Observational Study to Find Effectiveness of Trans Anal Suture Anopexy through Chivate's Procedure in management of Haemorrhoids.
India (MSAI) - Sumandeep Vidhyapeet, Vadodara
General Surgery
Dr. Vipul Gurjar
Dr. Vipul Gurjar
4 weeks
Cities/Months Jan Feb Mar Apr May Jun Jul Augt Sep Oct Nov Dec
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Type of Research Project
- Clinical Project with Laboratory work
What is the background of the project?
Haemorrhoids, a condition in India commonly known as Piles, is mostly found in elderly and pregnant. Caused due to swollen Haemorrhoidal Veins in colorectal regions because of extreme abdominal pressure, the USFDA puts to fact that approximately 75% of global population would be affected by Haemorrhoids at any point in their lives; 58% of people aged over 40 years have the disease in the USA. Severe complications may include Thrombosis, Necrosis and Anal Bleeding of Pre-Sinusoidal Arterioles. While line of treatment includes many options, however surgical intervention for complete ligation is required in almost one-third cases. Where the current surgical correction options include Miller Morgan’s Haemorrhoidectomy, Ferguson’s technique with sub mucosal dissection and PILE suture techniques, we here are going to study cutting edge technology in treatment of Piles, the Nobel Chivate’s Procedure which aims at lowering post-operative complications mainly pain and the recurrence rate
What is the aim of the project?
The aim of this research project is to evaluate Chivate’s new procedure of trans anal suture Anopexy for haemorrhoids for pain, bleeding, hospital stay, recurrence and complication in the cases symptomatic of Haemorrhoids in more than 200 patients that arrive at Dhiraj General Hospital located in Waghodia Taluka of Vadodara district in Gujarat. Observation of incontinence, recurrent anal bleeding, frequency of stools and tensusmus in post operative patients would be performed. During the current surgical interventions available, the blood vessels remain occluded atleast on one side in Haemorrhoidal plexuses, which is main reason for anal bleeding. The main objective of this current surgical research being to minimize the recurrence rate of 18 – 60% in other procedures using Doppler's transducers with proctoscope.
What techniques and methods are used?
Cohort Study with approximately 200 subjects positively symptomatic to Haemorrhoids or Piles for the duration of 4 weeks in a rural setting health center in Piparia Taluka called Dhiraj General Hospital.  The technique used for the study is Transanal Suture Anopexy, commonly known as The Nobel Chivate’s Procedure after clinical examination and surgical evaluation of patients, with exclusions of Thrombosed Haemorrhoids. Sigmoidoscopy would be done, if required to check for malignancies.  In this technique, two circumferential double locked suture lines, using 2/o polygalactin would be completed at 3 centimeter proximal to Dentate Line, to prevent excess anal bleeding and pain in postoperative period, under the generalized or local anaesthetics (Mostly Spinal Block).  Post Operative Patients would be observed for pain, itching and discharge around the anal circumference. Rectal oedema, Any persistent Mucosal Tears, ischemia or stenosis between both sutures, sever sepsis, perforation of the rectum, retroperitoneal abscess, severe bleeding would be observed as a part of post-operative examination.  Anterior Rectal Resection or colostomy maybe required in cases of extension post-operative complications.
What is the role of the student?
- The student will mainly observe
- The student will observe the practical experiments but will be highly involved in the analysis of the results
- The tasks of the student will be performed on his/her own
- The tasks will be done under supervision
What are the tasks expected to be accomplished by the student?
 Observership of Clinical and Surgical Scenario in the treatment of Haemorrhoids with cutting edge technology and Trans Anal Suture Anopexy along with Post Operative Care of Patients in a local setting Dhiraj General Hospital.  Appreciation of various Diagnostic Tools used for recording the gradual development of Haemorrhoids.  Recording Clinical History of Subjects before surgical intervention.  Hands on Training to understand the Chivate’s Procrddure for surgical correction of Haemorrhoids  Checking the subjects and the surgical complications in Post-Operative Care Unit  Collection of Evidence from Meta-analysis Longitudinal Prospective Study  Analysis of Evidence Level One
Will there be any theoretical teaching provided (preliminary readings, lectures, courses, seminars etc)
Students would be provided with Observational, Clinical and Surgical Lectures by Department of Surgery. Discussion and Demonstration for the same would be held.
What is expected from the student at the end of the research exchange? What will be the general outcome of the student?
- The student will prepare a scientific report
What skills are required of the student? Is there any special knowledge or a certain level of studies needed?
 Knowledge about Colorectal Anatomy  Generalised Idea about Surgical Techniques used in Patients with Haemorrhoids/Piles
Are there any legal limitations in the student’s involvement
Type of students accepted
This project accepts:
- Medical students
- Graduated students (less than 6 months)