Double PPH technique for hemorrhoidal prolapse: a multicentric, prospective, and nonrandomized trial.

INTRODUCTION: Longo's technique (or PPH technique) is well known worldwide. Meta-analysis suggests that the failure due to persistence or recurrence is close to 7.7%. One of the reasons for the recurrence is the treatment of the advanced hemorrhoidal prolapse with a single stapling device, which is not enough to resect the appropriate amount of prolapse. MATERIALS AND METHODS: We describe the application of "Double PPH Technique" (D-PPH) to treat large hemorrhoidal prolapses. We performed a multicentric, prospective, and nonrandomized trial from July 2008 to July 2009, wherein 2 groups of patients with prolapse and hemorrhoids were treated with a single PPH or a D-PPH. Results were compared. The primary outcome was evaluation of safety and efficacy of the D-PPH procedure in selected patients with large hemorrhoidal prolapse. RESULTS: In all, 281 consecutive patients suffering from hemorrhoidal prolapse underwent surgery, of whom 74 were assigned intraoperatively to D-PPH, whereas 207 underwent single PPH. Postoperative complications were 5% in both groups (P = .32), in particular: postoperative major bleeding 3.0% in PPH versus 4.1% D-PPH (P = .59); pain 37.9 % PPH versus 27.3% D-PPH (mean visual analog scale [VAS] = 2.5 vs 2.9, respectively; P = .72); and fecal urgency 2.1% PPH versus 5.7% D-PPH (P = .8). Persistence of hemorrhoidal prolapse at 12-month follow-up was 3.7% in the PPH group versus 5.9% in the D-PPH group (P = .5). CONCLUSIONS: Our data support the hypothesis that an accurate intraoperative patient selection for single (PPH) or double (D-PPH) stapled technique will lower in a significant way the incidence of recurrence after Longo's procedure for hemorrhoidal prolapse.

[Traffic-related injuries in children at Trieste, 1984-1986]. / Lesioni da traffico nel bambino a Trieste 1984-86.

Traffic-related injuries to children are poorly known in our country, in spite of their role in mortality and morbidity. Being that they are rather different from those reported in the adults, their study is useful in identifying risks and elaborating prevention strategies. This paper reports epidemiologic and clinical data on 1050 children under 16, referred to our hospital because of road traffic accidents. The study has been prospectively carried out during 1984-86; injuries severity was assessed according to the Abbreviated Injury Scale. Incidence rates resulted to increase with the age, highest values being observed for 15 year old children, due to motorcycle use. Patterns and severity of the injuries were significantly different according to the age and the group of injured subjects. Younger children as pedestrians and 14-15 y.o. motorcyclists resulted to be more involved than car passengers and bicyclists. At a telephone inquiry after 6-12 months sequelae resulted in 20-40% out of 482 children, according to different AIS Score.

[Evaluation of the usefulness of the motorcycle helmet in adolescents in Trieste]. / Valutazione dell'efficacia del casco da motociclista nell'adolescente triestino.

The effectiveness of the motorcycle helmet was assessed in 359 accidents involving adolescents under 16 in the Trieste area in 1985-88. Comparison of the 18 months preceding and following the introduction of the law revealed that helmet use significantly reduced the number and gravity (as objectively assessed using the Abbreviated Injury Scale) of cranial and facial injuries but made no significant difference to other areas. The 70-80% reduction in head injuries also significantly reduced the incidence of multiple injuries and hospital admissions. The effectiveness of the helmet demonstrated in this study primarily concerned with motorcycle accidents in urban areas suggests that it should now also be made obligatory for those currently exempt.