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Gefen R, Handal A, Ben-Ezra C, Parnasa SY, Mizrahi I, Abu-Gazala M, Pikarsky AJ, Shussman N. A patient tailored approach to the surgical treatment of hemorrhoids leads to equal satisfaction following hemorrhoidectomy, stapled hemorrhoidopexy or a combination of both. Langenbecks Arch Surg 2023; 408:233. [PMID: 37314660 DOI: 10.1007/s00423-023-02969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Up to 20% of patients suffering from symptomatic hemorrhoids will require surgery. Excisional hemorrhoidectomy (EH) and stapled hemorrhoidopexy (SH) are both standard and safe procedures. While SH has a short-term advantage of faster recovery and lower postoperative pain, its long-term efficacy is debatable. This study aims to compare the outcomes of EH, SH, and a combined procedure of both. METHODS A retrospective study compared the outcomes of patients treated surgically for hemorrhoids over a 5-year period. Eligible patients were asked by phone to complete a questionnaire evaluating recurrent symptoms, fecal incontinence, satisfaction, and self-assessed improvement in quality of life (QOL). RESULTS This study included 362 patients, of whom 215 underwent SH, 99 underwent EH, and 48 underwent a combined procedure. No statistically significant differences were found between groups regarding complications, symptoms recurrence, or fecal incontinence. Combined procedure patients had significantly higher self-assessed improvement in QOL (P=0.04). CONCLUSION In patients with symptomatic hemorrhoids, a tailored approach to symptomatic hemorrhoids is associated with high satisfaction rates and self-assessed improvement in QOL.
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Affiliation(s)
- Rachel Gefen
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel.
| | - Adham Handal
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel
| | - Carmel Ben-Ezra
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel
| | - Shani Y Parnasa
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel
| | - Ido Mizrahi
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel
| | - Mahmoud Abu-Gazala
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel
| | - Alon J Pikarsky
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel
| | - Noam Shussman
- Department of General Surgery. Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, POB 12000, 11920, Jerusalem, Israel
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Wei J, Ding X, Jiang J, Ji L, Huang H. Indications, Feasibility, and Safety of TST STARR Plus Stapler for Degree III Hemorrhoids: A Retrospective Study of 125 Hemorrhoids Patients. Front Surg 2022; 9:860150. [PMID: 35495741 PMCID: PMC9043453 DOI: 10.3389/fsurg.2022.860150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Stapler hemorrhoidopexy (SH) has been widely accepted for hemorrhoids patients because of its low postoperative pain, but it is also associated with a high recurrence rate. The recurrence might be due to failure to completely remove the prolapsed tissue or insufficient removal capacity of the instruments. Removing more prolapsed tissue to reduce the recurrence is believed to benefit more severe prolapsed hemorrhoids patients. Methods We evaluated the short- and long-term safety and efficacy in 125 hemorrhoids patients who underwent SH in 2013–2015. Eighty patients had prolapsed tissue less than half of the circular anal dilator (CAD) and underwent a procedure for prolapsing hemorrhoids (PPH), while the remaining 45 patients with hemorrhoid prolapse greater than half of the CAD were treated with a tissue selection therapy stapler stapled transanal rectal resection plus (TST STARR+). Results There were no significant differences between the two groups in terms of operative time, hospitalization time, overall satisfaction or complications. At follow-up of up to 4 years after surgery, there was no significant difference in recurrence rates between TST STARR+ group and PPH group (5.2% vs. 4.7%, p < 0.05). The mean width and volume of the resected tissues were significantly larger in the TST STARR+ group than in the PPH group (4.8 vs. 2.9 cm, 10.2 vs. 4.4 cm3, P < 0.05). Conclusion The TST STARR+ procedure can remove more hemorrhoidal tissue than PPH and it is better suited for patients with severe annular prolapsed hemorrhoids greater than half of the CAD. It has the advantages of convenient to operate, rapid recovery, fewer complications, and long-term satisfactory results.
