Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Comparison between hemorrhoidectomy using Doppler guided hae

No description
by

Mohamed Yehia Elbarmelgi

on 28 August 2014

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Comparison between hemorrhoidectomy using Doppler guided hae

Comparison between haemorrhoidectomy using Doppler guided haemorrhoidsal artery ligation (DGHAL) and mucopexy VS non-Doppler guided ligation and mucopexy.
Ahmad Farag(MD), Mohamed Yehia Elbarmelgi*(MSC),Hany M Michail (MD)

THANK YOU
Questions?

The intensity of postoperative pain will be measured every 8 hours during the first 24 hours by means of a 0 to 10 visual analog scale(VAS: 0….no pain and 10…maximum pain experienced) and during weekly follow up visits.


The following items were monitored in both groups:
The duration of the procedure.
Intra-operative blood loss.
Post operative pain.
Post operative complications.

This study showed that Mucopexy alone is a simple technique which depends on a basic surgical maneuver to suture hemorrhoidal vessel followed by disappearance of symptoms.
Mucopexy is less costly than DGHAL, where no need to special instruments.
In this study Mucopexy showed better results over the DGHAL, in regard of postoperative pain.

Conclusion

B) Non Doppler guided group:
1 case was complicated by moderate spontaneous bleeding on the 2nd day.
1 case was complicated by infection after 1 week.
P-value = 0.09 with no statistical significant difference.



Results

3. post operative pain:
DGHAL group:
Mean VAS was 3.80 (+ 2.8)
B) Non Doppler guided group:
Mean VAS was 3.20 (+ 1.6)

P-Value was 0.02 with statistical significance towards the Non-Doppler guided operation.





Results

1. Blood Loss:
The rate of blood loss was nearly the same in both groups ranging between no or minimal blood loss.


Results

Patients of both groups received spinal anesthesia with local anesthetic infiltration of lidocain 2 % and NSAIDs (declofinac sodium 75mg at regular interval every 8 hours).


Analgesia used

Surgical management includes:
Ferguson’s (closed) hemorrhoidectomy
Milligan-Morgan (open) hemorrhoidectomy
Harmonic and LigaSure hemorrhoidectomy
Doppler guided hemorrhoidal artery ligation
Stapled hemorrhoidectomy


Treatment of hemorrhoids

Hemorrhoids are vascular cushions
They consist of arterio-venous communications
Mainly between branches from superior rectal artery and others from superior hemorrhoidal artery,
OR may be between branches from inferior and middle hemorrhoidal arteries.
Altomare et al. 2006.


Introduction

Ahmad Farag(MD), Mohamed Yehia Elbarmelgi*(MSC),Hany M Michail (MD)


Comparison between haemorrhoidectomy using Doppler guided haemorrhoidal artery ligation (DGHAL) and mucopexy VS ligation non-Doppler guided and mucopexy.


More studies with larger number of patients and longer period of follow up is needed to reach more accurate results.

However

4. Postoperative complications:
A) DGHAL group:
2 cases were complicated by perianal edema.
2 cases were complicated by mucosal polyp.
2 cases were complicated by Fecal impaction.




Results

2. Intraoperative duration:
A) DGHAL group:
Mean time was 39.4+ 3.6 minutes.
B) Non Doppler guided group:
Mean time was 42.4+ 6.7 minutes.

P-Value was 0.21 with no statistically different significance.



Results

Post-operative pain was measured with the VAS (visual analogue score).


Pain

20 patients suffering from 3rd or 4th degree hemorrhoids ranging between 22 and 53 years old were included in the study between January 2012 to May 2013.
10 patients had DGHAL and mucopexy.
The other 10 patients had non-Doppler guided ligation and mucopexy.

Methodology

The essentials DGHAL are high, exact and selective ligation of the blood supply to the piles.
A mucopexy can be performed through the window of the (DG) HAL proctoscope to treat grades III and IV hemorrhoids.



Doppler guided hemorrhoidal artery ligation (DGHAL)

Nonsurgical methods of treatment include :
Increasing oral fluids to maintain hydration.
Fiber intake.
Sitz baths.
NSAIDS analgesics and rest.
Sclerotherapy.
Rubber band ligation and infrared coagulation.


Treatment of hemorrhoids

The aim of the study

Comparison between Hemorrhoidectomy using Doppler guided hemorrhoidal artery ligation (DGHAL) with mucopexy Vs. hemorrhoidectomy using ligation and mucopexy non-Doppler guided regarding post operative pain and any post-operative complication as bleeding and infection
Full transcript