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Hawkins AT, Davis BR, Bhama AR, Fang SH, Dawes AJ, Feingold DL, Lightner AL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum 2024; 67:614-623. [PMID: 38294832 DOI: 10.1097/dcr.0000000000003276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Alexander T Hawkins
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University, Nashville, Tennessee
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Anuradha R Bhama
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, Cleveland, Ohio
| | - Sandy H Fang
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Sciences University, Portland, Oregon
| | - Aaron J Dawes
- Department of Surgery, Section of Colon and Rectal Surgery, Stanford University School of Medicine, Stanford, California
| | - Daniel L Feingold
- Division of Colon and Rectal Surgery, Department of Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L Lightner
- Scripps Clinic Medical Group, Department of Surgery, La Jolla, California
| | - Ian M Paquette
- Department of Surgery Section of Colon and Rectal Surgery, University of Cincinnati, Cincinnati, Ohio
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Nada MAM, Awad PBA, Kirollos AMA, Abdelaziz MM, Mohamed KMS, Awad KBA, Hassan BHA. Comparison between stapled hemorrhoidopexy and harmonic scalpel hemorrhoidectomy in the management of third- and fourth-degree piles: a randomized clinical trial. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-02010-9. [PMID: 38157069 DOI: 10.1007/s00104-023-02010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND This study compared the results of stapled hemorrhoidopexy (SH) and harmonic scalpel hemorrhoidectomy (HSH) in the management of grade III and grade IV piles regarding the time of the procedure, postoperative pain, patient satisfaction, wound infection, bleeding, incontinence, and recurrence within 1 year. PATIENTS AND METHODS This was a single-blind, prospective, randomized, controlled, single-center trial conducted from January to December 2022 that included 50 (68.75%) male and 20 (31.25%) female patients with third- and fourth-degree piles. RESULTS The patients were divided into two groups of 35 patients each. Group I underwent SH and group II underwent HSH. The mean age of group I was 42.94 years and of group II, 42.20 years. The mean time of the procedure was 24.42 min ± 2.367 for SH and 31.48 min ± 2.21 for HSH. Postoperative pain in group I was lower than in group II during the first 2 weeks, but there was persistent mild pain in most patients in group I at the 2‑week follow-up. In group II there was significant improvement in pain after 2 weeks, with higher patient satisfaction. Wound infection was detected in 3 (5%) patients in group I and no patients in group II (p = 0.077). Postoperative bleeding occurred in 4 (11.4%) patients in group I in the form of spotting after defecation only during the first postoperative month; no bleeding was detected in group II (p = 0.039). There were 3 (15%) cases of flatus incontinence but after taking a detailed history these were found to be cases of urgency to defecate rather than incontinence. There were 7 (20%) cases of recurrence at the 1‑year follow-up in group I and 1 (2.9%) case in group II (p = 0.024). CONCLUSION Compared with SH, HSH was safer, easier, and associated with a lower incidence of recurrence after 1 year and with higher patient satisfaction.
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Perirectal hematoma after stapled surgery for hemorrhoidal prolapse and obstructed defecation syndrome: case series management to avoid panic-guided treatment. Updates Surg 2023; 75:627-634. [PMID: 36899291 PMCID: PMC10042767 DOI: 10.1007/s13304-023-01490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
Perirectal hematoma (PH) is one of the most feared complications of stapling procedures. Literature reviews have reported only a few works on PH, most of them describing isolated treatment approaches and severe outcomes. The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs. A retrospective analysis of a prospective database of three high-volume proctology units was performed between 2008 and 2018, and all PH cases were analyzed. In all, 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse. Among these, 14 (0.46%) large PH cases were reported, and 12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring); most of them were resolved with spontaneous drainage. Two patients with progressive PH (signs of active bleeding and peritonism) were submitted to CT and arteriography to evaluate the source of bleeding, which was subsequently closed by embolization. This approach helped ensure that no patients with PH were referred for major abdominal surgery. Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage. Progressive hematomas are rare and should undergo angiography with embolization to minimize the possibility of major surgery and severe complications.
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Moldovan C, Rusu E, Cochior D, Toba ME, Mocanu H, Adam R, Rimbu M, Ghenea A, Savulescu F, Godoroja D, Botea F. Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review. World J Clin Cases 2023; 11:366-384. [PMID: 36686344 PMCID: PMC9850966 DOI: 10.12998/wjcc.v11.i2.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hemorrhoidal disease (HD) is considered a low-severity pathology by both general population and physicians, but the lengthy conservative therapy and postoperative complications suggest otherwise.
AIM To assess the effectiveness of different treatment options, both conservative and surgical, in contrast with some preexisting comorbidities.
METHODS We conducted a retrospective, 10-yearlong study between January 2011 and December 2021 in two surgical centers, a private and a state-owned hospital. We compared the efficacy and safety of several treatment options, such as open hemorrhoidectomy, stapled hemorrhoidopexy, rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease (IBD), use of anticoagulant medication (AM) and liver cirrhosis. We also conducted a 20-years long PubMed research (1.263 articles) for relevant comparisons.
RESULTS Our study recorded 10940 patients with HD, 10241 with conservative and 699 with surgical treatment. Out of these, the male-to-female ratio of 1.3, and a peak in age distribution between 59 and 68 years old (32% of patients). For the entire study, we recorded a 90% incidence of immediate pain, immediate bleeding in 1.5% (11 cases), delayed bleeding in 1.0% (7 cases), and 0.6% surgical site infections. Urinary retention was also present, with 0.2% of patients, anal stricture in 1% and fecal incontinence for 0.5% of patients (4 cases). We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations. IBD accounted for 6% of the patients, with ulcerative colitis in 12% and Chron`s disease in 10.5%. 6.6% of the patients had AM, determining 4% immediate and 2% delayed bleeding, in surgically treated patients.
CONCLUSION Our study determined that most common complications (pain, urinary retention, bleeding, and stricture) are correlated with each surgical technique and pre-existing comorbidities.
