Haemorrhoidal Artery Ligation Operation Without Doppler Guidance.

BACKGROUND: A range of surgical options from banding to open haemorrhoidectomy are available for the treatment of haemorrhoids. Haemorrhoidal artery ligation operation (HALO) with or without Doppler guidance is a newer option with claims of having better efficacy. We aimed to study the efficacy of HALO without Doppler guidance in terms of presence of postoperative complications including pain, bleeding, prolapse and overall patient satisfaction. METHODS: This interventional study was conducted in the Department of Surgery Combined Military Hospital Rawalpindi, from 1st September 2013 to 31st July 2015. Consenting patients with second degree haemorrhoids not responding to banding or sclera-therapy and those with third and fourth degree haemorrhoids were included in the study. They were followed up at 1 week, 6 weeks and then at 6 months. All of them were questioned regarding pain, bleeding, prolapse and overall satisfaction with the procedure. RESULTS: A total of 97 patients (n=97) were included in the study. At 1 week follow up after HALO, mean pain score was 1.76, at 6 weeks it was 0.4 and at 6 months none of the patients had any pain. Postoperative bleeding was seen in 1 patient at 1 week (1.03%). None of the patients had bleeding at 6 weeks (0%), and 2 patients reported mild occasional bleeding at 6 months' post op (2.06%). Four of our patients had persistent prolapse post-operatively (4.12%) which persisted throughout follow up. Ninety-four (96.91%) patients were overall satisfied with the procedure, whereas 3 patients (3.09%) were not satisfied. CONCLUSION: Haemorrhoidal artery ligation operation without Doppler guidance is an effective method to treat haemorrhoids in terms of post-operative pain, bleeding and patient satisfaction.

Total thyroidectomy as primary elective procedure in multinodular thyroid disease.

BACKGROUND: Multinodular goitre is one of the commonest thyroid diseases encountered in the practice of surgery. The most common surgery being performed for multinodular goitre is subtotal thyroidectomy. Total thyroidectomy is designed to remove all of the thyroid tissue. The objective of this study was to evaluate total thyroidectomy as a primary elective procedure for treatment of multinodular thyroid disease. This descriptive study was carried out at Combined Military Hospital Rawalpindi from June 2003 to September 2006. METHODS: 88 patients of multinodular thyroid disease were included. Patients having evidence of recurrent laryngeal nerve damage, recurrent goitre, evidence of altered parathyroid functions or evidence of malignancy were excluded. All patients underwent total thyroidectomy by the same team of surgeons and the patients were closely followed up for postoperative complications especially in terms of recurrent laryngeal nerve damage and hypocalcaemic tetany. RESULTS: No major postoperative complication was noted. Only 1 patient (1.14%) developed unilateral recurrent laryngeal nerve damage and 2 patients (2.27%) developed transient hypocalcaemia that recovered quickly. CONCLUSION: Total thyroidectomy as a primary elective procedure in multinodular thyroid disease is a safe option and it removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of reoperative surgery.