The aim of this study was to evaluate the very long-term results of the stapled hemorrhoidopexy technique.
Stapled hemorrhoidopexy was performed on 155 patients between 2000 and 2003, and the early results have already been published. In this study, we evaluated the same patients after a very long follow-up. Data were collected with regard to late complications, rate and timing of recurrences, and patients’ degree of satisfaction.
From a total of 155 patients, 98 patients were evaluated: 59 (60.2%) were interviewed by telephone and 39 (39.8%) were evaluated by outpatient consultation. The mean follow-up was 193 months (range: 184-231), 52 were female, 52 were grade III hemorrhoids, and 46 were grade IV. Recurrence was higher in grade IV (26.1%) than in grade III (7.7%) (p=0.014). Recurrence after prolonged follow-up was seen in 16 patients (16.3%) and 11 (11.2%) required reoperations. The complications were skin tags (3.1%), anal sub-stenosis (2.1%), and fecal incontinence (2.1%). After a prolonged follow-up, 82.5% of patients were either very satisfied or satisfied with the surgery.
Stapled hemorrhoidopexy is a safe and effective treatment for hemorrhoidal disease grades III and IV. Recurrence is higher for grade IV hemorrhoids and may occur up to 9 years of follow-up. Reoperations were infrequent and there is a high patient’s degree of satisfaction associated with this technique.
In Brazil, an increasing number of people are submitted to colonoscopy, either for screening or for therapeutic purposes.
To evaluate whether there are advantages of using carbon dioxide (CO2) over air for insufflation.
Two hundred and ten of 219 patients were considered eligible for this study and were randomized into two groups according to the gas insufflation used: Air Group (n=104) and CO2 Group (n=97). The study employed a double-blind design.
The Air and CO2 Groups were similar in respect to bowel preparation evaluated using the Boston scale, age, gender, previous surgery, maneuvers necessary for the advancement of the device, and presence of polyps, tumors or signs of diverticulitis. However, “waking up with pain” and “pain at discharge” were more prevalent in the Air Group, albeit not statistically significant, with post-exam bloating seen only in the Air Group. The responses to a questionnaire, applied to analyze the late post-exam period, showed more comfort with the use of CO2.
The use of CO2 is better than air as it avoids post-examination bloating, thereby providing greater comfort to patients.
HEADINGS
Colonoscopy, Insufflation, Patient satisfaction, Clinical protocols,
Desenvolvido por Surya MKT