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Affiliation(s)
- Cosmin Moldovan
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Elena Rusu
- Department of Preclinic Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
| | - Daniel Cochior
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Sanador Clinical Hospital, Bucharest 010991, Romania
- Department of General Surgery, Monza Clinical Hospital, Bucharest 021967, Romania
| | - Madalina Elena Toba
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of General Surgery, Witting Clinical Hospital, Bucharest 010243, Romania
| | - Horia Mocanu
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of Ear, Nose and Throat, Ilfov County Clinical Emergency Hospital, Bucharest 022104, Romania
| | - Razvan Adam
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- Department of Orthopedics and Traumatology, Elias Emergency University Hospital, Bucharest 011461, Romania
| | - Mirela Rimbu
- Medical Doctoral School, Titu Maiorescu University of Bucharest, Bucharest 040317, Romania
| | - Adrian Ghenea
- Department of Coloproctology, MedLife SA Băneasa Hyperclinic, Bucharest 013693, Romania
| | - Florin Savulescu
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- 2nd Department of Surgery, Carol Davila Central Military Emergency University Hospital, Bucharest 010242, Romania
| | - Daniela Godoroja
- Department of Anesthesia, Ponderas Academic Hospital, Bucharest 014142, Romania
| | - Florin Botea
- Department of Medical Surgical Disciplines, Faculty of Medicine, Titu Maiorescu University of Bucharest, Bucharest 031593, Romania
- 2nd Department of Surgery, Fundeni Clinical Institute, Bucharest 022328, Romania
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The necessity of preoperative enema preparation for hemorrhoidal surgery: a single-center comparative study. Langenbecks Arch Surg 2022; 407:3005-3012. [PMID: 35729398 DOI: 10.1007/s00423-022-02587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hemorrhoidal surgery is a common treatment for high-grade hemorrhoids. The necessity of preoperative enema preparation (PEP) in hemorrhoidal surgery is inconclusive. This study aims to evaluate the benefit and safety of PEP in hemorrhoidal surgery. METHODS This comparative study analyzed data from electronic medical record database and outpatient questionnaire archive. Data of patients who underwent hemorrhoidal surgery from March 2020 to February 2021 were obtained. Patients were allocated to either the PEP or non-PEP group. Primary outcome measurements were postoperative pain and oral analgesic use. Secondary outcomes were the number of days until first defecation, length of hospital stay, time to return to work, incidence of urinary retention, delayed bleeding, and local infection. RESULTS Data of 270 consecutive patients, with 130 and 140 in the PEP and non-PEP groups, respectively, who underwent hemorrhoidal surgery were analyzed. Most patients underwent stapled hemorrhoidopexy, with 106 (81.54%) in PEP group and 113 (80.71%) in non-PEP group. The mean pain score was significantly higher in PEP than in non-PEP group at day 0 (6.21 ± 3.23 vs 5.31 ± 3.14), day 1 (5.79 ± 2.89 vs 4.68 ± 3.02), and day 2 (5.35 ± 2.86 vs 4.42 ± 2.76). No significant differences in postoperative recovery or complications rate were noted between groups. CONCLUSION Our findings revealed that performing PEP before hemorrhoidal surgery produced no benefit when compared with not performing PEP. Typically, the procedure of PEP is inconvenient and discomforting for patients. Therefore, we suggest that it can be omitted in hemorrhoidal surgery.
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Severe Postoperative Bleeding After Stapled Hemorrhoidopexy: Incidence and Causes. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Kurihara A, Yoshino Y, Sakai Y, Miura Y, Kagami S, Kaneko T, Ushigome M, Shiokawa H, Kaneko H, Funahashi K. Linear Pinched Hemorrhoidectomy: A Retrospective Observational Study (An Innovative, Simplified Hemorrhoidectomy). J Anus Rectum Colon 2021; 5:261-267. [PMID: 34395938 PMCID: PMC8321580 DOI: 10.23922/jarc.2020-076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/19/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES There was an urgent need to create a simple, reliable hemorrhoidectomy procedure for high-risk cases in our university hospital. We performed linear pinched hemorrhoidectomy (LPH) and evaluated its effectiveness compared to conventional hemorrhoidectomy (CH). METHODS We included 215 Goligher grade 3 and 4 hemorrhoid cases in this study. Of these cases, 167 were in the CH group, and 48 patients were in the LPH group. We retrospectively compared the lengths of hospital stay, operative times, blood loss, and complications. RESULTS The age tended to be higher in the LPH group (mean: CH 60 years, LPH 68 years). In the univariate analysis, LPH had more resections, shorter operative times, and less blood loss. LPH had shorter operative times in the multivariate analysis, less blood loss, and more anticoagulant use. There were no significant differences between the two groups in terms of complications. Five and two patients in the CH and LPH groups, respectively, had postoperative hemorrhage requiring hemostasis. Only the CH group had three and four cases of anal stenosis and wound edema, respectively. CONCLUSIONS We studied simplified hemorrhoidectomy using an ultrasonic scalpel and cylindrical proctoscope in a university hospital. We found that it a useful procedure with few complications and was easy for residents to learn. We believe that advances in surgical devices will make it possible to perform safer and simpler hemorrhoidectomy in the future.
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Affiliation(s)
- Akiharu Kurihara
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yu Yoshino
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yu Sakai
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yasuyuki Miura
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Satoru Kagami
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Tomoaki Kaneko
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Mitsunori Ushigome
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hiroyuki Shiokawa
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hironori Kaneko
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Kimihiko Funahashi
- Department of Surgery, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
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Simon N, Saiyara N, Kim HK, Gercek Y. Intra-abdominal rectal perforation post-haemorrhoidal artery ligation operation and converted Ligasure open haemorrhoidectomy. J Surg Case Rep 2021; 2021:rjab289. [PMID: 34257903 PMCID: PMC8272392 DOI: 10.1093/jscr/rjab289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report an unfortunate case of rectal perforation and subsequent peritonitis in a 74-year-old lady who underwent haemorrhoidal artery ligation in order to treat complex large external and internal haemorrhoids. Serious complications following haemorrhoid surgery are rare and this is the first documented case of delayed intra-abdominal rectal perforation following a haemorrhoid artery ligation operation and converted Ligasure open haemorrhoidectomy.
