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• W2945188212 abstract "Accordingly with the new physiopathologic insights of the 70s and 80s, hemorrhoidal disease appears to originate not much from venous hyperplasia but rather from a progressive deterioration of connective and support tissues with subsequent venous and mucosal prolapse. In the late 90s a new surgical technique for a more physiological treatment of hemorrhoids was introduced: stapled prolassectomy.Between October 2017 and June 2018 we performed 50 hemorrhoidal stapled prolassectomies under local-regional anesthesia. All patients were classified as ASA I and were aged between 18 and 65 years. Patients were administered Atropine 1 mg and Flunitrazepam 0,7 mg orally 30 minutes prior to the intervention. A topical anesthetic preparation of Lidocaine and Procaine was also applied. A local anesthesia of the anal and perineal region was performed by the surgeon in the presence of an anesthesiologist.Intraoperative pain control was found to be complete and optimal for the majority of patients (92%). Six of the patients (8%) reported mild pain during the stapling phase but did not require further intervention. A conversion to general anesthesia was never required. Forty-four of the patients (88%) were discharged on the same day of the operation. In four cases (9%) discharge was postponed and patients were kept overnight because of early postoperative complications.Over 20 years after its introduction, stapled prolassectomy has become the allows to gold standard for treating hemorrhoids. This procedure allows for an effective and appropriate treatment of the condition. It preserve the physiology of the anal channel and to reconstruct the correct topographic relationship between anal derma, anal-rectal mucosa, hemorrhoidal plexus and sphincter apparatus . The absence of surgical wounds in the perineal region allows for a reduced stimulation of pain receptors, leading to a less painful post-operatory course and to a reduced risk of long term complications such as stenotizing scarring and soiling .The use of a mechanic stapler leads to higher costs, but they are in part balanced by the possibility of a faster recovery of patients and of an earlier resumption of work activities. The possibility to perform the operation in day surgery may allow for a global reduction health care expenses leaving more resources available for more complex cases.Hemorrhoids, Recto-Anal prolapse, Posterior perineal block.In accordo con le nuove scoperte fisiopatologiche degli anni ’70 e ’80, la malattia emorroidaria sembra non dipendere dall’iperplasia venosa, ma piuttosto da un progressivo deterioramento dei tessuti connettivi e di supporto con conseguente prolasso venoso e mucoso. Alla fine degli anni ’90 fu introdotta una nuova tecnica chirurgica per un trattamento più fisiologico delle emorroidi: la mucoprolassectomia con stapler.Tra ottobre 2017 e giugno 2018 abbiamo eseguito 50 mucoprolassectomie per patologia emorroidaria in anestesia loco-regionale. Tutti i pazienti sono stati classificati come ASA I con un’età compresa tra 18 e 65 anni. Ai pazienti è stato somministrato Atropina 1 mg e Flunitrazepam 0,7 mg per via orale 30 minuti prima dell’intervento. È stata anche applicata una preparazione topica anestetica di Lidocaina e Procaina. Un’anestesia locale della regione anale e perineale è stata eseguita dal chirurgo con assistenza anestesiologica.Il controllo del dolore intraoperatorio è risultato completo e ottimale nel 92% dei pazienti. Sei pazienti (8%) hanno riportato un lieve dolore durante la fase di resezione. Una conversione in anestesia generale non è mai stata necessaria. Quarantaquattro pazienti (88%) sono stati dimessi lo stesso giorno dell’operazione. In quattro casi (9%) la dimissione è stata posticipata a causa di complicazioni postoperatorie precoci.A 20 anni dalla sua introduzione, la mucoprolassectomia con stapler è diventata il gold standard per il trattamento della patologia emorroidaria. Questa procedura permette di preservare la fisiologia del canale anale e di ricostruire la corretta relazione topografica tra derma anale, mucosa ano-rettale, plesso emorroidario e apparato sfinteriale. L’assenza di ferite chirurgiche nella regione perineale consente una ridotta stimolazione dei recettori del dolore, portando ad un decorso post-operatorio meno doloroso e ad un rischio ridotto di complicazioni a lungo termine. L’uso di una stapler comporta costi più elevati ma bilanciati dalla possibilità di un più rapido recupero e una più rapida ripresa delle attività lavorative. La possibilità di eseguire l’operazione in day surgery consente una riduzione globale delle spese sanitarie lasciando più risorse per casi più complessi." @default.
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• W2945188212 date "2018-01-01" @default.
• W2945188212 modified "2023-09-23" @default.
• W2945188212 title "Day-surgery stapled prolassectomy: a ten minutes job." @default.
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