Novel Operative Anoscope for Ferguson Hemorrhoidectomy: A Feasibility Study and Comparative Cohort Analysis. (April 2015)

• Record Type: Journal Article
• Authors: Champagne, Bradley J.; Stein, Sharon L.; Haridas, Manjunath; Ermlich, Bridgett; Hoffman, Lisa; Lee, Jennifer; Johnson, Eric K.; Steele, Scott R.
• Is Part Of: Surgical innovation. Volume 22:Number 2(2015:Apr.)
• Page Start: 149
• Page End: 154
• Publication Date: 2015-04
• Subjects: anoscope -- hemorrhoids -- Ferguson -- hemorrhoidectomy; Surgery, Operative -- Periodicals; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgical Procedures, Minimally Invasive -- Periodicals; Diffusion of Innovation -- Periodicals; Chirurgie opératoire -- Périodiques; Chirurgie endoscopique -- Périodiques; Chirurgie laparoscopique -- Périodiques; 617.91
• DOI: 10.1177/1553350614535859
• Languages: English
• ISSNs: 1553-3506

Abstract

Background . Operative hemorrhoidectomy can result in pain and altered continence from excessive excision of anoderm or surrounding tissue. We assessed a novel low-profile slotted anoscope to determine if the device would promote safe dissection, lessen trauma, and reduce operative times for hemorrhoidectomy. Methods . Patients requiring hemorrhoidectomy (June 2008 - January 2010) underwent a prospective phase-2 trial evaluating a new operating anoscope (CAD, Ethicon Endosurgery, Cincinnati, OH). Demographics and perioperative end points including bleeding, pain, fecal incontinence, stenosis, and symptom recurrence were analyzed at 4 weeks, 3 months, 6 months, and 1 year postoperatively. We compared these to patients undergoing hemorrhoidectomy (February 2010 - November 2012) with a traditional Hill-Ferguson anoscope (THF). Results . 40 patients (CAD, 20 vs THF, 20) were included. Presenting symptoms were similar, whereas mean duration of symptoms was longer for CAD (41.2 ± 8.4 vs 27 ± 9.5 months; P < .05). Estimated blood loss was lower for CAD [8.3 mL (range = 2-40 mL) vs 11.3 mL THF (range = 5-35 mL; P = .87)]. Mean operative times were lower for the CAD than the THF group (15.6 ± 3.4 vs 26.1 ± 4.1 minutes; P < .05). Visual analog pain scores were non-significantly increased in the THF group at 4 weeks ( P = .23). At 3 months, 6 months, and 1 year, there was no difference in continence. Conclusion . The CAD anoscope reduced operative times for modified Ferguson (closed) hemorrhoidectomy when compared with traditional retractors. There was no difference in incontinence or pain between groups.