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Affiliation(s)
- Natalie Simon
- Bedford Hospital, Bedford Hospital NHS Foundation Trust, Bedford, UK
| | - Noshin Saiyara
- Bedford Hospital, Bedford Hospital NHS Foundation Trust, Bedford, UK
| | - Hyun-Kyung Kim
- Bedford Hospital, Bedford Hospital NHS Foundation Trust, Bedford, UK
| | - Yuksel Gercek
- Bedford Hospital, Bedford Hospital NHS Foundation Trust, Bedford, UK
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Abstract
Introduction Hemorrhoidal disease is a common problem that arises when hemorrhoidal structures become engorged and/or prolapse through the anal canal. Both conservative and invasive treatment options are diverse and guidance to their implementation is lacking. Methods A Delphi consensus process was used to review current literature and draft relevant statements. These were reconciliated until sufficient agreement was reached. The grade of evidence was determined. These guidelines were based on the published literature up to June 2020. Results Hemorrhoids are normal structures within the anorectal region. When they become engorged or slide down the anal canal, symptoms can arise. Every treatment for symptomatic hemorrhoids should be tailored to patient profile and expectations. For low-grade hemorrhoids, conservative treatment should consist of fiber supplements and can include a short course of venotropics. Instrumental treatment can be added case by case : infrared coagulation or rubber band ligation when prolapse is more prominent. For prolapsing hemorrhoids, surgery can be indicated for refractory cases. Conventional hemorrhoidectomy is the most efficacious intervention for all grades of hemorrhoids and is the only choice for non-reducible prolapsing hemorrhoids. Conclusions The current guidelines for the management of hemorrhoidal disease include recommendations for the clinical evaluation of hemorrhoidal disorders, and their conservative, instrumental and surgical management.
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Hidalgo-Grau LA, Piedrafita-Serra E, Ruiz-Edo N, Llorca-Cardeñosa S, Heredia-Budó A, Estrada-Ferrer O, Suñol-Sala X. Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatment. World J Surg 2020; 44:3936-3942. [PMID: 32647985 DOI: 10.1007/s00268-020-05676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To know the influence of the stapled line height (SLH) in the recurrence rate and the postoperative disturbances in stapled anopexy (SA) for the treatment of hemorrhoids. DESIGN Simple randomized double-blind controlled clinical trial. Randomization with closed-envelope technique in two groups with two different SLH. SETTING Colorectal Surgery Unit. Department of General Surgery. Hospital de Mataró (Barcelona, Spain). PARTICIPANTS 119 patients with the diagnosis of symptomatic third- and fourth-grade hemorrhoids were included. INTERVENTION SA was performed with two different SLH: group A, 4.5 cm (58 patients) and group B, 6 cm (61 patients) from the external anal verge. Postoperative disturbances were evaluated by a colorectal surgeon who was blind for the randomization and pain was measured (visual analogic scale) one week and 3 months after surgery. Mean operative time, number of hemostatic stitches performed and resected mucosal area were considered as well. Mean follow-up was 11.05 ± 1.6 years. RESULTS Differences between the operative time and resected mucosa-submucosa area were not found. The patients of group A needed a significantly higher number of stitches for intraoperative bleeding control along the stapled line. We did not found differences between both groups in terms of postoperative pain neither anorectal disturbances. At the follow-up, persistence of symptomatology was 10.41% in group A and 10.71% in group B, without statistically significance. Neither mortality nor undesirable effects occurred in the series. CONCLUSIONS SLH do not influence the recurrence rate neither the postoperative evolution in SA. TRIAL REGISTRATION Clinical Trials NCT03383926.
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Affiliation(s)
| | - Encarna Piedrafita-Serra
- Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataró, Barcelona, Spain. .,Department of Surgery and Morphological Sciences, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Neus Ruiz-Edo
- Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataró, Barcelona, Spain
| | - Sara Llorca-Cardeñosa
- Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataró, Barcelona, Spain
| | - Adolfo Heredia-Budó
- Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataró, Barcelona, Spain
| | - Oscar Estrada-Ferrer
- Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataró, Barcelona, Spain
| | - Xavier Suñol-Sala
- Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataró, Barcelona, Spain
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Klang E, Sobeh T, Amitai MM, Apter S, Barash Y, Tau N. Post hemorrhoidectomy complications: CT imaging findings. Clin Imaging 2019; 60:216-221. [PMID: 31927497 DOI: 10.1016/j.clinimag.2019.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 12/15/2019] [Accepted: 12/20/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION We aimed to describe computed tomography (CT) findings of early complications after interventional hemorrhoid treatments in emergency department (ED) patients. MATERIALS AND METHODS We identified all ED patients requiring abdominal and/or pelvic CT between February 2012 and February 2019, and included only patients who underwent CT for suspected early (up to 30 days) post hemorrhoidectomy procedure complications. Presenting symptoms, salient CT findings and clinical outcomes were collected. RESULTS Overall, 48,425 abdominal and/or pelvic CTs were performed. Of these, we identified 12 patients (8 male, 4 female) who underwent CT in our ED following hemorrhoidectomy procedures. At presentation, peri-anal or abdominal pain was the most common symptom. One patient presented with hemodynamic instability. CT findings included proctitis (4/12), rectal perforation (2/12), peri-anal abscess (1/12) and peri-anal fistula (1/12). Two of the patients with proctitis presented with significant submucosal edema. On follow-up, three patients required intensive care hospitalization, and two of those underwent emergent laparotomy. The third patient died due to secondary infection during his hospitalization. CONCLUSION Hemorrhoidectomy procedures may result in severe complications which should be recognized by ED radiologists. These complications carry a potential risk for significant clinical consequences. Both clinicians and radiologists should be aware of the possibility of such complications when patients present to the ED early after hemorrhoid procedures.
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Affiliation(s)
- Eyal Klang
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Tamer Sobeh
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Marianne Michal Amitai
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Sara Apter
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Yiftach Barash
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Noam Tau
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
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Liu L, Zhang Y, Duan H, Su Y, Xiong F, Jia S. Rectal inclusion cyst as a complication of stapled hemorrhoidopexy: A case report. Medicine (Baltimore) 2018; 97:e10792. [PMID: 29851787 PMCID: PMC6393077 DOI: 10.1097/md.0000000000010792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Stapled hemorrhoidopexy is gaining popularity for prolapsing hemorrhoids. However, like any other operation, there is always the potential risk of complications. Rectal inclusion cysts are rare complications that results from the potential space in the staple line. PATIENT CONCERNS A 49-year-old woman was admitted to our hospital with a complaint of anorectal pain and fever complaints after stapled hemorrhoidopexy. The endoanal ultrasonography showed unclear fluid containing a cystic lesion circuit to the rectum at the staple line. DIAGNOSES The endoanal ultrasonography strongly indicates the rectal inclusion cysts. INTERVENTIONS AND OUTCOMES A full thickness excision of the cyst was carried out along the staple line. The patient had complete recovery, with no recurrence or complaints for at least 6 months after the surgery. LESSONS Endosonography has an important role in investigating symptomatic patients after stapled hemorrhoidopexy. Once an inclusion cyst is diagnosed, excision of the stapled line is the only choice of treatment.
