International journal of colorectal disease
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Int J Colorectal Dis · Dec 2009
Randomized Controlled TrialTreatment of grade III and IV haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results.
Haemorrhoidal disease is a frequently occurring entity in the western world. The Procedure for prolapse and haemorrhoids (PPH) and transanal haemorrhoidal dearterialisation (THD) are the most important surgical treatments that respect normal anal anatomy. This is the first randomized trial that compares both techniques in the treatment of grade III and IV haemorrhoids. ⋯ Both PPH and THD are safe treatments for grade III and IV haemorrhoids with acceptable complication rates and good short-term results. THD might be the preferred treatment because it carries the similar complication rate and short-term results, but results in less postoperative pain when compared with PPH. Moreover, it is a less invasive, more easily learned and less costly procedure.
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Int J Colorectal Dis · Dec 2009
Clinical TrialSacral neuromodulation for the treatment of fecal incontinence and urinary incontinence in female patients: long-term follow-up.
The purpose of this study was to evaluate improvement in symptoms of fecal incontinence (FI) in a group of women who also had urinary incontinence (UI) and were successfully implanted with the sacral neuromodulation (SNM) device primarily for urinary incontinence in one US institution. ⋯ SNM may be beneficial in selected female patients with UI associated with FI. Prospective trials may help delineate which patients will show FI improvement in this combined group.
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Int J Colorectal Dis · Oct 2009
Meta Analysis Comparative StudyFast-track vs standard care in colorectal surgery: a meta-analysis update.
Fast-track (FT) protocols accelerate patient's recovery and shorten hospital stay as a result of the optimization of the perioperative care they offer. The aim of this review is to examine the latest evidence for fast-track protocols when compared with standard care in elective colorectal surgery involving segmental colonic and/or rectal resection. ⋯ FT protocols show high-level evidence on reducing primary and total hospital stay without compromising patients' safety offering lower morbidity and the same readmission rates. Enhanced recovery programs should become a mainstay of elective colorectal surgery.
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Int J Colorectal Dis · Sep 2009
Randomized Controlled Trial Comparative StudyLigasure versus diathermy hemorrhoidectomy under spinal anesthesia or pudendal block with ropivacaine: a randomized prospective clinical study with 1-year follow-up.
We evaluate the safety and efficacy of a spinal anesthesia with lidocaine versus a local anesthesia of pudendal block with ropivacaine combined with intravenous sedation in the hemorrhoidectomy procedure and also we compared the short- and long-term efficacy of conventional diathermy versus Ligasure diathermy hemorrhoidectomy. ⋯ Hemorrhoidectomy under local anesthesia with pudendal block with ropivacaine and sedation reduced postoperative pain, analgesic requirements, and postoperative complications, and can be performed as day-case procedure. Ligasure diathermy hemorrhoidectomy reduced operating time and was equally effective than conventional diathermy in long-term symptom control.
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Int J Colorectal Dis · Aug 2009
Total mesorectal excision for rectal cancer in an unselected population: quality assessment in a low volume center.
The aim of this study was to review the results and long-term outcome after total mesorectal excision (TME) for adenocarcinoma of the rectum in an unselected population in a community teaching hospital. ⋯ Patients with rectal cancer can safely be treated with TME in a community teaching hospital and leads to a good overall survival and an excellent local control. In patients aged above 80, treatment-related mortality is an important competitive risk factor, which obscures the positive effect of modern rectal cancer treatment.