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Yuan C, Zhou C, Xue R, Jin X, Jin C, Zheng C. Outcomes of Modified Tissue Selection Therapy Stapler in the Treatment of Prolapsing Hemorrhoids. Front Surg 2022; 9:838742. [PMID: 35310446 PMCID: PMC8927070 DOI: 10.3389/fsurg.2022.838742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTissue selection therapy staplers (TSTs) are widely used to treat prolapsing hemorrhoids; however, some disadvantages exist. We describe a modified technique for the treatment of prolapsing hemorrhoids, with the aim of minimizing the risk of anal stenosis and anal incontinence and reducing the impact of postoperative complications from the stapling technique. We applied a modified TST procedure, and the preliminary data were used to test the efficacy and safety of this new technique.MethodsWe conducted a retrospective study of patients who underwent modified TST for prolapsing hemorrhoids at our department between January 2018 and January 2020. All patients received a modified TST. Most prolapsing hemorrhoids were not segmentally resected and were instead selectively removed. The demographics, preoperative characteristics, postoperative complications, therapeutic effects, and patient satisfaction were collected and analyzed.ResultsA total of 106 patients were included in the study; 53 were men and 53 women (mean age, 49.24 years). The mean operative time was 55.01 min, and the mean hospital stay was 7.82 days. After surgery, three patients experienced bleeding (2.83%), 2 patients experienced anal discharge (1.89%), 2 patients experienced tenesmus (1.89%), and 5 patients experienced anal tags (4.72%). Anal incontinence, persistent post stapler pain, rectovaginal fistula and anal stenosis did not occur. Two patients developed recurrent symptomatic hemorrhoids (1.89%). The total effective rate of the surgery and the total satisfaction rate of the patients was 97.17%.ConclusionsThe modified tissue selection therapy stapler technique was a satisfactory and economical treatment for prolapsing hemorrhoids at a follow-up period of 1 year. The modified TST was associated with reduced anal stenosis and anal incontinence, less persistent post stapler pain and a minimal risk of rectovaginal fistula.
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Affiliation(s)
- Chenchen Yuan
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chongjun Zhou
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rong Xue
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofeng Jin
- Department of Graduate Education Management Division, Wenzhou Medical University, Wenzhou, China
| | - Chun Jin
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chenguo Zheng
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Chenguo Zheng
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Yang Y, Cao YL, Zhang YY, Shi SS, Yang WW, Zhao N, Lyu BB, Zhang WL, Wei D. Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Yang Y, Cao YL, Zhang YY, Shi SS, Yang WW, Zhao N, Lyu BB, Zhang WL, Wei D. Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females. World J Clin Cases 2020; 8:5876-5886. [PMID: 33344586 PMCID: PMC7723707 DOI: 10.12998/wjcc.v8.i23.5876] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Internal rectal prolapse (IRP) is one of the most common causes of obstructive constipation. The incidence of IRP in women is approximately three times that in men. IRP is mainly treated by surgery, which can be divided into two categories: Abdominal procedures and perineal procedures. This study offers a better procedure for the treatment of IRP.
AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair (IPFLR) combined with a procedure for prolapse and hemorrhoids (PPH) and the laparoscopic IPFLR alone in the treatment of IRP in women.
METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014. The patients were divided into groups A and B. Group A had 63 patients who underwent laparoscopic IPFLR alone, and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH. The degree of internal rectal prolapse (DIRP), Wexner constipation scale (WCS) score, Wexner incontinence scale (WIS) score, and Gastrointestinal Quality of Life Index (GIQLI) score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.
RESULTS All laparoscopic surgeries were successful. The general information, number of bowel movements before surgery, DIRP, GIQLI score, WIS score, and WCS score before surgery were not significantly different between the two groups (all P > 0.05). The WCS score, WIS score, GIQLI score, and DIRP in each group 6 mo, and 2 years after surgery were significantly better than before surgery (P < 0.001). In group A, the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery (P < 0.001), and the GIQLI score progressively improved from 6 mo to 2 years after surgery (P < 0.05). In group B, the DIRP, WCS score and WIS score significantly improved from 6 mo to 2 years after surgery (P < 0.05), and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery (P < 0.05). The WCS score, WIS score, GIQLI score, and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery (all P < 0.001, Bonferroni) except DIRP at 2 years after surgery. There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery (P = 0.011). There was no significant difference in postoperative grade I-III complications between the two groups (P = 0.822).
CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.