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Affiliation(s)
| | | | | | - Yue Su
- Department of Colorectal Surgery
| | - Fang Xiong
- Department of Ultrasound, Beijing Coloproctological Hospital, Beijing Erlonglu Hospital, Beijing, China
| | - Shan Jia
- Department of Colorectal Surgery
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Yamana T. Japanese Practice Guidelines for Anal Disorders I. Hemorrhoids. J Anus Rectum Colon 2018; 1:89-99. [PMID: 31583307 PMCID: PMC6768674 DOI: 10.23922/jarc.2017-018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/07/2017] [Indexed: 02/07/2023] Open
Abstract
The pathogenesis of hemorrhoids is a weakening of the anal cushion and spasm of the internal sphincter. Bowel habits and lifestyles can be risk factors for hemorrhoids. The prevalence of hemorrhoids can encompass 4 to 55% of the population. Symptoms include bleeding, pain, prolapsing, swelling, itching, and mucus soiling. The diagnosis of hemorrhoids requires taking a thorough history and conducting an anorectal examination. Goligher's classification, which indicates the degree of prolapsing with internal hemorrhoids, is useful for choosing treatment. Drug therapy for hemorrhoids is typically utilized for bleeding, pain, and swelling. Ligation and excision (LE) is considered for Grade III and IV internal and external hemorrhoids. Rubber band ligation is used to treat up to Grade III internal hemorrhoids. Phenol almond oil is effective for internal hemorrhoids up to Grade III, while aluminum potassium sulfate and tannic acid have shown efficacy in treating prolapsing in internal hemorrhoids at Grades II, III, and IV. Procedure for prolapse and hemorrhoids (PPH) is surgically effective for Grade III internal hemorrhoids; however, the long-term prognosis is not favorable, with high recurrence rates. Separating ligation is effective surgical treatment for internal/external hemorrhoids Grade III and Grade IV. The basic approach to thrombosed external hemorrhoids and incarcerated hemorrhoids is conservative treatment; however, in some acute or severe cases, surgical resection is considered. Comparing the different instruments used for hemorrhoid surgery, all reduce operating time, blood loss, post-operative pain, and length of time until the return to normal activity. They do, of course, increase the cost of the procedure.
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Affiliation(s)
- Tetsuo Yamana
- Department of Coloproctology, Tokyo Yamate Medical Center
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Abstract
BACKGROUND Despite the advantages of stapled hemorrhoidopexy reported in the literature in terms of postoperative pain, hospital stay, and duration of convalescence, it was described to have a higher recurrence rate compared with conventional hemorrhoidectomy. OBJECTIVE The aim of this study was to evaluate clinical outcomes and patient satisfaction after stapled hemorrhoidopexy at 10-year follow-up. DESIGN This was a retrospective cohort analysis conducted on prospectively collected data. SETTINGS The study was conducted at a single tertiary care center. PATIENTS Eighty-six consecutive patients treated with stapled hemorrhoidopexy for grade 3 hemorrhoidal prolapse between January and December 2006 were included. MAIN OUTCOME MEASURES Patients satisfaction and recurrence rates were measured. RESULTS Eighty-six patients (45 men and 41 women; median age, 49 y (range, 31-74 y)) underwent stapled hemorrhoidopexy. Eight patients had urinary retention during the immediate postoperative period, and 2 patients required a reoperation for suture line bleeding. The median hospital stay was 12 hours (range, 12-96 h). No suture line dehiscence, rectovaginal fistula, pelvic sepsis, anal abscess, or anal stenosis was recorded during the follow-up. Seventy-seven patients (90%) completed the expected follow-up, with a median duration of 119.0 months (range 115.4-121.8 mo). Among them, 30 patients (39%) experienced a recurrent hemorrhoidal prolapse, 8 of whom needed a reoperation. Thirty-four patients (44%) reported urge to defecate with a median visual analog scale of 1 (range, 1-7). Six patients (8%) reported gas leakage at the last follow-up visit, whereas no liquid or solid stool leakage was recorded. Satisfaction rate at 10-year follow-up was 68%. LIMITATIONS The study was limited by its small sample size and lack of a control group. CONCLUSIONS The high recurrence rate and low patient satisfaction rate showed that stapled hemorrhoidopexy reduces its efficacy in the long-term. See Video Abstract at http://links.lww.com/DCR/A510.
