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Liu X, Sheng B, Zhang J, Wang J, Yu J, Zhang G, Dai F, Su H, Xu J, Hu W, Li T, Zhu P. Modified whitehead hemorrhoidectomy versus partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids: A retrospective analysis. Heliyon 2024; 10:e28465. [PMID: 38596109 PMCID: PMC11002042 DOI: 10.1016/j.heliyon.2024.e28465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Grade IV circular hemorrhoids are difficult to treat. We aim to describe the modified whitehead hemorrhoidectomy procedure and to assess the effectiveness and safety of this procedure for grade IV circular hemorrhoid patients. Methods Patients with grade Ⅳ circular hemorrhoids who underwent modified Whitehead hemorrhoidectomy and partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids were retrospectively reviewed. Clinical data were extracted from the database at our institution, and long-term postoperative complications were assessed through repeated outpatient examinations and telephonic communication. Results A total of 205 patients were included in this study. The mean operative time was 59.2 ± 13.8 min. The average hospital stay was 4.6 ± 1.0 days. For postoperative complications, 66 (32.2%) patients had urinary retention, 10 (4.9%) patients had a sense of incomplete rectal emptying, 5 (2.4%) patients had anal incontinence, and 6 (2.9%) patients had wound infection. For long-term postoperative complications, 3 (1.5%) patients experienced mild to moderate anal stricture, 2 (1%) patients experienced mucosal ectropion, they all had smooth recoveries, and none of them needed secondary surgery. None of these patients had a hemorrhoid recurrence. A total of 205 patients who received modified Whitehead hemorrhoidectomy and 161 who received partial hemorrhoidectomy were included. There were no residual hemorrhoids in patients who received modified Whitehead hemorrhoidectomy, and none had hemorrhoid recurrence. Fifty-eight patients who received partial hemorrhoidectomy had hemorrhoidal residues, and 19 patients experienced hemorrhoid recurrence. After modified Whitehead hemorrhoidectomy, 3 patients developed anal stenosis, and 2 had mucosal ectropion. Four patients developed anal stricture after partial hemorrhoidectomy, and none had mucosal ectropion. They all had smooth recoveries, and none of them needed a secondary surgery. For the mean duration of surgery, postoperative bleeding, postoperative pain, wound infection, sense of incomplete rectal emptying, anal incontinence, and urinary retention, no statistically significant differences were found between the two groups. Conclusions Compared with partial hemorrhoidectomy, modified whitehead hemorrhoidectomy is an effective and safe surgical procedure and does not significantly increase the risk of anal stenosis and mucosal ectropion for grade IV circular hemorrhoid patients. Prospective randomized controlled trials are needed to verify our results.
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Affiliation(s)
- Xie Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Bo Sheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jianbo Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jijian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jun Yu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Guanggang Zhang
- Department of General Surgery, The People's Hospital of Chongqing City, Chongqing, 400014, China
| | - Fengshun Dai
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Heng Su
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Jingsong Xu
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Wei Hu
- Department of General Surgery, the Renmin Hospital of Wushan County, Chongqing, 404700, China
| | - Tong Li
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Peng Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
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He J, Zhou MD, Wu WJ, Liu ZY, Wang D, Yang GG, Yang QY, Shen Z. The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study. BMC Gastroenterol 2023; 23:443. [PMID: 38104065 PMCID: PMC10725019 DOI: 10.1186/s12876-023-03062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES The objectives of this study were to present an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of grade IV hemorrhoids and to assess long-term outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). METHODS Conventional CSH kits combined with an intestinal spatula were used for performing C-PSH. A total of 256 patients with grade IV hemorrhoids referred to Hangzhou Third People's Hospital between January 2016 and June 2017 were obtained: 122 (47.7%) with C-PSH, and 134 (52.3%) with CSH. After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed. The primary outcome was the five-year recurrence rate of hemorrhoids. Secondary outcomes included intraoperative outcomes, postoperative outcomes and complications. RESULTS The operative time in the C-PSH group was slightly longer than that in the CSH group (p < 0.01). The vertical length of rectal mucosa specimen in the C-PSH group was shorter than that in the CSH group (p < 0.01). Compared with the CSH group, fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05). Multivariate Cox regression analysis revealed that constipation was an independent prognostic factor for hemorrhoidal recurrence. CONCLUSIONS The accessible C-PSH seems to be a safe and effective technique in managing grade IV hemorrhoids. It has advantages in alleviating postoperative pain at first defecation, fecal urgency and major complications compared with CSH. It could be an alternative technique in the treatment of grade IV hemorrhoids.
