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Tesi etd-06032017-104053


Thesis type
Tesi di specializzazione (5 anni)
Author
CAMINATI, FILIPPO
URN
etd-06032017-104053
Title
New anatomical/clinical-therapeutic classification of haemorrhoids. A prospective study.
Struttura
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
CHIRURGIA DELL'APPARATO DIGERENTE
Commissione
relatore Prof. Fucini, Claudio
correlatore Dott. Naldini, Gabriele
Parole chiave
  • surgery
  • stalper
  • hemorroidectomy
  • haemorrhoids
  • therapeutic
  • haemorrhoidal treatment
  • classification
Data inizio appello
06/07/2017;
Consultabilità
completa
Riassunto analitico
All publications about haemorrhoids treatment try to demonstrate the superiority of one technique over another, in heterogeneous patients groups selected according to Goligher classification. Goligher classification contains limitations and doesn’t appear useful for treatment choice. All other classifications appear to be not useful to improve surgical results. A proper classification, which correlates anatomical/clinical features with treatment indication, is necessary. We propose a new anatomical/clinical-therapeutic classification (A/CTC) of haemorrhoids. A/CTC considers types and frequency of symptoms, anatomical presentation, associated diseases, possible contraindications and the indicated treatments. Possible presentations are classified in four groups (A,B,C,D). To validate A/CTC and verify whether it can improve results, we evaluated the surgical groups. In 2014-2015, 381 patients underwent surgery, group B(39), C(202), D(140). Group B patients underwent doppler-guided dearterialization with mucopexies and Tissue Selective Therapy stapler, group C stapler procedures (TSTStarr+, TST33, DSH) and group D hemorrhoidectomy. The patients were followed on average for 24 months. The success rates were: B (85%), C (91,1%), D (95,7%).The overall success rate was 92,1%, recurrences 7,9%, post-operative complications 4,4%, long-term complications 4,7%, reoperations 2,8%. A/CTC showed to be an effective instrument to choose the proper treatment for each individual case. This classification appear to be feasible and useful to improve surgical results.
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