Dr Chivates procedure & modification

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Dr. Shanthikumar Chivate is an Indian surgeon known for developing and popularizing a modified procedure for hemorrhoids (piles) called Chivate’s Transanal Suture Rectopexy (TSR), also known as Chivate’s Procedure or Mucorectopexy. 
 
Transanal Suture Rectopexy for Haemorrhoids: Chivate's ...
 
 
 
Chivate’s procedure
  • Goal: A less invasive and potentially less painful alternative to conventional hemorrhoidectomy for Grade II to IV haemorrhoids.
  • Principle: Restoring lowered anal cushions to their original positions and ligating the blood flow to the anal canal, without extensive tissue removal, aiming to reduce nerve damage and tissue trauma.
  • Method: Involves placing two circumferential rows of sutures (typically absorbable sutures like Vicryl 2-0) in the anorectal junction above the dentate line.
    • Proximal suture: Disrupts the blood supply to the anal canal.
    • Distal suture: Repositions the anal cushion in its original place.
    • The sutures are placed at the mucosal and submucosal levels, in an interlocking and overlapping fashion to ensure stability and prevent slippage.
    • Care is taken to avoid over-tightening to prevent ischemia. 
 
Modifications and refinements
  • Proctoscope Design: Dr. Chivate also designed a self-illuminated slit with a sliding valve proctoscope to facilitate the procedure.
  • Suturing Technique: The suturing technique involves an interlocking suture pattern with two locking passes at each anchor point, and an overlapping suture fashion to enhance structural stability and minimize postoperative complications.
  • Learning Curve: Chivate’s procedure is described as a relatively simple stitching technique with a short learning curve. 
 
Reported outcomes
  • Reduced Postoperative Pain: Studies suggest significantly lower pain scores compared to conventional haemorrhoidectomy, especially in the early postoperative period.
  • Shorter Hospital Stay: Patients undergoing Chivate’s procedure experienced a shorter hospital stay.
  • Lower Complication Rates: Studies have shown lower rates of complications compared to conventional approaches, though the difference may not always be statistically significant.
  • Effective for Grade III and IV Haemorrhoids: The procedure has been reported to be effective in managing these advanced grades, even reducing pain in Grade IV cases.
  • Lower Recurrence Rate: Some studies suggest a lower recurrence rate compared to other procedures like Longo’s stapled hemorrhoidopexy.
  • Potential for Use in Resource-Limited Settings: The procedure’s comparative affordability makes it a suitable option in such settings. 
Note: Long-term follow-up studies are ongoing to assess the durability and recurrence rates associated with Chivate’s procedure. 
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