Ambulante Therapie des Hämorrhoidalleidens in einer chirurgischen Praxis

Outpatient treatment of hemorrhoidal disease in a surgical practice

Zusammenfassung

In der vorliegenden Studie wird das Management von Patienten mit Hämorrhoiden Grad 3–4 in einer deutschen Tagesklinik beschrieben. Es werden 3 Operationsmethoden untersucht: Hämorrhoidektomie nach Milligan-Morgan/Ferguson mit Thermokoagulationsklemmen, dopplergesteuerte Hämorrhoidenarterienligatur (DGHAL) mit Mukopexie und die Hämorrhoidektomie nach Fansler-Arnold. Die Analyse der prospektiven Daten von 332 Patienten zeigte, dass diese Operationsmethoden im ambulanten Bereich sicher durchgeführt werden können. Da der postoperative Verlauf sich im ambulanten vom stationären Bereich unterscheidet, musste die multimodale Schmerztherapie entsprechend angepasst werden. Um einen postoperativen Harnverhalt zu vermeiden, erhielten die Patienten keine Spinalanästhesie oder Analtamponaden. Keiner der Patienten musste wegen postoperativer Blutung, Schmerz oder Harnverhalt stationär aufgenommen werden.

Abstract

The aim of this article is to describe the management of patients with 3rd–4th grade hemorrhoids in a German day surgery clinic. A total of 3 different operation methods are examined: the Milligan-Morgan/Ferguson hemorrhoidectomy with thermocoagulation clamps, Doppler-guided hemorrhoid artery ligation (DGHAL) with mucopexy and the classical Fansler-Arnold hemorrhoidectomy. The analysis of the prospective data on 332 patients showed that these operations can be safely performed in an outpatient setting. As the postoperative course of ambulatory patients is different compared to patients in hospital, the multimodal pain therapy protocols had to be adapted. To avoid urinary retention, patients did not receive a spinal anesthesia or anal tampons. None of the patients had to be admitted to hospital for postoperative bleeding, pain or urinary retention.

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Correspondence to K.-H. Moser.

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K.-H. Moser gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Moser, KH. Ambulante Therapie des Hämorrhoidalleidens in einer chirurgischen Praxis. coloproctology 40, 251–257 (2018). https://doi.org/10.1007/s00053-018-0266-4

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Schlüsselwörter

  • Hämorrhoiden
  • Chirurgische Verfahren
  • Ambulante Operation
  • Schmerztherapie
  • Thermokoagulationsklemmen

Keywords

  • Hemorrhoids
  • Surgerical procedures
  • Day surgery
  • Pain therapy
  • Thermocoagulation clamps