Società Italiana di Chirurgia ColoRettale 2° Congresso Nazionale – Verona 15 – 17 Ottobre 2007 www.siccr.org 46
LA DEARTERIALIZZAZIONE EMORROIDARIA TRANSANALE DOPPLER GUIDATA VS L’ EMORROIDOPESSI CON "STAPLED": TRIAL PROSPETTICO NON RANDOMIZZATO.
PIERO NASTRO, MD, MRCS; SHAFY AHMED, MD, MRCS; PASQUALE GIORDANO, MD, MRCS
Introduzione: La malattia emorroidaria e’ il piu’ comune disordine proctologico. Meno del 50% dei casi richiede trattamento che nel 10-15% dei casi e’ chirurgico. L’emorroidectomia convenzionale e’ ancora l’intervento chirurgico piu’ eseguito ma negli ultimi dieci anni, al fine di ridurre il dolore post-operatorio e di rendere piu’ rapido il ritorno alle normali attivita’ quotidiane, nuove tecniche chirurgiche cosiddette "pain free" were introduced.
Of these the two most 'notes are emorroidopessi with "stapler", and the Doppler guided transanal haemorrhoidal dearterialization, better known as "PPH" and "THD". Several trials have shown that PPH and 'an effective technique with minimal postoperative pain, but in the long term seems to be suffering from a relapse rate higher and can' cause serious complications such as chronic anal pain on defecation and urgency.
individual studies and one randomized trial vs the conventional hemorrhoidectomy with short-term follow-up carried out showed that the THD and 'a safe and effective technique with minimal postoperative pain, but the results are not yet known a distanza. Obiettivo dello studio e’ stato quello di paragonare l’efficacia e la sicurezza a breve termine della THD vs la PPH nei pazienti con emorroidi di II e III grado in cui il trattamento conservativo avevano fallito. Pazienti e Metodi: La PPH e’ stata eseguita secondo la tecnica di Longo. La THD consiste nella legatura multipla delle branche terminali dell’arteria emorroidaria superiore identificate tramite un apposito doppler posizionato all’estremita’ di uno speciale proctoscopio monouso. In seguito una mucopessi del cuscinetto emorroidario prolassato viene eseguita al di sopra della linea dentata con punti di Vycril 2/0. Tutti gli interventi sono stati eseguiti in "Day Surgery" e in anestesia generale. I sintomi, il dolore post-operative pain expected by the patient, possible complications and the return to normal activity 'daily were analyzed prospectively with a questionnaire. The follow-up and 'state of 2 and 8 months. Results: The study was carried out between September 2004 and December 2005, included 52 patients (36 males with age 'average of 51) of which 28 (20M, age' average 54) were subject to the THD and 24 PPH (16 M, eta ' average 48). In group THD 16 patients had Grade II hemorrhoids and 12 grade III, while in the PPH group were 15 and 9 respectively. The average postoperative pain assessed by visual scale from 0 to 10 and 'state 2 (THD) vs. 3.5 (PPH) (p = ns). The average pain since the patient assessed with visual scale from -5 (less than expected) to +5 (more 'than expected) and' state of -4 (THD) vs -3 (PPH). And there 'was no difference in the use of postoperative analgesics required (paracetamol + diclofenac), but 25/28 (vs 12/24) THD patients to have returned to normal activity' daily within 4 days (p = 0.01). At follow-up of 8 months were 2 recurrences THD vs 1 and PPH Symptoms are 'resolved in 25 patients in the THD and 21 in the PPH group. In the PPH group, 2 patients complained of urgency to defecation and one developed a rectal stenosis, whereas in the group and THD is' un'ematoma had two complications and rectal submucosal minor technical.
Conclusion: With a median follow-up both short-term techniques have proved effective and safe with minimal postoperative pain for the surgical treatment of haemorrhoids of grade II and III. The group of patients THD but 'has not developed any serious complication, and all have returned to their normal activities the first' day. Prospective randomized trial with long-term follow-up but are 'necessary to confirm the results of our study.
0 comments:
Post a Comment