EP771 - Case series presentation of Transfix Ligation in the management of Internal hemorrhoids

Purpose/Background: Background: Internal hemorrhoids is one of the most common anorectal conditions often requiring surgical intervention. While various surgical techniques are used for its management there are varied outcomes with respect to recurrence and post-surgical complications. Transfix ligation, a surgical technique used to achieve complete necrosis of the hemorrhoidal mass of all 2nd ,3rd and 4th degree mass.

Objective: The objective of this study is to present results of case series of internal hemorrhoids in patients managed with transfix ligation over the last 7 years.

Methods/Interventions:: A total of 970 surgical cases managed with the use of transfix ligation over the last 7 years (2017 to 2024) were assessed primarily for morbidity, complications, relapse or recurrence. Transfix ligation (30 no linen thread) involves surgical technique securing blood vessels or pedicles, especially large ones, by passing a needle and suture through the tissue and tying it off to ensure complete necrosis of the hemorrhoidal mass. It involves piercing the tissue with a needle and suture, tying one end, then passing the suture below the pedicle to tie a second knot, which provides secure compression for complete necrosis of the hemorrhoid mass . The procedure was performed under appropriate anesthesia. All participants who underwent the procedure were followed regularly initially for every 6 months for 2 years and thereafter annually further 5 years.

Results/Outcomes: A total of 680 males (70.10%) and 290 females (29.89%) between the age of 17 to 84 years, mean age 42.53 ± 13.74 years suffering from 2nd, 3rd and 4th degree hemorrhoids for an average duration of 3.56 ±1.02 years were considered for assessment. There were 340 (35.05%) cases of 2nd degree hemorrhoids, 532 (54.84%) of 3rd degree and 98 (10.10%) of 4th degree hemorrhoids. A total of 96 (9.89%) cases had single hemorrhoid mass, 388 (40%) had two hemorrhoid mass and 486 (50.10%) and 3 masses. Complete cessation of bleeding was observed within 7.21 ±3.22 days. No post-surgical complications including bleeding, incontinence and stenosis were observed in any of the treated cases. None of the patients had reactionary or secondary hemorrhage requiring any active treatment. A small number of patients, 38 (3.91%) patients required parenteral painkillers while rest (96.08%) required oral NSAIDs post-surgery. A total of 30 (3.09%) patients showed development of skin tag.5 Patients reported recurrence of the disease.

Conclusion/Discussion: The study concludes that transfix ligation shows high degree of success and low recurrence and morbidity in the management of internal hemorrhoids.

Key-Words: Transfixation ligation, hemorrhoids

METHODOLOGY OF SURGERY
FINAL OUTCOME OF THE SURGERY
METHODOLOGY OF SURGERY
IMMEDIATE POST-OP VISIBLE NECROSIS