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Affiliation(s)
- Jun He
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Meng-Dan Zhou
- Department of Nursing, Hangzhou First People's Hospital, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Wen-Jing Wu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Zhi-Yong Liu
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Dong Wang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Guan-Gen Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China
| | - Qin-Yan Yang
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
| | - Zhong Shen
- Department of Colorectal Surgery, Hangzhou Third People's Hospital, Hangzhou, 310009, Zhejiang, People's Republic of China.
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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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Chen HX, Chen ZQ, Huang L, Han CP, Dou RX, Ren DL, Lin HC. Modified Stapled Transanal Rectal Resection Procedure for Limited Rectal Prolapse: A Viable Alternative to the Delorme Operation. Surg Innov 2020; 27:468-473. [PMID: 32510277 DOI: 10.1177/1553350620929470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose. The optimal surgical approach for full-thickness rectal prolapse (FTRP) remains controversial. In China, patients with limited FTRP (<5 cm in length) are usually managed by perineal surgery. We retrospectively assessed the outcome of Delorme's procedure and compared it with modified stapled transanal rectal resection (STARR). Methods. The study was conducted in 2 public tertiary referral centers in China with modified STARR or Delorme's procedure performed by experienced surgeons. Outcomes assessed recurrence, operative times, blood loss, complications, length of hospital stay, and continence and constipation scoring. Results. Between December 2012 and May 2019, 65 patients were assessed, including 48 with modified STARR (group 1) and 17 with Delorme's procedure (group 2). The median follow-up was 22 months (range, 3-86 months). The mean operative time for group 1 was 37.4 ± 17.5 minutes vs 74.3 ± 30.6 minutes for group 2 (P < .001). The blood loss for group 1 was significantly lower than that for group 2 (17.4 ± 15.9 mL vs 27.8 ± 16.7 mL, respectively; P = .028). There was no significant difference between groups in recurrence (group 1 18.8% vs group 2 23.5%; P = .944) with no effect of operation type. Both procedures showed improvement in constipation and continence scoring with a similar impact. Conclusions. Modified STARR and the Delorme operation are comparable in managing limited FTRP with superior results in operative time and blood loss for STARR.
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Affiliation(s)
- Hua-Xian Chen
- Department of Colorectal Surgery, 66278The First People's Hospital of Foshan, People's Republic of China
| | - Zu-Qing Chen
- Department of Colorectal Surgery, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, People's Republic of China
| | - Liang Huang
- Department of Coloproctology, 373651The Sixth Affiliated Hospital of Sun Yat-sen University (Gastrointestinal & Anal Hospital of Sun Yat-sen University), People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, People's Republic of China
- Guangdong Institute of Gastroenterology, People's Republic of China
| | - Chang-Peng Han
- Department of Coloproctology, 194026Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, People's Republic of China
| | - Ruo-Xu Dou
- Department of Coloproctology, 373651The Sixth Affiliated Hospital of Sun Yat-sen University (Gastrointestinal & Anal Hospital of Sun Yat-sen University), People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, People's Republic of China
- Guangdong Institute of Gastroenterology, People's Republic of China
| | - Dong-Lin Ren
- Department of Coloproctology, 373651The Sixth Affiliated Hospital of Sun Yat-sen University (Gastrointestinal & Anal Hospital of Sun Yat-sen University), People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, People's Republic of China
- Guangdong Institute of Gastroenterology, People's Republic of China
| | - Hong-Cheng Lin
- Department of Coloproctology, 373651The Sixth Affiliated Hospital of Sun Yat-sen University (Gastrointestinal & Anal Hospital of Sun Yat-sen University), People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, People's Republic of China
- Guangdong Institute of Gastroenterology, People's Republic of China
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Popivanov G, Fedeli P, Cirocchi R, Lancia M, Mascagni D, Giustozzi M, Teodosiev I, Kjossev K, Konaktchieva M. Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR-A Proposal for a Decision-Making Algorithm. ACTA ACUST UNITED AC 2020; 56:medicina56060269. [PMID: 32486112 PMCID: PMC7353849 DOI: 10.3390/medicina56060269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/01/2020] [Accepted: 05/26/2020] [Indexed: 01/22/2023]
Abstract