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Affiliation(s)
- Yang Yang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Yong-Li Cao
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Yuan-Yao Zhang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Shou-Sen Shi
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Wei-Wei Yang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Nan Zhao
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Bing-Bing Lyu
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Wen-Li Zhang
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
| | - Dong Wei
- Institute of Anal-Colorectal Surgery, the 989 Hospital of The Joint Logistics Support Force of PLA, Luoyang 471031, Henan Province, China
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Ji L, Li L, Weng L, Hu Y, Huang H, Wei J. Tissue selecting technique mega-window stapler combined with anal canal epithelial preservation operation for the treatment of severe prolapsed hemorrhoids: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e23122. [PMID: 33157990 PMCID: PMC7647576 DOI: 10.1097/md.0000000000023122] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Hemorrhoidal disease is one of the most common and frequently occurring benign anorectal disorders, presented with bleeding and prolapsed, and surgery is the main and effective method for severe prolapsed hemorrhoids. Yet, the recurrence rate after procedure for prolapse and hemorrhoids (PPH) is significantly higher. To reduce the recurrence rate and protect the anus function, we try to carry out a randomized, controlled, prospective study to compare the efficacy and recurrence rate of tissue selecting technique (TST) with mega-window stapler (TST-MS) combined with anal canal epithelial preservation operation and PPH combined with external hemorrhoidectomy and inferior internal hemorrhoid ligation operation for the treatment of severe prolapsed hemorrhoids. METHODS This study is a single-center, evaluator-blinded, randomized, controlled clinical trial. Participants meet the inclusion and exclusion criteria in this RCT will be randomly divided into treatment group (TST-MS combined with anal canal epithelial preservation operation group) and control group (PPH combined with external hemorrhoidectomy and inferior internal hemorrhoid ligation operation) in a 1:1 ratio according to a computer-generated randomization list. The outcomes of recurrence, anal function, intraoperative variables, and postoperative complications will be recorded at different follow-ups. CONCLUSION The findings of the study will help to explore the efficacy and recurrence rate of TST-MS combined with anal canal epithelial preservation operation on the treatment of severe prolapsed hemorrhoids. TRIAL REGISTRATION This study protocol was registered in open science framework (OSF). (Registration number: DOI 10.17605 / OSF.IO / 4JYNF).
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Affiliation(s)
- Lijiang Ji
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu Province
| | - Lei Li
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Liping Weng
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu Province
| | - Yuemeng Hu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hua Huang
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu Province
| | - Jun Wei
- Department of Anorectal Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, Jiangsu Province
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Gallo G, Di Saverio S, Clerico G, Sturiale A, Manigrasso M, Luc AR, Trompetto M, Sammarco G. Mesoglycan for pain control after open excisional HAEMOrrhoidectomy (MeHAEMO): an observational multicentre study on behalf of the Italian Society of Colorectal Surgery (SICCR). BMC Surg 2020; 20:251. [PMID: 33092570 PMCID: PMC7583301 DOI: 10.1186/s12893-020-00914-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022] Open
Abstract
Background Excisional haemorrhoidectomy is the gold standard technique in patients with III and IV degree haemorrhoidal disease (HD). However, it is associated with a significant rate of post-operative pain. The aim of our study was to evaluate the efficacy of mesoglycan in the post-operative period of patients who underwent open excisional diathermy haemorrhoidectomy (OEH). Methods This was a retrospective multicentre observational study. Three hundred ninety-eight patients from sixteen colorectal referral centres who underwent OEH for III and IV HD were enrolled. All patients were followed-up on the first post-operative day (T1) and after 1 week (T2), 3 weeks (T3) and 6 weeks (T4). BMI, habits, SF-12 questionnaire, VAS at rest (VASs), after defecation (VASd), and after anorectal digital examination (VASe), bleeding and thrombosis, time to surgical wound healing and autonomy were evaluated. Results In the mesoglycan group, post-operative thrombosis was significantly reduced at T2 (p < 0.05) and T3 (p < 0.005), and all patients experienced less post-operative pain at each time point (p < 0.001 except for VASe T4 p = 0.003). There were no significant differences between the two groups regarding the time to surgical wound healing or post-operative bleeding. There was an early recovery of autonomy in the mesoglycan group in all three follow-up periods (T2 p = 0.016; T3 p = 0.002; T4 p = 0.007). Conclusions The use of mesoglycan led to a significant reduction in post-operative thrombosis and pain with consequent early resumption of autonomy. Trial registration NCT04481698—Mesoglycan for Pain Control After Open Excisional HAEMOrrhoidectomy (MeHAEMO) https://clinicaltrials.gov/ct2/show/NCT04481698?term=Mesoglycan+for+Pain+Control+After+Open+Excisional+HAEMOrrhoidectomy+%28MeHAEMO%29&draw=2&rank=1
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Affiliation(s)
- G Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy. .,Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy.
| | - S Di Saverio
- Department of General Surgery, University of Insubria, Varese, Italy
| | - G Clerico
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - A Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - M Manigrasso
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - A Realis Luc
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G Sammarco
- Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
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Naldini G, Sturiale A. Stapled hemorrhoidopexy and THD/HAL-RAR: false myths of the third millennium. Tech Coloproctol 2020; 24:985-986. [PMID: 32601751 DOI: 10.1007/s10151-020-02267-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Affiliation(s)
- G Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy
| | - A Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy.
