Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids.

AIM: Doppler-guided transanal haemorrhoid dearterialization (THD) and stapler haemorrhoidopexy (SH) have been demonstrated to be less painful than the Milligan-Morgan procedure. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of third-degree haemorrhoids in an equivalent trial. METHOD: One hundred and sixty-nine patients with third-degree haemorrhoids were randomized online to receive THD (n = 85) or SH (n = 84) in 10 Colorectal Units in which the staff were well trained in both techniques. The mean follow-up period was 17 (range 15-20) months. RESULTS: Early minor postoperative complications occurred in 30.6% of patients in the THD group and in 32.1% of patients in the SH group. Milder spontaneous pain and pain on defecation were reported in the THD group in the first postoperative week, but this was not statistically significant. Late complications were significantly higher (P = 0.028) in the SH group. Residual haemorrhoids persisted in 12 patients in the THD group and in six patients in the SH group (P = 0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P = 0.34). No differences were found in postoperative incontinence. The obstructed defecation score (ODS) was significantly higher in the SH group (P < 0.02). Improvement in quality of life was similar in both groups. Postoperative in-hospital stay was 1.14 days in the THD group and 1.31 days in the SH group (P = 0.03). CONCLUSION: Both THD and SH techniques are effective for the treatment of third-degree haemorrhoids in the medium term. THD has a better cost-effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.

A venous ""patch"" technique improves patency rate of primary radiocephalic fistulas.

A retrospective study was designed to evaluate the outcome of native wrist arteriovenous fistula (AVF) constructed with standard versus venous ""patch"" techniques in terms of immediate, early and late failures. Between January 1991 and July 2001, 1948 patients underwent primary wrist radiocephalic AVF. Thirty eight per cent (740) of the fistulas were created using the venous patch technique. Immediate and/or early failure rate was significantly lower in the venous ""patch"" technique (Group II) compared to the standard technique (Group I). Although the difference in late failures between Groups I and II did not reach statistical significance, the cumulative patency rates were significantly better in Group II. Radiocephalic fistula constructed with the use of venous patch is recommended whenever the anatomy is feasible.

Gastroesophageal reflux and a comparison of the different antireflux procedures following esophagomyotomy: an experimental study in rabbits.

The surgical options for achalasia remain controversial regarding the surgical access route, whether it be transthoracic or transabdominal, the need of, and the type of an added antireflux procedure following an esophagomyotomy. These questions were investigated in an experimental study that used 30 albino rabbits divided into six groups, as follows: transabdominal Heller's esophagomyotomy (TAHE), transthoracic Heller's esophagomyotomy (TTHE), TAHE and Nissen total fundoplication (NF), TAHE and partial fundoplication (PF), TAHE and modified fundoplication (MF), and a control group. Esophageal transit time (ETT) and gastroesophageal reflux (GER) were evaluated by scintigraphy on the seventh postoperative day. When an esophagomyotomy was performed either with a transabdominal or transthoracic approach, a significantly increased GER rate was found in comparison to the controls. All types of antireflux procedures performed prevented GER effectively. Although NF and PF groups showed a significant delay in ETT when compared to the control group (P < 0.001), no such finding was observed in the MF group. In conclusion, an antireflux procedure following an esophagomyotomy is recommended. A modified fundoplication was thus found to be as effective as the other techniques in preventing GER, and was even a safer method when obstructive findings following a total or partial fundoplication were considered.

Gluteus maximus flap for persistent fecal fistula following rectal resection via the posterior approach.

An alternative technique for the treatment of persistent anastomotic leak following resection of the rectum via combined celiotomy and posterior approach is described. Lower aspect of the gluteus muscle is advanced and sutured to cover the anastomotic gap.

The effect of prostaglandin E1 on experimental colitis in the rat.

Prostaglandin E1 (PGE1) is known to have a strong vasodilator effect and to block coagulation and inflammation in high concentrations. The aim of this study has been to investigate whether PGE1 has an inhibitory effect on inflammation in experimental colitis. Experimental colitis was produced by rectal instillation of 10% acetic acid in 60 rats. These were divided into prostaglandin (PG) (n = 30) and control groups (n = 30). Twelve hours later, an intraperitoneal injection of 2 micrograms PGE1 in 1 ml saline was given to the PG group and 1 ml saline to the control group. This was repeated daily and the animals were sacrificed in groups of 10 on the 3rd, 7th and 10th day. Histopathological examination and hydroxyproline determination for assessment of collagen synthesis were performed. PGE1 significantly decreased inflammation on third day with the hydroxyproline level significantly higher in the PG group compared with the control group (p < 0.05). This difference was however not significant at the 7th and 10th day. The present study supports a beneficial role for prostaglandin E1 in reducing the severity of colonic inflammation following chemically induced colitis but only in the early stages of development.

[The role of peritoneal lavage in treatment of penetrating abdominal injuries]. / Die Rolle der Peritoneallavage bei der Behandlung der penetrierenden Bauchverletzungen.

Preventing negative laparotomies is one of the most challenging problems in the management of penetrating abdominal injuries. The term "selective laparotomy" has been therefore introduced and has found an ever increasing acceptance. The peritoneal lavage is a useful tool in patient selection for laparotomy but the main problem is where to set the boundary between a positive and a negative peritoneal lavage. The manipulation of this boundary leads to significant changes in the sensitivity and specificity of the peritoneal lavage. Here we are presenting 162 consecutive cases of penetrating abdominal trauma and discussing our methods of evaluation and management.