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L.h. Oliveira - One of the best experts on this subject based on the ideXlab platform.

  • High macro rubber band ligature
    Journal of Coloproctology, 2013
    Co-Authors: José A. Reis Neto, Jose Alfredo Reis Junior, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, L.h. Oliveira
    Abstract:

    PURPOSE: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. METHODS: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). RESULTS: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6 %, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. CONCLUSIONS: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief.

  • High macro rubber band ligature
    Elsevier, 2013
    Co-Authors: José Reis A. Neto, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, José A. Reis, L.h. Oliveira
    Abstract:

    Purpose: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. Methods: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). Results: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6%, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. Conclusions: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief. Resumo: Objetivo: o objetivo de uma ligadura com banda de borracha é promover a fibrose da submucosa com subsequente fixação do epitélio ao esfíncter anal subjacente. Seguindo esse princípio, uma nova técnica de ligadura foi desenvolvida baseada em dois aspectos: 1. macro bandas: para obter uma melhor fibrose e fixação ao atingir um volume maior de mucosa e 2. ligadura alta: para obter essa fixação na origem do deslocamento do coxim hemorroidal. Métodos: 1634 pacientes com doença hemorroidária interna de grau II ou III foram tratados pela técnica de macro ligadura elástica alta. Não houve distinção de idade, sexo ou etnia. Para executar essa técnica, um novo dispositivo hemorroidário foi especialmente projetado com um diâmetro maior e uma maior capacidade de aspiração de volume da mucosa. Recomenda-se utilizar um anoscópio mais longo e largo para obter uma melhor vista do canal anal, o que facilitará a injeção da submucosa a nível mais alto no canal anal e a inserção do dispositivo elástico. O coxim hemorroidal deve ser ligado a um nível mais alto no canal anal (4 cm acima da linha de pectinato). É preferível o tratamento de todas as hemorróidas em uma única sessão (máximo de três zonas submetidas à ligadura). Resultados: a análise foi retrospectiva, sem qualquer comparação com a ligadura convencional. O período de avaliação variou de de um a doze anos. A análise dos resultados mostrou edema perianal em 1,6% dos pacientes, tenesmo imediato em 0,8%, dor intensa (necessidade de analgesia parenteral) em 1,6%, retenção urinária em 0,1% dos pacientes e uma taxa de recorrência sintomática de 4,2%. Todos os pacientes com recorrência sintomática foram tratados com uma nova sessão de macro ligadura elástica. Nenhum dos pacientes desenvolveu septicemia anal ou retal. Uma pequena hemorragia pós-ligadura foi observada em apenas 0,8% dos pacientes. Conclusões: a técnica de macro ligadura elástica alta representa um método alternativo para o tratamento da doença hemorroidal classe II ou III, com bons resultados a um baixo custo. A análise dos resultados observados mostrou uma pequena incidência de complicações menores, com alto índice de alívio sintomático. Keywords: Hemorrhoids, Ambulatory treatment, Non surgical treatment, Palavras-chave: Hemorroidas, Tratamento ambulatorial, Tratamento não cirúrgic

Saburo Onishi - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of endoscopic mucosal resection for laterally spreading rectal tumors
    Endoscopy, 2004
    Co-Authors: S Tamura, K Nakajo, Yuichi Yokoyama, Kohji Ohkawauchi, Takayoshi Yamada, Y Higashidani, Takako Miyamoto, H Ueta, Saburo Onishi
    Abstract:

