Prolapsed hemorrhoids is a common clinical disease, and severe symptoms can significantly affect work and life. The transanal stapler has the advantages of simple operation and less trauma in treating prolapsed hemorrhoids. Its clinical efficacy is closely related to the selection of indications, the standardization of surgical operations, and the prevention and treatment of complications. In current clinical practice, there is no consensus on the treatment of prolapsed hemorrhoids with transanal stapler. Hence a discussion was held by the Professional Committee of Colorectal Diseases of Chinese Society of Integrated Chinese and Western Medicine, concerning the indications, contraindications, operating specifications and perioperative management of prolapsed hemorrhoids. A consensus was consequently formed, aiming to provide a guideline for the clinical practice.
Anal Canal/surgery* ; China ; Consensus ; Hemorrhoidectomy/methods* ; Hemorrhoids/surgery* ; Humans ; Surgical Stapling/methods* ; Treatment Outcome

The circular stapled hemorrhoidectomy is a new treatment modality for hemorrhoids requiring surgical management. This study reviews the available information concerning the present results of this procedure. A medline search and a review of the literature wene conducted to identify available information on the procedure, with a special attention being given to on-going or published randomized clinical trials. The advantages of circular stapled hemorrhoidectomy were analyzed based on different areas of concern, including postoperative pain, operating time, duration of hospital stay and recovery of normal activity, postoperative wound care, and types and rates of complications. Continence status and patient satisfaction following a circular stapled hemorrhoidectomy are also reported. The circular stapled hemorrhoidectomy is safe, easy to perform, and effective in the treatment of advanced hemorrhoids with an external mucosal prolapse. Other advantages include minimal postoperative complications, easier postoperative management, and a shorter time to return to work congenial to a conventional hemorrhoidectomy. Despite the higher cost and difficult access, this study confirms the feasibility of using a circular stapled hemorrhoidectomy in the treatment of hemorrhoids. The circular stapled hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach. A longer follow-up is required to confirm the true efficacy of this surgical method.
Follow-Up Studies ; Hemorrhoidectomy* ; Hemorrhoids* ; Humans ; Length of Stay ; Methods ; Pain, Postoperative ; Patient Satisfaction ; Postoperative Complications ; Prolapse ; Return to Work ; Wounds and Injuries

PURPOSE: A variety of instruments, including circular staplers, ultrasonic scalpels, lasers, and bipolar electrothermal devices, are currently used when performing a hemorrhoidectomy. This study compared outcomes between hemorrhoidectomies performed with an ultrasonic scalpel and conventional methods. METHODS: The study was a randomized prospective review of data available between May 2013 and December 2013, involving 50 patients who had undergone a hemorrhoidectomy for grade III or IV internal hemorrhoids. The hemorrhoidal pedicle was coagulated with an ultrasonic device in the ultrasonic scalpel group (n = 25) and sutured with 3-0 vicryl material after excision in the conventional method group (n = 25). RESULTS: The patients' demographics, clinical characteristics, and lengths of hospital stay were similar in both groups. The mean ages of the conventional and the ultrasonic scalpel groups were, respectively, 20.8 ± 1.6 and 22.4 ± 5.0 years (P = 0.240). In comparison with the conventional method group, the ultrasonic scalpel group had a shorter operation time (P < 0.005), less postoperative pain on the visual analogue scale score (for example, P = 0.211 on postoperative day 1), and less postoperative bleeding (P = 0.034). No significant differences in postoperative complications were observed between the 2 groups. CONCLUSION: A hemorrhoidectomy using an ultrasonic scalpel is an effective and safe procedure. The ultrasonic scalpel reduces the operation time, the postoperative blood loss, and the postoperative pain. Long-term follow-up with larger-scale studies is required to evaluate normal activity after a hemorrhoidectomy performed with an ultrasonic scalpel.
Demography ; Follow-Up Studies ; Hemorrhage ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Methods ; Pain, Postoperative ; Polyglactin 910 ; Postoperative Complications ; Postoperative Hemorrhage ; Prospective Studies ; Ultrasonics*

BACKGROUNDEpidural lidocaine can be used when regional anesthesia needs to be established quickly, but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration (MLAC) of lidocaine is not known. We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults.

METHODSOne hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions: lidocaine, or lidocaine plus fentanyl 1 µg/ml, 2 µg/ml, or 3 µg/ml. The first patient in each group was administered 1% lidocaine weight by volume; subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments. Efficacy was assessed using a visual analog pain scale, and accepted if this was = 10 mm on a 100 mm scale within 30 minutes. The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery, respectively.

RESULTSThe MLAC of lidocaine in those receiving lidocaine alone was 0.785% (95%CI 0.738 - 0.864). A significant dose-dependent reduction was observed with the addition of fentanyl: the MLAC of lidocaine with fentanyl at 2 µg/ml was 0.596% (95%CI 0.537 - 0.660) and 0.387% with fentanyl at 3 µg/ml (95%CI 0.329 - 0.446, P < 0.001).

CONCLUSIONEpidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects.

Adult ; Analgesia, Epidural ; methods ; Drug Interactions ; Female ; Fentanyl ; administration & dosage ; therapeutic use ; Fistula ; surgery ; Hemorrhoidectomy ; Humans ; Lidocaine ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Urinary Bladder Neoplasms ; surgery