Nahum Werbin

First 100 Cases With Doppler-Guided Hemorrhoidal Artery Ligation

PurposeThis study was designed to examine the benefits of a Doppler-guided hemorrhoidal artery ligation technique in terms of surgical outcome, functional recovery, and postoperative pain.MethodsUsing local, regional, or general anesthesia, 100 patients with symptomatic Grades II or III hemorrhoids underwent sonographic identification and suture ligation of six to eight terminal branches of the superior rectal artery above the dentate line. Visual Analog Scales were used for postoperative pain scoring. Surgical and functional outcomes were assessed at 6 weeks and 3, 6, and 12 months after surgery.ResultsThere were 42 (42 percent) males and 58 (58 percent) females (mean age, 42 years; median duration of symptoms, 6.3 years). The mean operative time was 19 minutes. Local anal block combined with intravenous sedation (n = 93) or general or spinal (n = 7) anesthesia was used. Only five were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative course. The mean pain score decreased from 2.1 at two hours postoperative to 1.3 on the first postoperative day. All patients had a complete functional recovery by the third postoperative day. Ninety-four patients remained asymptomatic after a mean follow-up of six months: four patients required additional surgical excision, and two required rubber band ligations for persistent bleeding. On follow-up, there was no report of incontinence to gas or feces, fecal impaction, or persistent pain.ConclusionsOur experience indicates that Doppler-guided hemorrhoidal artery ligation is safe and effective and can be performed as an outpatient procedure with local or regional anesthesia and with minimal postoperative pain and early recovery.

Colonic metastases from lobular carcinoma of the breast

Metastatic involvement of the gastrointestinal tract secondary to breast cancer is rare. A case of diffuse infiltration of the colon by metastatic infiltrating lobular breast cancer is reported. Awareness of this condition may lead to proper investigations including intestinal biopsy, thus avoiding unnecessary surgery.

Treatment of pilonidal sinus disease using fibrin glue as a sealant.

Abstract.BackgroundComplete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension–free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing.MethodsA curved incision of the carried out, 2–3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline. The sinus was completely excised with all of its extensions. The flap was then sutured back to its original place by several interrupted monofilament mattress sutures. Then, 2–4 ml of fibrin glue was injected through the original pilonidal sinus opening to the sinus bed in order to obliterate the dead space.ResultsThirty patients with pilonidal sinus disease were treated by this technique. In four patients, there was a temporary purulent discharge through the opening of the sinus, and there were no other complications. The mean period for returning to daily activities and to work for patients was 11 days (SD=6 days). No infection or recurrent disease was noticed during the follow–up period (23±3 months).ConclusionsComplete excision with tensionfree closure with fibrin glue application may be a useful technique for the treatment of pilonidal sinus disease.

Irradiation-induced colonic stricture and colitis cystica profunda: Report of a case

SummaryA 57-year-old patient was operated upon for a colonic stricture that appeared 18 years after removal of a clear-cell carcinoma of the kidney, followed by irradiation therapy. In addition to typical irradiation-induced changes and fibrotic stricture, colitis cystica profunda was discovered. Review of the literature showed no similar case.

Bacteremia in anal dilatation

One hundred patients underwent anal dilatation for acute or chronic anal fissure during the period 1983–1984; white blood count, serum, muscle enzymes, and blood cultures were done. Positive blood cultures were found following the procedure in eight patients. A correlation based on serum enzymes, bacteremia, and trauma can be made. Prophylactic broad-spectrum antibiotics are recommended for patients at risk.

Recurrent spontaneous perforation of the colon

A 58-year-old man with recurrent spontaneous perforations of the colon is reported. The first two events were of the sigmoid colon, and a sigmoidectomy was performed after the second perforation. The third spontaneous perforation had occurred in the transverse colon, however, although a patent sigmoid colostomy was present. Neither primary colonic pathology nor elevated intraluminal pressure were found, which means that the cause and pathogenesis of these perforations are unknown. Six months later, a subtotal colectomy with ileosigmoid anastomosis was performed with an apparent satisfactory result.