Background and Objectives: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. Materials and methods: A systematic literature review was performed that combined the published and the obtained original data after a search of PubMed, Web of Science, and SCOPUS. Results: The present systematic review includes 16 articles with 37 patients. Twelve papers report perirectal and six report intra-abdominal bleeding. Stapled hemorrhoidopexy (SH) was performed in 57% of cases (3 PPH 01 and 15 PPH 03), stapled transanal rectal resection (STARR) in 13%, and for 30% information was not available. The median age was 49 years (±11.43). The sign and symptoms of perirectal bleeding were abdominal pain (43%), pelvic discomfort without rectal bleeding (36%), urinary retention (14%), and external rectal bleeding (21%). The median time to bleeding was 1 day (±1.53 postoperative days), with median hemoglobin at diagnosis 8.8 ± 1.04 g/dL. Unstable hemodynamic was reported in 19%. Computed tomography scan (CT) was the first examination in 77%. Only two cases underwent the abdominal US, but subsequently, a CT scan was also conducted. Non-operative management was performed in 38% (n = 14) with selective arteriography and percutaneous angioembolization in two cases. A surgical treatment was performed in 23 cases - transabdominal surgery (3 colostomies, 1 Hartmann' procedure, 1 low anterior resection of the rectum, 1 bilateral ligation of internal iliac artery and 1 ligation of vessels located at the rectal wall), transanal surgery (n = 13), a perineal incision in one, and CT-guided paracoccygeal drainage in one. Conclusions: Because of the rarity and lack of experience, no uniform tactic for the treatment of perirectal hematomas exists in the literature. We propose an algorithm similar to the approach in pelvic trauma, based on two main pillars -hemodynamic stability and the finding of contrast CT.
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Affiliation(s)
- Georgi Popivanov
- Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria; (I.T.); (K.K.)
- Correspondence:
| | - Piergiorgio Fedeli
- Institute of Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, 06100 Perugia, Italy; (R.C.); (M.L.)
| | - Massimo Lancia
- Department of Surgical Science, University of Perugia, 06100 Perugia, Italy; (R.C.); (M.L.)
| | - Domenico Mascagni
- Department of Surgical Science, Surgical Proctology Unit, Sapienza University of Rome, 00100 Rome, Italy;
| | - Michela Giustozzi
- Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, 06100 Perugia, Italy;
| | - Ivan Teodosiev
- Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria; (I.T.); (K.K.)
| | - Kirien Kjossev
- Department of Surgery, Military Medical Academy, 1606 Sofia, Bulgaria; (I.T.); (K.K.)
| | - Marina Konaktchieva
- Department of Gastroenterology, Military Medical Academy, 1606 Sofia, Bulgaria;
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Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial. Dis Colon Rectum 2019; 62:223-233. [PMID: 30489326 PMCID: PMC6365260 DOI: 10.1097/dcr.0000000000001261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Long-term outcomes and efficacy of partial stapled hemorrhoidopexy are not known. OBJECTIVE The purpose of this study was to compare the long-term clinical efficacy and safety of partial stapled hemorrhoidopexy with circumferential stapled hemorrhoidopexy. DESIGN This was a parallel group, randomized, noninferiority clinical trial. SETTINGS The study was conducted at a single academic center. PATIENTS Patients with grade III/IV hemorrhoids between August 2011 and November 2013 were included. INTERVENTIONS Three hundred patients were randomly assigned to undergo either partial stapled hemorrhoidopexy (group 1, n = 150) or circumferential stapled hemorrhoidopexy (group 2, n = 150). MAIN OUTCOME MEASURES The primary outcome was the rate of recurrent prolapse at a median follow-up period of 5 years with a predefined noninferiority margin of 3.75%. Secondary outcomes included incidence and severity of postoperative pain, fecal urgency, anal continence, and the frequency of specific complications, including anorectal stenosis and rectovaginal fistula. RESULTS The visual analog scores in group 1 were less than those in group 2 (p < 0.001). Fewer patients in group 1 experienced postoperative urgency compared with those in group 2 (p = 0.001). Anal continence significantly worsened after both procedures, but the difference between preoperative and postoperative continence scores was higher for group 2 than for group 1. Postoperative rectal stenosis did not develop in patients in group 1, although it occurred in 8 patients (5%) in group 2 (p = 0.004). The 5-year cumulative recurrence rate between group 1 (9% (95% CI, 4%-13%)) and group 2 (12% (95% CI, 7%-17%)) did not differ significantly (p = 0.137), and the difference was within the noninferiority margin (absolute difference, -3.33% (95% CI, -10.00% to 3.55%)). LIMITATIONS The study was limited because it was a single-center trial. CONCLUSIONS Partial stapled hemorrhoidopexy is noninferior to circumferential stapled hemorrhoidopexy for patients with grade III to IV hemorrhoids at a median follow-up period of 5 years. However, partial stapled hemorrhoidopexy was associated with reduced postoperative pain and urgency, better postoperative anal continence, and minimal risk of rectal stenosis. See Video Abstract at http://links.lww.com/DCR/A790.Trial registration (chictr.org) identifier is chiCTR-trc-11001506.