    Background and Study Aims: We undertook this retrospective study to evaluate the frequency and prognosis of endoscopic treatment of laterally spreading tumors (LSTs) in the rectum. The recurrence rate for lesions of the lower rectum was compared with that of the upper rectum. Patients and Methods: During the period from July 1989 to June 2002, a total of 1237 rectal tumors were detected. LSTs accounted for 6.9% (85/1237) of all rectal tumors. A total of 224 tumors of the lower rectum were detected among the 1237 rectal tumors. LSTs accounted for 16.1% (36/224) of all the lower rectal tumors. From 85 LST lesions, 67 were evaluated for their prognosis after endoscopic mucosal resection (EMR). Patients whose LSTs had been resected were followed up by endoscopy at the following frequencies: once 15 (22.4%); twice (more than 1 year), 20 (29.9%); three times (more than 3 years), 21(31.3%); and four times or more (more than 5 years),11(16.4%). Results: A total of 67 patients with endoscopically treated LSTs were followed up by endoscopy. We observed recurrences in two lesions of the upper rectum (2/38, 5.3%) and five lesions of the lower rectum (5/29, 17.2%) (P=0.2364); all seven lesions were resected piecemeal. LSTs whose horizontal margin reached the Pectinate Line frequently recurred in the lower rectum, at a rate of 80% (4/5). However, all patients were completely cured by additional endoscopic resections, the greatest number of treatments being four. Conclusion: For early detection of recurrence and successful endoscopic cure, further colonoscopic examination within a few months after the first treatment is necessary.

Sergio Oliva Banci - One of the best experts on this subject based on the ideXlab platform.

  • High macro rubber band ligature
    Journal of Coloproctology, 2013
    Co-Authors: José A. Reis Neto, Jose Alfredo Reis Junior, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, L.h. Oliveira
    Abstract:

    PURPOSE: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. METHODS: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). RESULTS: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6 %, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. CONCLUSIONS: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief.

  • High macro rubber band ligature
    Elsevier, 2013
    Co-Authors: José Reis A. Neto, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, José A. Reis, L.h. Oliveira
    Abstract:

    Purpose: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. Methods: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). Results: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6%, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. Conclusions: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief. Resumo: Objetivo: o objetivo de uma ligadura com banda de borracha é promover a fibrose da submucosa com subsequente fixação do epitélio ao esfíncter anal subjacente. Seguindo esse princípio, uma nova técnica de ligadura foi desenvolvida baseada em dois aspectos: 1. macro bandas: para obter uma melhor fibrose e fixação ao atingir um volume maior de mucosa e 2. ligadura alta: para obter essa fixação na origem do deslocamento do coxim hemorroidal. Métodos: 1634 pacientes com doença hemorroidária interna de grau II ou III foram tratados pela técnica de macro ligadura elástica alta. Não houve distinção de idade, sexo ou etnia. Para executar essa técnica, um novo dispositivo hemorroidário foi especialmente projetado com um diâmetro maior e uma maior capacidade de aspiração de volume da mucosa. Recomenda-se utilizar um anoscópio mais longo e largo para obter uma melhor vista do canal anal, o que facilitará a injeção da submucosa a nível mais alto no canal anal e a inserção do dispositivo elástico. O coxim hemorroidal deve ser ligado a um nível mais alto no canal anal (4 cm acima da linha de pectinato). É preferível o tratamento de todas as hemorróidas em uma única sessão (máximo de três zonas submetidas à ligadura). Resultados: a análise foi retrospectiva, sem qualquer comparação com a ligadura convencional. O período de avaliação variou de de um a doze anos. A análise dos resultados mostrou edema perianal em 1,6% dos pacientes, tenesmo imediato em 0,8%, dor intensa (necessidade de analgesia parenteral) em 1,6%, retenção urinária em 0,1% dos pacientes e uma taxa de recorrência sintomática de 4,2%. Todos os pacientes com recorrência sintomática foram tratados com uma nova sessão de macro ligadura elástica. Nenhum dos pacientes desenvolveu septicemia anal ou retal. Uma pequena hemorragia pós-ligadura foi observada em apenas 0,8% dos pacientes. Conclusões: a técnica de macro ligadura elástica alta representa um método alternativo para o tratamento da doença hemorroidal classe II ou III, com bons resultados a um baixo custo. A análise dos resultados observados mostrou uma pequena incidência de complicações menores, com alto índice de alívio sintomático. Keywords: Hemorrhoids, Ambulatory treatment, Non surgical treatment, Palavras-chave: Hemorroidas, Tratamento ambulatorial, Tratamento não cirúrgic

  • Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum
    2012
    Co-Authors: Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, Jose Alfredo, Reis Neto, Luciane H. Oliveira
    Abstract:

    Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 % to 55 % seems immutable in several published series. The main cause for those results is the high incidence of re-currence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the Pectinate Line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients –400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radio-therapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducin

Joaquim Simões Neto - One of the best experts on this subject based on the ideXlab platform.

