Stapled haemorrhoidopexy vs. Milligan-Morgan haemorrhoidectomy for grade III haemorrhoids: a randomized clinical trial

The aim of this double blind randomized clinical trial was to compare the short-term and long-term outcomes of stapled haemorrhoidopexy (SH group) performed using a circular stapler with that of the Milligan-Morgan haemorrhoidectomy (MMH group). A total of 79 consecutive patients with grade III haemorrhoids were randomized into two groups treated with SH (n. 39) and MMH (n. 40). The outcomes of the procedures were evaluated postoperatively and over a follow-up period of minimum 2 years. Patients undergoing the SH procedure showed greater short term advantages than MMH group with reduced pain, shorter length of hospital stay, earlier return to work and high patient satisfaction. Long-term follow-up has indicated more favourable results in MMH group in terms of resumption of symptoms with absence of residual prolapse and risk of recurrence of prolapse. At two years follow-up recurrent prolapse was confirmed in six patients of SH group (13%) whereas in none of the MMH group. At six months follow-up there weren’t significant difference in the mean satisfaction score for the two groups. At two years the mean satisfaction score was higher in the MMH group vs SH group. Seven patients in the SH group needed a reoperation whereas none in MMH group. From January 2009, in our Surgery Unit the patients are always informed about a higher recurrence rate of SH and we perform this technique only when the patient choices to accept this risk to take advantage of the short-term benefits of this procedure.

Surgical strategy for the treatment of sporadic medullary thyroid carcinoma: our experience

Background. Medullary thyroid carcinoma (MTC) is a rare disease which accounts for approximately 5-9% of all thyroid cancers and originates from the calcitonin-secerning parafollicular C cells. MTC can be divided into two subgroups: sporadic (75%) or inherited (25%). The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies. Objectives. The purpose of the study is to review our single institution's experience with MTC since 1998 and to evaluate surgical strategy, patterns of lymph node metastases and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent sporadic medullary thyroid carcinoma. Methods. A retrospective review of 26 patients treated for MTC at the “Antonio Cardarelli” Hospital referral center, in Naples, between 1998 and 2012. There were 18 female and 8 male patients, median age at presentation was 55 years, and median follow-up for survivors was 5 years. Total thyroidectomy was performed in all 26 patients; central compartment (CC) node dissection (level VI) in 12 (46%) patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 7 (27%) patients. 4 patients (15%) underwent reoperation for loco-regional recurrent/persistent MTC. Results. After a median post-surgical follow-up of 5 years (range 1-10 years), 63 % of patients were living disease-free, 15% were living with disease and/or persistently elevated calcitonin levels after surgery, 11% were deceased due to MTC and 11 % were lost to follow-up. Conclusions. We agree with most authors advocating for a total thyroidectomy and prophylactic central neck dissection in the setting of clinically detected MTC. Lateral neck dissection may be best reserved for patients with positive preoperative imaging. Nevertheless MTC has a high rate of lymph node metastases that are sub optimally detected preoperatively in the central compartment by neck ultrasound or intra-operatively by the surgeon, and reoperation is associated with a higher rate of surgical complications. In our limited experience, patients with thyroid confined nodular pathology, without nodal disease and unknown preoperative diagnosis of MTC, underwent only total thyroidectomy with a good prognosis.

Complicaciones perioperatorias en el manejo de corrección de escoliosis en un hospital de tercer nivel en la ciudad de Bogotá entre el 2010-2014

Introducción: la escoliosis, definida como una deformidad de la columna vertebral en más de 10 grados, se agrupa en 4 orígenes distintos: idiopática, congénita, neuromuscular y sindromática. Cada una de ellas con diferente riesgo de progresión en severidad, lo que determina la necesidad de corrección quirúrgica para cada caso en su tratamiento. Conocer las probabilidades de complicación en la etapa peri operatoria, abre la posibilidad de dar asesoría integral que mida la relación riesgo - beneficio de la medida terapéutica. Métodos: se realiza un estudio retrospectivo de corte transversal. La información se obtiene de los registros de las historias clínicas desde el año 2010 al 2014, de pacientes intervenidos quirúrgicamente para la corrección de escoliosis. Resultados: Se obtuvieron 318 registros de procedimientos en 230 pacientes. El tipo de escoliosis presentado con mayor frecuencia es de origen idiopático 108 (47%); en los 4 tipos de escoliosis se observa mayor número de mujeres 169 (73,4%). La edad donde se concentran la mayor cantidad de cirugías para corrección de escoliosis está entre 10 - 14 años. De 13 complicaciones seleccionadas, aquellas de origen respiratorio son las de mayor probabilidad de ocurrencia (OR 30 - sig 0,000). La característica sociodemográfica “edad” logra predecir el 46% de las complicaciones perioperatorias. Discusión: La corrección de escoliosis va acompañada de comorbilidades, datos sociodemográficos y diagnósticos que en conjunto determinan el grado de complicación peri operatoria. Se necesitan registros clínicos muy completos para poder determinar la asociación entre la etiología de la escoliosis con las complicaciones más comunes. Este trabajo propone y evidencia los datos de los registros clínicos como predictores de complicaciones quirúrgicas de escoliosis. Esto exige un trabajo institucional interno que garantice la calidad en los registros de datos clínicos.