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum 2018; 61:284-292. [PMID: 29420423 DOI: 10.1097/dcr.0000000000001030] [Citation(s) in RCA: 142] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Watson AJ, Cook J, Hudson J, Kilonzo M, Wood J, Bruhn H, Brown S, Buckley B, Curran F, Jayne D, Loudon M, Rajagopal R, McDonald A, Norrie J. A pragmatic multicentre randomised controlled trial comparing stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease: the eTHoS study. Health Technol Assess 2017; 21:1-224. [PMID: 29205150 PMCID: PMC5733386 DOI: 10.3310/hta21700] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Haemorrhoids are a benign anorectal condition and are highly prevalent in the UK population. Treatments involve clinic-based procedures and surgery. The surgical procedures available include stapled haemorrhoidopexy (SH) and traditional haemorrhoidectomy (TH), and over 25,000 operations are performed for haemorrhoids annually in the UK. The disease is therefore important both to patients and to health service commissioners. Debate remains as to which of these surgical procedures is the most clinically effective and cost-effective. OBJECTIVE The aim of this study was to compare the clinical effectiveness and cost-effectiveness of SH with that of TH. DESIGN A large, open two-arm parallel-group pragmatic multicentre randomised controlled trial involving 32 UK hospitals and a within-trial cost-benefit analysis. A discrete choice experiment was conducted to estimate benefits (willingness to pay). PARTICIPANTS Patients with grades II-IV haemorrhoids who had not previously undergone SH or TH were included in the study. INTERVENTIONS Participants were randomised to receive either SH or TH. Randomisation was minimised at 1 : 1, in accordance with baseline EuroQol-5 Dimensions, three-level version (EQ-5D-3L) score, haemorrhoid grade, sex and centre, via an automated system. MAIN OUTCOME MEASURES The primary outcome was area under the quality-of-life curve measured using the EQ-5D-3L descriptive system over 24 months, and the primary economic outcome was the incremental cost-effectiveness ratio. Secondary outcomes included disease-specific quality of life, recurrence, complications, further interventions and costs. RESULTS Between January 2011 and August 2014, 777 patients were randomised (389 to receive SH and 388 to receive TH). There were 774 participants included in the analysis as a result of one post-randomisation exclusion in the SH arm and two in the TH arm. SH was less painful than TH in the short term. Surgical complications were similar in both arms. EQ-5D-3L score was higher for the SH arm in the first 6 weeks after surgery, but over 24 months the TH group had significantly better EQ-5D-3L scores (-0.073, 95% confidence interval -0.140 to -0.006; p = 0.0342). Symptoms and further interventions were significantly fewer in the TH arm at 24 months. Continence was better in the TH arm and tenesmus occurred less frequently. The number of serious adverse events reported was 24 out of 337 (7.1%) for participants who received SH and 33 out of 352 (9.4%) for those who received TH. There were two deaths in the SH arm, both unrelated to the eTHoS (either Traditional Haemorrhoidectomy or Stapled haemorrhoidopexy for haemorrhoidal disease) study. Patient preference did not seem to influence the treatment difference. SH was dominated by TH as it cost more and was less effective. The net benefit for the TH arm was higher than that for the SH arm. LIMITATIONS Neither the participants nor the assessors were masked to treatment assignment and final recruitment was slightly short of the total target of 800. There were also substantial missing follow-up data. CONCLUSIONS While patients who received SH had less short-term pain, after 6 weeks, recurrence rates, symptoms, re-interventions and quality-of-life measures all favoured TH. In addition, TH is cheaper. As part of a tailored management plan for haemorrhoids, TH should be considered over SH as the surgical treatment of choice for haemorrhoids refractory to clinic-based interventions. FUTURE WORK Perform an updated meta-analysis incorporating recently conducted European trials [eTHoS, HubBLe (haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids) and LingaLongo (Cost-effectiveness of New Surgical Treatments for Haemorrhoidal Disease)]. TRIAL REGISTRATION Current Controlled Trials ISRCTN80061723. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 70. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Angus Jm Watson
- NHS Highland, Department of Surgery, Raigmore Hospital, Inverness, UK
| | - Jonathan Cook
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jessica Wood
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Hanne Bruhn
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Steven Brown
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Brian Buckley
- Department of Surgery, University of the Philippines Manila, Manila, the Philippines
| | - Finlay Curran
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David Jayne
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Malcolm Loudon
- NHS Highland, Department of Surgery, Belford Hospital, Fort William, UK
| | - Ramesh Rajagopal
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, North Wales, UK
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Sait MR, Srinivasaiah N. Tips for safe stapled haemorrhoidopexy. Br J Hosp Med (Lond) 2017; 78:176. [PMID: 28277767 DOI: 10.12968/hmed.2017.78.3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M R Sait
- Locum Consultant Department of Surgery West Middlesex University Hospital Isleworth Middlesex
| | - N Srinivasaiah
- Consultant Laparoscopic Colorectal Surgeon Department of Surgery The Princess Alexandra Hospital Harlow Essex CM20 1QX
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Ryu S, Bae BN. Rectal free perforation after stapled hemorrhoidopexy: A case report of laparoscopic peritoneal lavage and repair without stoma. Int J Surg Case Rep 2016; 30:40-42. [PMID: 27902953 PMCID: PMC5133467 DOI: 10.1016/j.ijscr.2016.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 12/26/2022] Open
Abstract
Stapled hemorrhoidopexy (SH) is common treatment for prolapsed hemorrhoid. Unexpected abdominal pain following SH may related rectal perforation. Laparoscopic repair of rectal perforation is feasible in selective patients. A transanal rectal tube keep in several days may substitute diverting stoma.
Introduction Stapled hemorrhoidopexy is widely performed for treatment of prolapsed hemorrhoids because of advantages, including shorter hospital stay and less discomfort, compared with conventional hemorrhoidectomy. However, it can have severe adverse effects, such as rectal bleeding, perforation, and sepsis. Presentation of case We report the case of a healthy 28-year-old man who presented to the emergency department with sudden-onset diffuse abdominal pain and hematochezia. He had undergone stapled hemorrhoidopexy 5 days earlier and was discharged after an uneventful postoperative course. For the present condition, after immediate evaluation, we successfully performed emergency laparoscopic repair of the rectal perforation without any stoma. His postoperative course was uneventful, and he was discharged on postoperative day 16. Discussion This is a rare case of rectal perforation after stapled hemorrhoidopexy in which the perforation was treated successfully by laparoscopic repair. In most cases of rectal perforation following stapled hemorrhoidopexy, surgeons perform open laparotomy and create diverting stoma. However, our patient underwent totally laparoscopic lavage and primary closure without diverting stoma. Multiple investigators have reported that laparoscopic lavage for perforated diverticulitis may be an appropriate treatment option. Factors favoring this approach include early surgery, young age, sufficient irrigation, and meticulous primary closure. Conclusion Stapled hemorrhoidopexy can have severe adverse effects, such as rectal bleeding, pelvic sepsis, and rectal perforation, which are potentially life-threatening. Laparoscopic lavage and primary repair without stoma can be performed successfully in select patients with rectal perforation following stapled hemorrhoidopexy.
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Affiliation(s)
- Seokyong Ryu
- Department of Emergency Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Byung-Noe Bae
- Department of General Surgery, Inje University Sanggye Paik Hospital, Seoul,Republic of Korea.
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20
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Bach SP, Fearnhead NS. eTHoS piles pressure on haemorrhoidopexy. Lancet 2016; 388:2328-2330. [PMID: 27726952 DOI: 10.1016/s0140-6736(16)31802-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Simon P Bach
- Diagnostics, Drugs, Devices and Biomarkers Early Phase Trials Unit, Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, B15 2TH, UK.
