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      Evaluación funcional y encuesta de satisfacción de los pacientes operados de hemorroides con técnica de PPH Translated title: Satisfaction survey of patients after hemorrhoid surgery using the procedure for prolapse and hemorrhoids (PPH) technique

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          Abstract

          Introducción: La patología hemorroidal es una condición muy frecuente en la población general y aproximadamente un 10% de los afectados requerirá cirugía. Existen distintas técnicas para su abordaje, siendo la operación de Longo o PPH (procedimiento para el prolapso y las hemorroides) una alternativa que ha cobrado relevancia. Existe poca evidencia de los resultados desde el punto de vista de la satisfacción de los pacientes. El objetivo de nuestro trabajo es dar a conocer la evaluación y percepción de los pacientes operados de hemorroides con la técnica de PPH en un seguimiento a mediano plazo. Material y Métodos: Se identificaron todos los pacientes operados con la técnica de PPH entre enero de 2007 y enero de 2009. Se aplicó una encuesta diseñada para consignar la presencia de algunos síntomas antes y después de la cirugía. Resultados: 57 pacientes completaron la encuesta, con un seguimiento promedio de 17,6 meses (extremos 8-31). Un 94% de los pacientes refirió la desaparición del sangrado, el 85% del prolapso hemorroidal y un 68% del ensuciamiento (soiling) tras la intervención. En una escala de evaluación de 1 a 7, el 88% de los pacientes calificó el procedimiento con nota > 5 y el 87% recomendaría el uso de esta técnica a otros pacientes afectados por esta patología. Conclusión: El uso de la técnica de PPH es evaluada favorablemente por la mayoría de los pacientes en relación a la resolución de sus síntomas, al estado funcional y al grado de satisfacción en un seguimiento postoperatorio a mediano plazo.

          Translated abstract

          Background: Hemorrhoidal disease is very common and approximately 10% of the patients require surgery. Within the different surgical techniques, the Longo procedure or PPH (procedure for prolapse and hemorrhoids) has gained importance. Aim: To evaluate the patients' perception of PPH hemorrhoidectomy in a medium term follow-up. Material and Methods: All patients undergoing PPH hemorrhoidectomy between January 2007 and January 2009 were identified. A survey was designed to assess the presence of specific symptoms before and after surgery, and applied to all patients. Results: Fifty-seven patients completed the survey, with a follow-up ranging from 8 to 31 months. Ninety-four percent of patients referred improvement of bleeding, 85% of hemorrhoidal prolapse and 68% of soiling after the intervention. On a scale of 1 to 7, 88% of patients rated the procedure with a score over 5, and 87% would recommend the use of this technique to other patients suffering from the disease. Conclusions: Most patients favorably assess PPH hemorrhoidectomy in terms of postoperative resolution of the symptoms, functional status and overall satisfaction in a medium-term follow-up.

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          Most cited references62

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          Etiology and management of fecal incontinence

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            The nature of haemorrhoids.

            An anatomical and clinical study aimed at uncovering factors likely to be helpful in understanding the true nature of haemorrhoids is described. The main finding was of specialized 'cushions' of submucosal tissue lining the anal canal; it is argued that piles are merely the result of their displacement.
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              Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy).

              The procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy) has been introduced as an alternative to conventional hemorrhoidectomy. This is a systematic review on stapled hemorrhoidopexy of all randomized, controlled trials that have been published until August 2006. All published, randomized, controlled trials comparing stapled hemorrhoidopexy to conventional hemorrhoidectomy were identified from Ovid MEDLINE, EMBASE, CINAHL, and all Evidence-Based Medicine Reviews (Cochrane Central Register of Controlled Trial, Cochrane Database of Systemic Review, and Database of Abstracts of Reviews of Effects) between January 1991 and August 2006. Meta-analysis was performed by using the Forest plot review if feasible. A total of 25 randomized, controlled trials with 1,918 procedures were reviewed. The follow-up duration was from 1 to 62 months. Stapled hemorrhoidopexy was associated with less operating time (weighted mean difference, -11.35 minutes; P = 0.006), earlier return of bowel function (weighted mean difference -9.91 hours; P < 0.00001), and shorter hospital stay (weighted mean difference, -1.07 days; P = 0.0004). There was less pain after stapled hemorrhoidopexy, as evidenced by lower pain scores at rest and on defecation and 37.6 percent reduction in analgesic requirement. The stapled hemorrhoidopexy allowed a faster functional recovery with shorter time off work (weighted mean difference, -8.45 days; P < 0.00001), earlier return to normal activities (weighted mean difference, -15.85 days; P = 0.03), and better wound healing (odds ratio, 0.1; P = 0.0006). The patients' satisfaction was significantly higher with stapled hemorrhoidopexy than conventional hemorrhoidectomy (odds ratio, 2.33; P = 0.003). Although there was increase in the recurrence of hemorrhoids at one year or more after stapled procedure (5.7 vs. 1 percent; odds ratio, 3.48; P = 0.02), the overall incidence of recurrent hemorrhoidal symptoms--early (fewer than 6 months; stapled vs. conventional: 24.8 vs. 31.7 percent; P = 0.08) or late (1 year or more) recurrence rate (stapled vs. conventional: 25.3 vs. 18.7 percent; P = 0.07)--was similar. The overall complication rate did not differ significantly from that of conventional procedure (stapled vs. conventional: 20.2 vs. 25.2 percent; P = 0.06). Compared with conventional surgery, stapled hemorrhoidopexy has less postoperative bleeding (odds ratio, 0.52; P = 0.001), wound complication (odds ratio, 0.05; P = 0.005), constipation (odds ratio, 0.45; P = 0.02), and pruritus (odds ratio, 0.19; P = 0.02). The overall need of surgical (odds ratio, 1.27; P = 0.4) and nonsurgical (odds ratio, 1.07; P = 0.82) reintervention after the two procedures was similar. The Procedure for Prolapse and Hemorrhoid (stapled hemorrhoidopexy) is safe with many short-term benefits. The long-term results are similar to conventional procedure.
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                Author and article information

                Journal
                rchcir
                Revista chilena de cirugía
                Rev Chil Cir
                Sociedad de Cirujanos de Chile (Santiago, , Chile )
                0718-4026
                December 2010
                : 62
                : 6
                : 600-606
                Affiliations
                [02] orgnameHospital Barros Luco orgdiv1Servicio de Cirugía Chile
                [05] orgnameUniversidad de Chile orgdiv1Facultad de Medicina orgdiv2Sede Centro Chile
                [04] orgnameHospital San Borja Arriarán orgdiv1Servicio de Cirugía Chile
                [01] orgnameClínica Las Condes orgdiv1Unidad de Coloproctología Chile
                [03] orgnameUniversidad de Chile orgdiv1Facultad de Medicina orgdiv2Sede Sur Chile
                Article
                S0718-40262010000600010 S0718-4026(10)06200600010
                10.4067/S0718-40262010000600010
                46d86bb8-378e-4640-b7dd-bdff71c6aa4e

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 18 March 2010
                : 19 April 2010
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 7
                Product

                SciELO Chile

                Categories
                ARTÍCULOS DE INVESTIGACIÓN

                Procedimiento para el prolapso y las hemorroides (PPH),patient satisfaction,PPH,Hemorroides,Procedure for Prolapse and Hemorrhoids,Hemorrhoidectomy,Hemorrhoids,Hemorroidectomía,Hemorroidopexia,Hemorroidopexia con engrapadora

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