China
Africa
Explore chapters and articles related to this topic
Management of Internal Hemorrhoids
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
The traditional hemorrhoidectomy involves an elliptical incision, excision of the hemorrhoidal tissue, and closure of the mucosa over the defect. The stapled hemorrhoidopexy has been introduced as an alternative procedure. This procedure circumferentially excises the tissue above the hemorrhoidal cushion, reapproximating the mucosa using a staple line to pexy the tissue and prevent prolapse. Due to the promising initial reports with this technique, a multicenter randomized trial was conducted to compare the short- and long-term outcomes of excisional hemorrhoidectomy and stapled hemorrhoidopexy (Watson et al., 2016). The two procedures had similar short-term complication rates, and patients who underwent the stapled hemorrhoidopexy procedure reported lower levels of pain. However, despite early superiority of the stapled procedure, at 12- and 24-month follow-up, patients treated with traditional excisional hemorrhoidectomy reported lower symptom scores and lower rates of recurrence.
Open hemorrhoidectomy
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
In North America particularly, a modified technique in which the hemorrhoidectomy wound is closed as described by Ferguson is more widely used (see Chapter 2.7). Despite several randomized trials, there appears to be little difference in outcome.7 Stapled hemorrhoidopexy (see Chapter 2.8) is associated with less postoperative discomfort and an earlier return to work than open hemorrhoidectomy.9 However, a Cochrane review has concluded that if hemorrhoid recurrence and prolapse are the most important clinical outcomes, then conventional hemorrhoidectomy (open or closed) remains the ‘gold standard’ in the surgical treatment of internal hemorrhoids.10
Hemorrhoids: Surgical Treatment
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
David J. Maron, Steven D. Wexner
When dietary modifications and nonoperative treatments fail to improve symptoms related to hemorrhoids, operative therapy should be considered. Operative therapy has traditionally been in the form of surgical excision of the hemorrhoidal tissue, but stapled hemorrhoidopexy now offers an excellent alternative method of surgical treatment of hemorrhoids in the United States. Good outcomes require that the surgeon be skilled at more than one procedure and that treatment be tailored to the individual patient.
Recommendations and best practice on the management of hemorrhoidal disease in Saudi Arabia
Published in Hospital Practice, 2022
Mohamed Zaki El-Kelani, Raouf Kerdahi, Samir Raghib, Mohamed Ashraf Shawkat, Naser Abdelnazer, Ishag Mudawi, Magdy Mahmoud, Wassim Abi Hussein, Mohamed Tawfik, Waleed Wahdan
In case of failure of conservative treatment, a safe anal surgery should be performed according to the grade of the hemorrhoidal disease, available medical resources, patient’s fitness and preferences, and surgeon’s experience.The existence of several procedures for one pathology means that none is completely effective yet. Hemorrhoidectomy can be used in patients with Grade I to III hemorrhoidal disease who failed the outpatient procedures. It is also indicated in circumferential prolapsing Grade III and IV hemorrhoidal disease. It can be done using an open (Milligan–Morgan) or closed (Ferguson) method [13], and performed using energy devices like Harmonic Scalpel™ and LigaSure™.Doppler-guided hemorrhoidal artery ligation (DG-HAL)/transanal hemorrhoidal dearterialization (THD) can be done with or without mucopexy. It can be used in patients with Grade II and III hemorrhoidal disease, is effective and safe [23].Stapled hemorrhoidopexy can be used in patients with Grade II and III hemorrhoidal disease or in hemorrhoid refractory to outpatient procedures. This technique requires special expertise to avoid major complications.New surgical procedures like stapled hemorrhoidopexy and DG-HAL are more effective with less side effects than classic open hemorrhoidectomies as the new procedures are done above the dentate line and cause less pain and less complications.Surgical hemorrhoidectomy results in fewer recurrences than stapled hemorrhoidopexy [24].Lord’s manual dilatation must be avoided as it might lead to fecal incontinence and it is not related to any evidence-base practice.