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Watson AJM, Hudson J, Wood J, Kilonzo M, Brown SR, McDonald A, Norrie J, Bruhn H, Cook JA. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet 2016; 388:2375-2385. [PMID: 27726951 PMCID: PMC5269572 DOI: 10.1016/s0140-6736(16)31803-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/16/2016] [Accepted: 09/19/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Two commonly performed surgical interventions are available for severe (grade II-IV) haemorrhoids; traditional excisional surgery and stapled haemorrhoidopexy. Uncertainty exists as to which is most effective. The eTHoS trial was designed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery. METHODS The eTHoS trial was a large, open-label, multicentre, parallel-group, pragmatic randomised controlled trial done in adult participants (aged 18 years or older) referred to hospital for surgical treatment for grade II-IV haemorrhoids. Participants were randomly assigned (1:1) to receive either traditional excisional surgery or stapled haemorrhoidopexy. Randomisation was minimised according to baseline EuroQol 5 dimensions 3 level score (EQ-5D-3L), haemorrhoid grade, sex, and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery. The primary outcome was area under the quality of life curve (AUC) measured with the EQ-5D-3L descriptive system over 24 months, assessed according to the randomised groups. The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables. This trial is registered with the ISRCTN registry, number ISRCTN80061723. FINDINGS Between Jan 13, 2011, and Aug 1, 2014, 777 patients were randomised (389 to receive stapled haemorrhoidopexy and 388 to receive traditional excisional surgery). Stapled haemorrhoidopexy was less painful than traditional excisional surgery in the short term and surgical complication rates were similar between groups. The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months; mean difference -0·073 (95% CI -0·140 to -0·006; p=0·0342). EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery, the traditional excisional surgery group had significantly better quality of life scores than the stapled haemorrhoidopexy group. 24 (7%) of 338 participants who received stapled haemorrhoidopexy and 33 (9%) of 352 participants who received traditional excisional surgery had serious adverse events. INTERPRETATION As part of a tailored management plan for haemorrhoids, traditional excisional surgery should be considered over stapled haemorrhoidopexy as the surgical treatment of choice. FUNDING National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Jessica Wood
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Alison McDonald
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Hanne Bruhn
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jonathan A Cook
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
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23
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Abstract
A systematic review addressing reported complications of stapled hemorrhoidopexy was conducted. Articles were identified via searching OVID and MEDLINE between July 2011 and October 2013. Limitations were placed on the search criteria with articles published from 1998 to 2013 being included in this review. No language restrictions were placed on the search, however foreign language articles were not translated. Two reviewers independently screened the abstracts for relevance and their suitability for inclusion. Data extraction was conducted by both reviewers and entered and analyzed in Microsoft Excel. The search identified 784 articles and 78 of these were suitable for inclusion in the review. A total of 14,232 patients underwent a stapled hemorrhoidopexy in this review. Overall complication rates of stapled hemorrhoidopexy ranged from 3.3%-81% with 5 mortalities documented. Early and late complications were defined individually with overall data suggesting that early complications ranged from 2.3%-58.9% and late complications ranged from 2.5%-80%. Complications unique to the procedure were identified and rates recorded. Both early and late complications unique to stapled hemorrhoidopexy were identified and assessed.
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Hidalgo Grau LA, Ruiz Edo N, Llorca Cardeñosa S, Heredia Budó A, Estrada Ferrer Ó, Del Bas Rubia M, García Torralbo EM, Suñol Sala X. Circular mucosal anopexy: Experience and technical considerations. Cir Esp 2016; 94:287-93. [PMID: 26997121 DOI: 10.1016/j.ciresp.2015.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 11/12/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Circular mucosal anopexy (CMA) achieves a more comfortable postoperative period than resective techniques. But complications and recurrences are not infrequent. This study aims to evaluate of the efficacy of CMA in the treatment of hemorrhoids and rectal mucosal prolapse (RMP). METHOD From 1999 to 2011, 613 patients underwent surgery for either hemorrhoids or RMP in our hospital. CMA was performed in 327 patients. Gender distribution was 196 male and 131 female. Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade. Major ambulatory surgery (MAS) was performed in 79.9%. Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared. Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications. RESULTS A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade). No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age. In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week. Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain. CONCLUSIONS Recurrence rate is higher in CMA than in resective techniques. CMA is a useful technique for the treatment of hemorrhoids in MAS. Pain and the rate of complications are both low.
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Affiliation(s)
- Luis Antonio Hidalgo Grau
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Neus Ruiz Edo
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
| | - Sara Llorca Cardeñosa
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Adolfo Heredia Budó
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Óscar Estrada Ferrer
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Marta Del Bas Rubia
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Eva María García Torralbo
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
| | - Xavier Suñol Sala
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España
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Feo CF, Trompetto M, Chioso PC, Fancellu A, Ginesu GC, Porcu A. Stapled hemorrhoidopexy complicated by rectourethral fistula. Tech Coloproctol 2016; 20:425-426. [PMID: 26980329 DOI: 10.1007/s10151-016-1453-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 02/05/2023]
Affiliation(s)
- C F Feo
- Clinica Chirurgica, University of Sassari, Sassari, Italy.
| | - M Trompetto
- Chirurgia Coloproctologica, Clinica Santa Rita, Vercelli, Italy
| | - P C Chioso
- Urologia, Clinica La Vialarda, Biella, Italy
| | - A Fancellu
- Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - G C Ginesu
- Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - A Porcu
- Clinica Chirurgica, University of Sassari, Sassari, Italy
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Abstract
Stapled haemorrhoidectomy was proposed as an 'ideal' solution for symptomatic haemorrhoids, with minimal postoperative pain, no perianal wound requiring postoperative wound care and a relatively short operative time. Some randomised controlled trials and reviews confirmed these findings, claiming that stapled haemorrhoidopexy is the most effective and safe procedure for haemorrhoids. However, there are increasing number of publications highlighting that the technique is associated with serious and life threatening complications. Maybe it is now the time to accept that stapled haemorrhoidopexy has done its role in directing our attention to the fact that modern surgical treatment of haemorrhoids should avoid excision of anorectal skin but should instead aim at treatment intervention above the dentate line.
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Affiliation(s)
- J-L Faucheron
- Department of Colorectal Surgery, University Hospital, BP 217, 38043 Grenoble, France; Joseph Fourier University, 38043 Grenoble, France.
| | - B Trilling
- Department of Colorectal Surgery, University Hospital, BP 217, 38043 Grenoble, France; Joseph Fourier University, 38043 Grenoble, France
| | - F Reche
- Department of Colorectal Surgery, University Hospital, BP 217, 38043 Grenoble, France; Joseph Fourier University, 38043 Grenoble, France
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Ratto C, Parello A, Veronese E, Cudazzo E, D'Agostino E, Pagano C, Cavazzoni E, Brugnano L, Litta F. Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Colorectal Dis 2015; 17:O10-9. [PMID: 25213152 DOI: 10.1111/codi.12779] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/20/2014] [Indexed: 12/11/2022]
Abstract
AIM This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome. METHOD Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni- and multivariate analyses of the potential predictive factors for failure were performed. RESULTS The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life-threatening complications occurred. After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively. Sixteen out of 47 patients undergoing re-operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (P < 0.0001). At multivariate analysis the absence of morbidity and performance of a distal Doppler-guided dearterialization were associated with a better outcome. CONCLUSION THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.
