Surgery News - December 2007 - (Page 12)

12 GENERAL SURGERY SURGERY NEWS • D E C E M B E R 2 0 0 7 Hemorrhoidal Dearterialization Hastens Recovery B Y M I C H E L E G. S U L L I VA N Else vier Global Medical Ne ws N E W O R L E A N S — Transanal hemorrhoidal dearterialization gets patients back to their normal activities faster than the procedure for prolapse and hemorrhoids, and appears to be associated with fewer serious complications, Dr. Piero Nastro reported at the annual clinical congress of the American College of Surgeons. And although dearterialization is slight- ly more expensive than stapled hemorrhoidopexy (SH)—about $150—the fact that most patients return to work within 4 days may actually make the procedure cheaper overall, said Dr. Nastro of Whipp’s Cross University Hospital, London. Transanal hemorrhoidal dearterialization (THD) is performed with a dedicated proctoscope outfitted with a Doppler transducer. Under ultrasound guidance, the surgeon identifies the terminal branch of the hemorrhoidal artery, and inserts two stitches to close off the blood supply. A ligation of the rectal mucosa then lifts the hemorrhoid up inside the anal canal. The technique was introduced in Japan about 10 years ago, Dr. Nastro said. Case studies suggest it is safe, results in minimal postoperative pain, and is easy to learn. However, data comparing THD to other techniques are limited. Dr. Nastro’s nonrandomized prospective trial compared THD with SH in 52 patients (average age 50 years) with second- and third-degree Membership in the American College of Surgeons? H E R E ’ S W H Y I T ’ S I M P O R TA N T: AS A BODY REPRESENTING ALL OF SURGERY, THE COLLEGE: • Provides a cohesive voice addressing societal issues related to surgery. • Is working toward having an increasingly proactive and timely voice in setting a national tone and agenda with regard to health care. • Is dedicated to promoting the highest standards of surgical care through education of and advocacy for its Fellows and their patients. • Serves as a national forum through which surgeons can reinforce the values and ethics that traditionally have characterized the surgical profession. HERE ARE SOME OF THE MANY BENEFITS BEING A MEMBER OF THE COLLEGE AFFORDS YOU: • Free registration at the Clinical Congress • Access to the College’s free coding consultation hotline • Subscription to ACS NewsScope, the College’s weekly electronic newsletter • Subscription to the Bulletin of the American College of Surgeons • Subscription to the Journal of the American College of Surgeons • Access to all College-sponsored insurance, credit card, and other helpful programs • Free posting of resume on ACS Career Opportunities • Access to Surgeons Diversiﬁed Investment Fund THERE IS STRENGTH IN NUMBERS. Our members represent every specialty, practice setting, and stage of practice. Their views and concerns are helping to shape the College’s agenda for the future. If you aren’t a member of the American College of Surgeons, apply for Fellowship today. If you are already a member, maintain that status and consider getting involved in the work of the College. Only by banding together and using our collective strength can we bring about positive change for our patients and ourselves—and for surgeons of the future. hemorrhoids. All patients had failed sclerotherapy. The investigators did not have approval for randomization, so they explained both procedures in detail and let the patients choose. THD was performed on 28 patients, while 24 received SH. In the THD group, 16 patients had second-degree hemorrhoids and 12 had thirddegree hemorrhoids. In the SH group, 15 patients had second-degree hemorrhoids and 9, third degree. All procedures were performed during the day, with general anesthesia. Postoperative pain scores were slightly, but not significantly, different between the groups. There were three minor complications in the THD group: one submucosal hematoma and two technical problems during surgery, which required no additional treatment. In the SH group, five complications occurred: two cases of fecal urgency; one rectal stenosis that required surgery; and two postoperative bleeds that required readmission, but were successfully addressed in one visit. Symptoms resolved in almost all patients (25 of 28 in the THD group, and 21 of 24 in the SH group). At a mean followup of 4 months, there was no significant difference in recurrence. Almost all of the THD patients (25) returned to work 4 days after surgery, while only 50% (12) of the SH patients were able to do so. This significant difference probably makes THD more cost effective, Dr. Nastro said, because patients are not losing as much productive time to recovery. In discussing the paper, Dr. Bradford Sklow said that THD may prove a viable alternative for SH. “[Stapled hemorrhoidopexy] is not the magic bullet we once thought it was,” said Dr. Sklow, an ACS Fellow from Salt Lake City. “It has a learning curve, and because of the potential serious complications—including pelvic sepsis, rectovaginal fistula, and even death—physicians need special credentialing to perform it.” THD looks to be easier to learn, he said, and, from the limited data available now, seems to be associated with fewer serious complications than SH. A prospective, randomized controlled trial of the two techniques is needed to fully ascertain the place of THD in hemorrhoidal treatment, Dr. Nastro concluded. ■ Patients Who Returned To Work 4 Days After Surgery 89% or contact Cynthia Hicks, Credentials Section, Division of Member Services, via phone at 1-800/293-9623, or via e-mail at chicks@facs.org. Transanal hemorrhoidal dearterialization (n = 28) Source: Dr. Nastro Stapled hemorrhoidopexy (n = 24) ELSEVIER GLOBAL MEDICAL NEWS Information on becoming a member of the College and an application form are available online at w w w.f ac s .org/dept /fellowship/index .html 50% http://www.facs.org/dept/fellowship/index.html

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Surgery News - December 2007 Contents Breast Radiation Boost Cuts Cancer Recurrence Mortality Soars in Some Patients With Respiratory Distress New Codes Promote Alcohol Screening New Ideas News From the College: Quality Standards General Surgery: Helping Hand Trauma: Spleen Protocol

Surgery News - December 2007

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