Minimally invasive procedure for hemorrhoids: Surgical results

Objectives: The purpose of the present study was to determine the surgical results of stapled hemorrhoidectomy and overall satisfaction of the patient and to evaluate its suitability as a routine day care surgery procedure in this part of the world. Materials & Methods: A total of 30 patients were operated from June 2006 to Dec 2008. The median age of the patients was 49.1 years. The main symptom was digital recognition of perianal mass (96%). The procedure was performed under regional (epidural or spinal) or general anesthesia. The average operative time was 31.08 minutes. The procedure was performed with PPH03, a 33 mm diameter hemorrhoidal circular stapler. The patients were prospectively evaluated for postoperative pain and bleeding, satisfaction scores, anorectal function, return to work and cost effectiveness of the procedure. Results: The duration of the PPH procedure ranged from 30-45 minutes (average 31.08 minutes). The suture line was on average 3.5cm (3 - 4.5) above the dentate line. Excision of external skin tags while undergoing PPH was performed in 16.6% cases (n=5). No stapler failure was detected. Seven patients (23.3%) had bleeding after the stapler off and 3 patients (10%) had bleeding in the first post operative day. Patients average pain score was 1.57 (VAS 1-5) at 24 hrs in the 1st postoperative period. Of note, three patients had no pain at all immediately after surgery. No patients had recurrence of hemorrhoidal prolapse, bleeding or anastomotic stricture upon rectal exam or fecal incontinence Ninety percent of patients (n=27) were discharged in a day while as 10% were discharged after 2 days because of their co morbid conditions Return to work was early between 5-7 days postoperatively with high patient satisfaction score. Conclusions: Stapled hemorrhoidectomy (SH) is a safe, effective and well tolerated procedure in the treatment of grade 3 and grade 4 hemorrhoids with less postoperative pain and high patient satisfaction, which seems to have all the requirements for Day Care Surgery

Gastric carcinoma in young patients.

Study Design: Retrospective and prospective hospital based study. Objectives: To study the clinico-pathological features of gastric carcinoma in young patients (<40 years) and compare them with older patients and to know the association of gastric cancer in young patients with P53 gene and compare them with older patients. Method: The present study included 502 patients. Four hundred & fifty-two patients were >40 years of age and 50 patients <40 years of age. Retrospective group included 209 patients and prospective group included 293 patients. Study period was 2004 to 2008. Results: Male to female ratio in young patients was 1:1.08 v/s 2.5:1 in older patients. Family history of stomach cancer was present in 10% and 3% in younger and older patients respectively. Main presenting symptoms was epigastric pain. Mean age of presentation was 35+5.8 in young and 53+4.8 years in older patients. Lower 1/3rd of stomach was main site of lesion in both groups. Young patients had significantly more poorly differentiated histology and older had moderately differentiated histology. Diffuse type of lesions was more common in younger patients. Resectability rate was more in older patients. Most common procedure performed was lower partial gastrectomy with gastrojejunostomy. Invasion of adjacent organs was more common in young patients. Both groups presented with advanced stage disease. Local recurrence was more frequent in young patients. P53 mutations were present in significant percent in older patients as compared to young. P53 mutations were more in smokers as compared to non-smokers. Intestinal type of histology had more expression of P53 than diffuse type. Conclusions: Diffuse or poorly differentiated carcinoma shows poor prognostic results. A gastric lesion in young patients presenting with non-specific symptoms should not be considered benign