Survey of patient satisfaction after Doppler-guided transanal hemorrhoidal dearterialization performed in ambulatory settings.

BACKGROUND: Transanal hemorrhoidal dearterialization (THD) is a recently developed procedure to minimize postoperative pain from hemorrhoidectomy. This technique utilizes Doppler signals to aid ligation of hemorrhoidal arteries followed by mucopexy of redundant mucosa if needed. The aim of the present study was to assess patient satisfaction after THD. METHODS: This is a retrospective cohort study of patients who underwent THD at three different sites from April 2007 through October 2010. All procedures were performed in ambulatory settings according to protocol. Telephone surveys were conducted after a minimum of 1-month follow-up to assess patients' satisfaction on a scale of 1-10. Patients were asked whether the procedure had alleviated their symptoms. Patients were asked to recall duration of pain and time from surgery to return to work. RESULTS: Between April 2007 and October 2010, 216 patients with grade III-IV hemorrhoids underwent THD. There were 165 males and 61 females. Average age was 52.2 ± 14.2 years. All patients were discharged the same day after meeting ambulatory surgery center discharge criteria. Postoperative difficulty urinating occurred in 37 (17 %) patients, and six of them required temporary urinary catheterization. Transitory postoperative bleeding was reported by 38 (18 %) patients. Transitory incontinence to stool and flatus occurred in 18 (9 %) and 16 patients (8 %), respectively. Pelvic muscle spasms occurred in 21 (10 %) patients. Median follow-up was 23 months (range 1-42 months) with 143 (66 %) having at least 9 months between procedure and interview. Mean patient satisfaction was 8.5 ± 0.7 (on a scale of 1-10 with 10 being the best), and 91.5 % of patients felt the procedure had "helped" them. Average number of days with discomfort was 6.7 ± 2.1. Patients returned to work after an average of 10.3 ± 3.2 days. Our study is limited by lack of long-term follow-up and by retrospective complication assessment. CONCLUSIONS: Patient satisfaction with THD performed in ambulatory settings is high. Our data support performance of this procedure in an ambulatory setting.

Application of the Cecil-Culp repair for treatment of urethrocutaneous fistulas after hypospadias surgery.

OBJECTIVES: To present our technique and results using a modification of the Cecil-Culp technique of hypospadias repair in a select group of boys with urethrocutaneous fistula during a 6-year period. Urethrocutaneous fistula remains the most common complication of hypospadias repair. Coverage of suture lines with vascularized tissue is thought to decrease fistula formation. METHODS: Between 1994 and 1999, 15 boys with hypospadias fistula underwent repair with a modified two-stage Cecil technique. The records were reviewed with respect to age, type of original hypospadias repair, number of previous fistulas, location of the fistulas, and complications. RESULTS: The average age at the time of the first stage of fistula repair was 3.5 years (range 1.8 to 6.0). Five, four, and two patients had undergone one, two, and three previous fistula repairs, respectively. Four boys in this series had deficient penile skin at the time of their first fistula repair. Most had one fistula at the time of the Cecil repair, including eight at the corona, four along the penile shaft, and three in a more proximal location. No patients had a recurrent fistula, with an average follow-up of 21 months (range 1 to 62). CONCLUSIONS: Boys with recurrent fistula, despite previous fistula repair, and deficient penile skin present a technical reconstructive challenge. The modified Cecil technique for fistula repair takes advantage of penile mobility to place it in a scrotal location, ensuring excellent vascularized tissue coverage. Although this technique requires a brief second-stage operation, no recurrent fistula has occurred in any of our patients.