Long-term Outcome of Stapled Transanal Rectal Resection (STARR) versus Stapled Hemorrhoidopexys (STH) for Grade III-IV Hemorrhoids: Preliminary Results.

Circular stapled transanal hemorrhoidopexy (STH) was first introduced by A. Longo for the correction of internal mucosal prolapse and obstructed defecation and in 1998, was proposed as alternative to conventional excisional hemorrhoidectomy. More recently, stapled transanal rectal resection (STARR) has gradually gained popularity, as the Longo procedure, in the treatment of hemorrhoids. The aim of our study was to evaluate the usefulness of STARR as alternative to STH in patients with grade III (n=218, 68.1%) and IV (n=102, 31.9%) hemorrhoids. A group of 320 consecutive patients (median age=51 years; range=16-85) underwent STH (n=281) or STARR (n=39) procedure. The rate of postoperative bleeding (53.8% vs. 74.4%, p<0.01) was significantly reduced in patients who underwent STARR procedure, which required a longer (45\ub122 vs. 26\ub111 min, p<0.01) operative time. There were no differences between groups with regard to use of painkillers, postoperative pain intensity, short-(three months) and long-term (one and three years) residual pain, soiling, incontinence and urgency. Patients treated with the STARR procedure had lower recurrence rate of hemorrhoids and a lower incidence of prolapse, both at one year (none vs. 1.4%, p=0.593 and 2.6% vs. 5.3%, p=0.396, respectively) and at two years (none vs. 6.8%, p=0.078 and none vs. 13.2%, p=0.012, respectively). The one-year (9.0\ub11.8 vs. 9.4\ub10.7, p=0.171) and two-year (9.6\ub10.8 vs. 9.1\ub11.7, p=0.072) general satisfaction was similar but higher in STARR patients than in the STH group. In conclusion, according to our preliminary results, the STARR procedure leads to a lower incidence of complications and recurrences and should be considered for patients with grade III or IV hemorrhoids previously selected for stapled hemorrhoidectomy, as a promising alternative to STH

Elective abdominal aortic aneurysm repair in the very elderly: a systematic review.

ABSTRACT Background Abdominal aortic aneurysm (AAA) is an age related disease, so the people aging has led to an increased number of elderly undergoing AAA repair. To analyze the perioperative mortality and complications rates and long-term survival of elderly people after AAA repair, we conducted a systematic review of the literature. Methods The literature was searched using the Medline, Embase and Cochrane library databases up to May 2008. All studies reporting on perioperative and long-term outcomes of patients 80 years old or more undergoing elective open (OAR) or endovascular AAA repair (EVAR) were considered. The risk of perioperative mortality and morbidity were calculated using the odds ratio (OR), with 95% confidence intervals (CIs), and the \u3c72 test. Results Thirty-five studies on OAR, five on EVAR and four on both OAR and EVAR were included. In the OAR group, the mortality rate (38 studies/1793 patients) was 5.6% (95% CI, 4.5 to 6.7) and the morbidity rate (18 studies/725 patients) 26.9% (95% CI, 23.7 to 30.1). Twenty studies reported a median 5-year survival rate of 60% (range, 14% to 86%). In the EVAR group, the mortality rate (9 studies/1159 patients) was 4.5% (95% CI, 3.3 to 5.7) and the morbidity rate (8 studies/1078 patients) 16.9% (95% CI, 23.7 to 30.1). Follow-up data lasted < 5 years in 5 studies. Although the perioperative death rate was higher after OAR than after EVAR, the difference was not statistically significant (p = .170; 95% CI, 0.90 to 1.78). The rate of major systemic morbidity was significantly higher after OAR (p < .01; 95% CI, 1.43 to 2.26). Conclusions Although the perioperative mortality rate was comparable between the two surgical procedures, the high levels of selection bias cannot be ignored and could actually indicate higher mortality rates for both procedures. Although mid- and long-term survival rates after OAR and EVAR were acceptable, more information on long-term outcome after EVAR with a greater sample size is needed to evaluate the durability of the less invasive procedure