Results We randomized 44 patients, 22 to LigaSure and 22 to diathermy; 43 patients were evaluated. They were aged between 19 and 71 years. There were no differences in patient demographics or type of haemorrhoid being oper
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randomized clinical trial comparing ligasure haemorrhoidectomy with open diathermy haemorrhoidectomy
Techniques in Coloproctology, 2008Co-Authors: Kokyang Tan, H L Sim, T. Zin, A. Cheng, P L Poon, K. MakAbstract:Background Milligan-Morgan excision haem-orrhoidectomy remains a very popular treatment modality for third and fourth degree haemorrhoids due to its cost effectiveness and good long-term results. The LigaSure tissue-sealing device is an alternative technique used in haemorrhoidectomy that has been shown to produce favourable results. The aim of this study was to assess the effectiveness of the LigaSure tissue sealing device in comparison with conventional diathermy haemorrhoidectomy
Richard A Malthaner - One of the best experts on this subject based on the ideXlab platform.
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stapled hemorrhoidopexy is associated with a higher long term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery
Diseases of The Colon & Rectum, 2007Co-Authors: Shiva Jayaraman, Patrick H D Colquhoun, Richard A MalthanerAbstract:PURPOSE: The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional Hemorrhoidectomy in patients with internal hemorrhoids. METHODS: A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional Hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain. RESULTS: Twelve trials were included. Follow-up varied from six months to four years. Conventional Hemorrhoidectomy was more effective in preventing long-term recurrence of hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47-10.07; P<0.006). Conventional Hemorrhoidectomy also prevents hemorrhoids in studies with follow-up of one year or more (OR, 3.6; 95 percent CI, 1.24-10.49; P<0.02). Conventional Hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 95 percent CI, 1.33-6.58; P< 0.008). Conventional Hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year or more (OR, 2.68; 95 percent CI, 0.98-7.34; P<0.05). Nonsignificant trends in favor of conventional Hemorrhoidectomy were seen in the proportion of asymptomatic patients, bleeding, soiling/difficultly with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery. Nonsignificant trends in favor of stapled hemorrhoidopexy were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis. CONCLUSIONS: Conventional Hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of internal hemorrhoids. Fewer patients who received conventional Hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up compared with stapled hemorrhoidopexy.
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stapled hemorrhoidopexy is associated with a higher long term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery
Diseases of The Colon & Rectum, 2007Co-Authors: Shiva Jayaraman, Patrick H D Colquhoun, Richard A MalthanerAbstract:PURPOSE: The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional Hemorrhoidectomy in patients with internal hemorrhoids. METHODS: A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional Hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain. RESULTS: Twelve trials were included. Follow-up varied from six months to four years. Conventional Hemorrhoidectomy was more effective in preventing long-term recurrence of hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47-10.07; P<0.006). Conventional Hemorrhoidectomy also prevents hemorrhoids in studies with follow-up of one year or more (OR, 3.6; 95 percent CI, 1.24-10.49; P<0.02). Conventional Hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 95 percent CI, 1.33-6.58; P< 0.008). Conventional Hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year or more (OR, 2.68; 95 percent CI, 0.98-7.34; P<0.05). Nonsignificant trends in favor of conventional Hemorrhoidectomy were seen in the proportion of asymptomatic patients, bleeding, soiling/difficultly with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery. Nonsignificant trends in favor of stapled hemorrhoidopexy were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis. CONCLUSIONS: Conventional Hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of internal hemorrhoids. Fewer patients who received conventional Hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up compared with stapled hemorrhoidopexy.