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Affiliation(s)
- C Ratto
- Proctology Unit, Department of Surgical Sciences, Catholic University, Rome, Italy
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Bilgin Y, Hot S, Barlas İS, Akan A, Eryavuz Y. Short- and long-term results of harmonic scalpel hemorrhoidectomy versus stapler hemorrhoidopexy in treatment of hemorrhoidal disease. Asian J Surg 2014; 38:214-9. [PMID: 25451631 DOI: 10.1016/j.asjsur.2014.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/23/2014] [Accepted: 09/19/2014] [Indexed: 01/24/2023] Open
Abstract
PURPOSE In this prospective randomized study, our aim is to compare the short- and long-term results of harmonic scalpel hemorrhoidectomy (HSH) and stapler hemorrhoidopexy (SH) methods in the surgical treatment of Grade III and Grade IV hemorrhoidal disease. METHODS Ninety-nine consecutive patients diagnosed with Grade III or Grade IV internal hemorrhoidal disease were included in the study. Patients were randomized to HSH (n = 48) or SH (n = 51) treatments. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, additional analgesic requirement, postoperative short- and long-term complications, and recurrence of hemorrhoidal disease were also recorded. Patients were regularly followed for a total period of 24 (6-36) months. RESULTS The patient demographic and clinical characteristics were similar in the two groups. The operative time was significantly shorter in the HSH group compared with the SH group. Overall pain scores were not significantly different between the groups, although severe pain was significantly more common in the HSH group. Recurrence was significantly lower in the HSH group compared with the SH group. CONCLUSION HSH and SH are both safe and effective methods for surgical treatment of Grade III and Grade IV hemorrhoidal disease. In our study, the HSH method was determined to be safer, easier, and faster to perform, and associated with fewer long-term recurrences than the SH method.
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Affiliation(s)
- Yusuf Bilgin
- General Surgery Department, Okmeydanı Training Research Hospital, Istanbul, Turkey
| | - Semih Hot
- General Surgery Department, Okmeydanı Training Research Hospital, Istanbul, Turkey.
| | - İlhami Soykan Barlas
- General Surgery Department, Okmeydanı Training Research Hospital, Istanbul, Turkey
| | - Arzu Akan
- General Surgery Department, Okmeydanı Training Research Hospital, Istanbul, Turkey
| | - Yavuz Eryavuz
- General Surgery Department, Okmeydanı Training Research Hospital, Istanbul, Turkey
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Hidalgo-Grau LA, Llorca-Cardeñosa S, Heredia-Budó A, Estrada-Ferrer Ò, Del Bas-Rubia M, García-Torralbo EM, Suñol-Sala X. Does stapled anopexy for bleeding haemorrhoids cure associated anaemia? Colorectal Dis 2014; 16:O356-9. [PMID: 24888538 DOI: 10.1111/codi.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/06/2014] [Indexed: 01/05/2023]
Abstract
AIM The aim of this study was to evaluate the effectiveness of stapled anopexy (SA) in patients with chronic bleeding haemorrhoids and secondary anaemia. METHOD Our department performed 340 SA procedure per patient for haemorrhoids between January 1999 and December 2011. Fifty (14.7%) of these patients (25 male patients and 25 female patients) had anaemia (haemoglobin concentration < 13 g/dl in male patients and < 12 g/dl in female patients) secondary to chronic haemorrhoidal bleeding. Patients with colorectal bleeding and anaemia not caused by haemorrhoids were excluded. The mean (SD) age was 56.4 (13.9) years and the mean (SD) haemoglobin concentration was 9.2 (1.6) g/dl for male patients and 10.4 (1.2) g/dl for female patients. Five (10%) patients with anaemia had Grade II, 22 (44%) had Grade III and 23 (46%) had Grade IV haemorrhoids. The median (range) duration of postoperative follow-up was six (1-12) years. RESULTS None of the patients required early postoperative admission or experienced early or late complications related to SA. The procedure was successful (normal haemoglobin concentration and no bleeding at 6 months postsurgery) in 45 (90%) patients. Of the five (10%) patients in whom SA was ineffective, one had Grade II, three had Grade III and one had Grade IV haemorrhoids. All these patients underwent Milligan-Morgan haemorrhoidectomy 3 months after SA. CONCLUSION SA is an effective treatment for patients with bleeding haemorrhoids and subsequent anaemia. In our experience, the success rate was satisfactory and there were no serious complications.
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Affiliation(s)
- L A Hidalgo-Grau
- Unit of Colorectal Surgery, General and Digestive Surgery Department, Hospital de Mataró, Mataró, Spain
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Ratto C, de Parades V. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future. J Visc Surg 2014; 152:S15-21. [PMID: 25262549 DOI: 10.1016/j.jviscsurg.2014.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The transanal hemorrhoidal de-arterialization (THD) procedure is an effective treatment of hemorrhoidal disease. The ligation of hemorrhoidal arteries ("de-arterialization") can provide a significant reduction of arterial blood flow to the hemorrhoidal tissues. Plication of redundant rectal mucosa/submucosa ("mucopexy") can reposition prolapsing tissue to its original anatomical site. In this paper the surgical technique using a specific device (THD(®) Doppler) and peri-operative patient management are illustrated. METHODS After appropriate clinical assessment, patients undergo the THD procedure under general or spinal anesthesia, in either the dorsal lithotomy or prone jackknife position. A specifically designed device is used. In all patients, THD is performed, consisting of selective ligation of hemorrhoidal arteries identified by Doppler and marked with a mucosal stitch overlying the artery. In patients with hemorrhoidal or mucosal prolapse, a mucopexy is also performed using continuous suture(s) that include the redundant prolapsing mucosa and submucosa. RESULTS In long-term follow-up, THD results in resolution of symptoms in the majority of patients. The most common complication is transient but sometimes-painful tenesmus. Rectal bleeding occurs in only a very limited number of patients. There is little or no risk of fecal incontinence or chronic pain. Ano-rectal manometry and endo-anal ultrasound show no evidence of injury to physiologic sphincteric function. CONCLUSIONS THD is a safe procedure and is, at present, one of the most effective treatments of hemorrhoidal disease.