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Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years. Tech Coloproctol 2018; 22:689-696. [PMID: 30288629 DOI: 10.1007/s10151-018-1860-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hemorrhoidal prolapse is a common benign disease. The introduction of circular-stapled hemorrhoidopexy as an alternative to the conventional hemorrhoidectomy led to a new spectrum of postoperative outcomes and complications. The aim of the present study was to evaluate long-term results after stapled hemorrhoidopexy. METHODS All the patients who had stapled hemorrhoidopexy using a PPH03 stapler, from January 2003 to December 2005, were retrospectively collected in a dedicated database. Between March and May 2016, all the patients were asked by phone to complete a questionnaire. The study evaluated anatomical recurrence, symptom recurrence and frequency, and satisfaction after surgery. The postoperative complications recorded were hemorrhage, hematoma, urinary retention, anastomotic stenosis, persistent anal pain, tenesmus, and impaired anal continence evaluated also with the Faecal Incontinence Severity Index score. RESULTS One hundred and ninety four patients were identified and 171 completed the questionnaire. The mean follow-up was 12 ± 0.8 years (range 11-13 years). Anatomical self-reported prolapse recurrence was 40.9% (n = 70). In 75.6% (n = 129) of patients, the severity and frequency of symptoms improved. The overall complication rate was 56.7% (n = 40) with a serious adverse event rate of 8.7% (n = 15). The overall tenesmus rate was 38.2% (n = 65) and the overall impaired continence rate was 39.1% (n = 67). Medical therapy was still required occasionally by 40.3% (n = 69) of the patients and 9.3% (n = 16) of the patients underwent surgery for recurrence. Patient satisfaction rate was good (≥ 3 on a scale of 1 to 5) in 81.2% (n = 139) of cases. CONCLUSIONS The study showed that stapled hemorrhoidopexy using the first-generation devices is safe and feasible but associated with a high recurrence and incontinence rate. More stringent selection criteria in association with the use of large volume devices can lead to better results in the future.
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Prospective, Multicenter Randomized Controlled Trial Comparing Two Hemorrhoidopexy Staplers: The HEMOSTASIS Study. Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00171.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to compare two hemorrhoidopexy staplers (EEA versus PPH03). Stapled hemorrhoidopexy is a treatment option for patients with symptomatic internal hemorrhoids who have failed more conservative measures. However, staple line bleeding remains common. Recent improvements in stapler design have attempted to reduce intraoperative bleeding and the need for intervention. HEMOSTASIS is a prospective, multicenter, 1:1 randomized controlled trial. Twelve hospital centers in the United States enrolled participants between 18 and 85 years of age with symptomatic grades 2 to 3 internal hemorrhoids. The primary end point was intraoperative bleeding, defined as bleeding requiring intervention (e.g., placement of sutures, cauterization, or ligation to achieve hemostasis). Secondary end points included staple line location, postoperative pain, quality of life, operative time, length of hospital stay, adverse events, and complication rates. On the primary end point, the rates of intraoperative bleeding requiring intervention were 41.0% (32 of 78) with EEA and 70.4% (50 of 71) with PPH (P < 0.001). Treatment for active bleeding was required in 30.8% versus 57.7% (P < 0.001) in the EEA and PPH arms, respectively. There were no significant differences between groups in postoperative pain. Adverse events and perioperative complication rates were generally mild/moderate and were similar between groups: 74.1% (60 of 81) of patients in the EEA group reported at least one adverse event versus 80.9% (55 of 68) in the PPH group (P = 0.32). Intraoperative bleeding occurred less often after stapled hemorrhoidopexy with the EEA stapler compared with the PPH03 stapler. Intervention to achieve hemostasis was required less often with the EEA stapler.