  • High macro rubber band ligature
    Journal of Coloproctology, 2013
    Co-Authors: José A. Reis Neto, Jose Alfredo Reis Junior, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, L.h. Oliveira
    Abstract:

    PURPOSE: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. METHODS: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). RESULTS: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6 %, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. CONCLUSIONS: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief.

  • High macro rubber band ligature
    Elsevier, 2013
    Co-Authors: José Reis A. Neto, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, José A. Reis, L.h. Oliveira
    Abstract:

    Purpose: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. Methods: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). Results: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6%, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. Conclusions: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief. Resumo: Objetivo: o objetivo de uma ligadura com banda de borracha é promover a fibrose da submucosa com subsequente fixação do epitélio ao esfíncter anal subjacente. Seguindo esse princípio, uma nova técnica de ligadura foi desenvolvida baseada em dois aspectos: 1. macro bandas: para obter uma melhor fibrose e fixação ao atingir um volume maior de mucosa e 2. ligadura alta: para obter essa fixação na origem do deslocamento do coxim hemorroidal. Métodos: 1634 pacientes com doença hemorroidária interna de grau II ou III foram tratados pela técnica de macro ligadura elástica alta. Não houve distinção de idade, sexo ou etnia. Para executar essa técnica, um novo dispositivo hemorroidário foi especialmente projetado com um diâmetro maior e uma maior capacidade de aspiração de volume da mucosa. Recomenda-se utilizar um anoscópio mais longo e largo para obter uma melhor vista do canal anal, o que facilitará a injeção da submucosa a nível mais alto no canal anal e a inserção do dispositivo elástico. O coxim hemorroidal deve ser ligado a um nível mais alto no canal anal (4 cm acima da linha de pectinato). É preferível o tratamento de todas as hemorróidas em uma única sessão (máximo de três zonas submetidas à ligadura). Resultados: a análise foi retrospectiva, sem qualquer comparação com a ligadura convencional. O período de avaliação variou de de um a doze anos. A análise dos resultados mostrou edema perianal em 1,6% dos pacientes, tenesmo imediato em 0,8%, dor intensa (necessidade de analgesia parenteral) em 1,6%, retenção urinária em 0,1% dos pacientes e uma taxa de recorrência sintomática de 4,2%. Todos os pacientes com recorrência sintomática foram tratados com uma nova sessão de macro ligadura elástica. Nenhum dos pacientes desenvolveu septicemia anal ou retal. Uma pequena hemorragia pós-ligadura foi observada em apenas 0,8% dos pacientes. Conclusões: a técnica de macro ligadura elástica alta representa um método alternativo para o tratamento da doença hemorroidal classe II ou III, com bons resultados a um baixo custo. A análise dos resultados observados mostrou uma pequena incidência de complicações menores, com alto índice de alívio sintomático. Keywords: Hemorrhoids, Ambulatory treatment, Non surgical treatment, Palavras-chave: Hemorroidas, Tratamento ambulatorial, Tratamento não cirúrgic

  • Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum
    2012
    Co-Authors: Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, Jose Alfredo, Reis Neto, Luciane H. Oliveira
    Abstract:

    Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 % to 55 % seems immutable in several published series. The main cause for those results is the high incidence of re-currence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the Pectinate Line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients –400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radio-therapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducin

Odorino Hideyoshi Kagohara - One of the best experts on this subject based on the ideXlab platform.

  • High macro rubber band ligature
    Journal of Coloproctology, 2013
    Co-Authors: José A. Reis Neto, Jose Alfredo Reis Junior, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, L.h. Oliveira
    Abstract:

    PURPOSE: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. METHODS: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). RESULTS: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6 %, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. CONCLUSIONS: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief.