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Affiliation(s)
- C Ratto
- Proctology Unit, Catholic University, 8, Largo A. Gemelli, 00168 Rome, Italy.
| | - V de Parades
- Service de Proctologie Médico-Chirurgicale, Groupe hospitalier Paris Saint-Joseph, Institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France
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Loganathan A, Das A, Luck A, Hewett P. Transanal haemorrhoidal dearterialization for the treatment of grade III and IV haemorrhoids: a 3-year experience. ANZ J Surg 2014; 86:59-62. [DOI: 10.1111/ans.12816] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Arun Loganathan
- Department of Colorectal Surgery; The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Atandrilla Das
- Department of Colorectal Surgery; The Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Andrew Luck
- Department of Colorectal Surgery; Lyell McEwin Hospital; Adelaide South Australia Australia
| | - Peter Hewett
- Department of Colorectal Surgery; The Queen Elizabeth Hospital; Adelaide South Australia Australia
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Mustafa A, Jabbar M, Rashid M, Downey M, Shalli K. Rectal obliteration following stapled haemorrhoidopexy: a new endoscopic approach to restore luminal continuity. Colorectal Dis 2014; 16:644-6. [PMID: 24854053 DOI: 10.1111/codi.12673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/15/2014] [Indexed: 02/04/2023]
Affiliation(s)
- A Mustafa
- Department of Surgery, Wishaw General Hospital, NHS Lanarkshire, Wishaw, ML2 0DP, UK
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Agarwal A, Gupta BK, Agarwal S, Bhagoliwal A, Pandey K. Life-threatening severe sepsis following stapled hemorrhoidopexy. J Anaesthesiol Clin Pharmacol 2014; 30:124-5. [PMID: 24574620 PMCID: PMC3927283 DOI: 10.4103/0970-9185.125737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Apurva Agarwal
- Department of Anaesthesiology and Critical Care Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Bikram Kumar Gupta
- Department of Anaesthesiology and Critical Care Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Shaily Agarwal
- Department of Obstetrics and Gynaecology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Ajay Bhagoliwal
- Department of Social & Preventive Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
| | - Kiran Pandey
- Department of Obstetrics and Gynaecology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India
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Park YJ. Pneumoretroperitoneum after procedure for prolapsed hemorrhoid. Ann Coloproctol 2013; 29:256-8. [PMID: 24466542 PMCID: PMC3895551 DOI: 10.3393/ac.2013.29.6.256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/15/2013] [Indexed: 02/02/2023] Open
Abstract
Procedure for prolapsed hemorrhoid (PPH) is well recognized alternative to the traditional hemorrhoidectomy, and is associated with reduced pain and earlier return to normal activity. Over the past decade, there have been reports of severe life-threatening complications after a PPH, although the incidence is very low. Rectal perforation due to staple-line dehiscence is one of the serious complications that can cause severe pelvic sepsis or a pneumoretroperitoneum. Here, the first Korean case of a pneumoretroperitoneum due to staple-line dehiscence is described.
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Affiliation(s)
- Young Jin Park
- Department of Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
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Abstract
Symptoms thought related to hemorrhoids must be carefully considered before intervention. The first line of therapy for any hemorrhoidal complaint remains conservative management with increased fluid and fiber intake and appropriate modification of toileting behavior. Bleeding in grades 1 and 2 hemorrhoids that does not respond to this can be satisfactorily and safely managed with office-based therapies; some grade 3 hemorrhoids would also respond to this, though more treatment sessions would likely be required. Operative therapy is the best choice for management of persistently symptomatic grade 2 disease and for grades 3 and 4 symptomatic hemorrhoids as well. With proper patient selection and preparation, along with a familiarity with instrumentation and techniques, good results can be obtained with newer operative interventions for internal hemorrhoids. Outcomes must always be compared with those obtained with classic excisional hemorrhoidectomy.
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Dugue L, Charlier A. Is the morbidity from the Longo hemorrhoidal technique acceptable? J Visc Surg 2013; 150:293-4. [PMID: 24016713 DOI: 10.1016/j.jviscsurg.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- L Dugue
- Service de chirurgie viscérale, hôpital Saint-Camille, 2, rue des Pères-Camiliens, 94360 Bry-sur-Marne, France.
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A four-year retrospective study and review of selection criteria and post-operative complications of stapled haemorrhoidopexy. Tech Coloproctol 2012; 16:369-72. [PMID: 22821277 DOI: 10.1007/s10151-012-0862-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 07/05/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Severe life-threatening complications have been reported from the use of procedure for prolapsed haemorrhoids (PPH). First, we assessed post-operative complication rates over 4 years of PPH experience. We then sought to assess the impact of selection criteria for patients receiving PPH on post-operative complication rates and review our findings in the context of published literature. METHODS Over a 4-year period 2006-2010 at Hinchingbrooke Hospital, all 118 patients receiving PPH were audited for readmissions with post-operative complications using the admission database. A further retrospective audit of 50 patients' notes assessed the impact of selection criteria for PPH on post-operative complication rates. All PPH operations were performed by one of two senior colorectal consultants using the standard technique with a circular stapler. RESULTS Of the 118 patients from the 4-year audit, 12 (10 %) patients were readmitted. Two (1.7 %) of these 12 patients had post-operative pain, six (5.1 %) had rectal bleeding, three (2.5 %) had urinary retention, and one (0.8 %) had localised infection. There was one (0.8 %) patient mortality resulting from severe sepsis from an infected intra-abdominal haemorrhagic collection. In the following audit of 50 patients' notes, 15 patients had internal prolapsed haemorrhoids alone, of which one (6.6 %) experienced post-operative complications compared with six (55 %) of the 11 patients who had haemorrhoids and skin tags. CONCLUSIONS With careful selection of patients, PPH may be indicated for prolapsed internal haemorrhoids. More specific national guidelines are required with regard to contraindications to PPH.
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J. Deutsch C, Chan K, Alawattegama H, Sturgess J, J. Davies R. Doppler-Guided Transanal Haemorrhoidal Dearterialisation is a Safe and Effective Daycase Procedure for All Grades of Symptomatic Haemorrhoids. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ss.2012.311107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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