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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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Naldini G, Fabiani B, Menconi C, Giani I, Toniolo G, Martellucci J. Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus. Int J Colorectal Dis 2015. [PMID: 26208412 DOI: 10.1007/s00384-015-2314-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of the study was to assess the results of the stapled transanal procedure in the treatment of hemorrhoidal prolapse in terms of postoperative complications and recurrence rate using a new dedicated device, TST Starr plus. METHODS Patients affected by III-IV degree hemorrhoidal prolapsed that underwent stapled transanal resection with the TST Starr plus were included in the present study. Results of the procedure with perioperative complications, postoperative complications, and recurrence rate were reported. RESULTS From November 2012 to October 2014, 52 patients (19 females) were enrolled in the study. The main symptoms were prolapse (100 %) and bleeding (28.8 %). Transanal rectal resection was performed with parachute technique in 24 patients (46.2 %) and purse string technique in 23 patients (53.8 %). A mild hematoma at the suture line occurred in one patient (1.9 %). Postoperative bleeding was reported in three patients (5.7 %), in one of which, reoperation was necessary (1.9 %). Tenesmus occurred in one patient (1.9 %), and it was resolved with medical therapy. Urgency was reported in nine patients (17.1 %) at 7 days after surgery. Of these, three patients (5.7 %) complained urgency at the median follow-up of 14.5 months. Reoperation was performed in one patient (1.9 %) for chronic anal pain for rigid suture fixed on the deep plans. Occasional bleeding was reported in four patients (7.7 %). No recurrence of prolapse was reported at a median of 14.5 months after surgery, even if one patient (1.9 %) had a partial recurrent prolapse of a downstaged single pile. CONCLUSIONS TST Starr plus seems to be safe and effective for a tailored transanal stapled surgery for the treatment of III-IV degree hemorrhoidal prolapse. The new conformation and innovative technology of the stapler seems to reduce some postoperative complications and recurrence rate.
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Affiliation(s)
- G Naldini
- Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - B Fabiani
- Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - C Menconi
- Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - I Giani
- Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - G Toniolo
- Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy
| | - J Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy.
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Li YR, Gu YF, Chen YQ, Zhu P. Clinical application of procedure for prolapse and hemorrhoids. Shijie Huaren Xiaohua Zazhi 2015; 23:2245-2249. [DOI: 10.11569/wcjd.v23.i14.2245] [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] [Indexed: 02/06/2023] Open
Abstract
As the sliding anal cushion theory is widely accepted, the procedure for prolapse and hemorrhoids (PPH) has been applied all over the world. PPH mainly involves restoring the normal anatomy of the anal canal by circular excision of the mucosa above the hemorrhoids. Therefore, the blood supply is partially blocked so that hemorrhoids will gradually shrink. PPH has many advantages such as rapid rehabilitation, minimal invasiveness, and good short-term outcome (early resumption, less rectal bleeding and postoperative pain). However, many retrospective studies and meta-analyses indicate that, compared with the traditional surgery, PPH still has a number of deficiencies, including relatively high costs, high rates of relapse in a long term and so on. This review discusses the strategies, postoperative complications and clinical application of PPH.
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Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus. Int J Colorectal Dis 2014; 29:623-9. [PMID: 24569943 DOI: 10.1007/s00384-014-1845-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study was to assess the safety, efficacy and feasibility of stapled transanal procedures performed by a new dedicated device, TST STARR Plus, for tailored transanal stapled surgery. METHODS All the consecutive patients admitted to eight referral centres affected by prolapses with III-IV degrees haemorrhoids or obstructed defecation syndrome (ODS) with rectocele and/or rectal intussusception that underwent stapled transanal resection with TST STARR plus were included in the present study. Haemostatic stitches for bleeding of the suture line, specimen volume, operative time, hospital stay and perioperative complications were recorded. RESULTS From 1 November 2012 to 31 March 2013, 160 consecutive patients (96 females) were enrolled in the study. In 94 patients, the prolapse was over the half of the circular anal dilator (CAD). The mean duration of the procedure was 25 min. The mean resected volume of the specimen was 13.3 cm(3), the mean hospital stay was 2.2 days. In 88 patients (55%), additional stitches on the suture line were needed (mean 2.1). Suture line dehiscence was reported in four cases, with intraoperative reinforcement. Bleeding was reported in seven patients (5%). Urgency after 30 days was reported in one patient. No major complication occurred. CONCLUSIONS The new device seems to be safe and effective for a tailored approach to anorectal prolapse due to haemorrhoids or obstructed defecation.
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