  • High macro rubber band ligature
    Elsevier, 2013
    Co-Authors: José Reis A. Neto, Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, José A. Reis, L.h. Oliveira
    Abstract:

    Purpose: The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects: 1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and 2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. Methods: 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the Pectinate Line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). Results: The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6%, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. Conclusions: The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief. Resumo: Objetivo: o objetivo de uma ligadura com banda de borracha é promover a fibrose da submucosa com subsequente fixação do epitélio ao esfíncter anal subjacente. Seguindo esse princípio, uma nova técnica de ligadura foi desenvolvida baseada em dois aspectos: 1. macro bandas: para obter uma melhor fibrose e fixação ao atingir um volume maior de mucosa e 2. ligadura alta: para obter essa fixação na origem do deslocamento do coxim hemorroidal. Métodos: 1634 pacientes com doença hemorroidária interna de grau II ou III foram tratados pela técnica de macro ligadura elástica alta. Não houve distinção de idade, sexo ou etnia. Para executar essa técnica, um novo dispositivo hemorroidário foi especialmente projetado com um diâmetro maior e uma maior capacidade de aspiração de volume da mucosa. Recomenda-se utilizar um anoscópio mais longo e largo para obter uma melhor vista do canal anal, o que facilitará a injeção da submucosa a nível mais alto no canal anal e a inserção do dispositivo elástico. O coxim hemorroidal deve ser ligado a um nível mais alto no canal anal (4 cm acima da linha de pectinato). É preferível o tratamento de todas as hemorróidas em uma única sessão (máximo de três zonas submetidas à ligadura). Resultados: a análise foi retrospectiva, sem qualquer comparação com a ligadura convencional. O período de avaliação variou de de um a doze anos. A análise dos resultados mostrou edema perianal em 1,6% dos pacientes, tenesmo imediato em 0,8%, dor intensa (necessidade de analgesia parenteral) em 1,6%, retenção urinária em 0,1% dos pacientes e uma taxa de recorrência sintomática de 4,2%. Todos os pacientes com recorrência sintomática foram tratados com uma nova sessão de macro ligadura elástica. Nenhum dos pacientes desenvolveu septicemia anal ou retal. Uma pequena hemorragia pós-ligadura foi observada em apenas 0,8% dos pacientes. Conclusões: a técnica de macro ligadura elástica alta representa um método alternativo para o tratamento da doença hemorroidal classe II ou III, com bons resultados a um baixo custo. A análise dos resultados observados mostrou uma pequena incidência de complicações menores, com alto índice de alívio sintomático. Keywords: Hemorrhoids, Ambulatory treatment, Non surgical treatment, Palavras-chave: Hemorroidas, Tratamento ambulatorial, Tratamento não cirúrgic

  • Adjuvant Therapy on Cancer of the Lower Rectum. Evaluation of the Effects of Preoperative Radiotherapy on the Prognosis of Patients with Cancer of the Lower Rectum
    2012
    Co-Authors: Odorino Hideyoshi Kagohara, Joaquim Simões Neto, Sergio Oliva Banci, Jose Alfredo, Reis Neto, Luciane H. Oliveira
    Abstract:

    Aims: The prognosis on treatment of the cancer of the rectum has not changed in the last fifty years. Survival rates of 50 % to 55 % seems immutable in several published series. The main cause for those results is the high incidence of re-currence, either local or widespread. Local recurrence is directly related to the number of undifferentiated cells and to the grade of wall invasion. Widespread recurrence depends specifically on the lymphatic and vascular spreading. So any kind of treatment that would diminish the number of undifferentiated cells and the size or the tumor wall penetration would certainly decrease the local recurrence rate, lengthening the interval free from cancer and, perhaps, modifying the long term survival rate. Between 1978 and 2009, a total of 538 patients with adenocarcinoma of the lower rectum (from the Pectinate Line to 10 cm above) were treated by preoperative radiotherapy. Methodology: The same protocol was used in all the patients –400 cGy, 200 cGy/day, during 4 consecutive weeks (anterior and posterior pelvic fields) by means of a Linear Megavoltage Accelerator (25 MeV). Surgery was performed 2 months after completion of the radio-therapy. Results: Statistical analysis of the whole group showed that preoperative radiotherapy does decrease frequency of undifferentiated cells. Moreover, the incidence of local recurrence diminished after irradiation by 3.4%. Preoperative radiotherapy reduces tumor volume (ERUS) and wall invasion, as well as the mortality rate due to local recurrence (2.4%) and alters long-term survival rate (80.1%). Conclusion: Preoperative radiotherapy is really effective in reducin