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Leung ALH, Cheung TPP, Tung K, Tsang YP, Cheung H, Lau CW, Tang CN. A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique. Tech Coloproctol 2017; 21:737-743. [DOI: 10.1007/s10151-017-1669-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 06/19/2017] [Indexed: 12/22/2022]
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Affiliation(s)
- Jin Sub Kim
- Good Morning Coloproctology Clinic, Seoul, Korea
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Lin LH, Siu JJY, Liao PC, Chiang JH, Chou PC, Chen HY, Ho TJ, Tsai MY, Chen YH, Chen WC. Association of chronic obstructive pulmonary disease and hemorrhoids: A nationwide cohort study. Medicine (Baltimore) 2017; 96:e6281. [PMID: 28272246 PMCID: PMC5348194 DOI: 10.1097/md.0000000000006281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
According to traditional Chinese medicine (TCM) theory, a specific physiological and pathological relationship exists between the lungs and the large intestine. The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and hemorrhoids in order to verify the "interior-exterior" relationship between the lungs and the large intestine. A retrospective cohort study is conceived from the National Health Insurance Research Database, Taiwan. The 2 samples (COPD cohort and non-COPD cohort) were selected from the 2000 to 2003 beneficiaries of the NHI, representing patients age 20 and older in Taiwan, with the follow-up ending on December 31, 2011. The COPD cohort (n = 51,506) includes every patient newly diagnosed as having Chronic Obstructive Pulmonary Disease (COPD, ICD-9-CM: 490-492, 494, 496), who have made at least 2 confirmed visits to the hospital/clinic. The non-COPD cohort (n = 103,012) includes patients without COPD and is selected via a 1:2 (COPD: non-COPD) matching by age group (per 5 years), gender, and index date (diagnosis date of COPD for the COPD cohort). Compared with non-COPD cohorts, patients with COPD have a higher likelihood of having hemorrhoids and the age-, gender- and comorbidies-adjusted hazard ratio (HR) for hemorrhoids is 1.56 (95% confidence intervals [CI]:1.50-1.62). The adjusted HR of hemorrhoids for females is 0.79 (95% CI: 0.77-0.83), which is significantly less than that for males. The elderly groups, 40 to 59 years and aged 60 or above, have higher adjusted HRs than younger age groups (20-39 years), 1.19 (95% CI: 1.14-1.26), and 1.18 (95% CI: 1.12-1.24), respectively. Patients with COPD may have a higher likelihood to have hemorrhoids in this retrospective cohort study. This study verifies the fundamental theorem of TCM that there is a definite pathogenic association between the lungs and large intestine.
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Affiliation(s)
- Lih-Hwa Lin
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
| | - Justin Ji-Yuen Siu
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Po-Chi Liao
- Department of Urology, Taichung Veterans General Hospital
| | - Jen-Huai Chiang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Pei-Chi Chou
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Huey-Yi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
| | - Tsung-Jung Ho
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Division of Chinese Medicine, An Nan Hospital, China Medical University, Tainan
- Division of Chinese Medicine, China Medical University Beigang Hospital, Yunlin
| | - Ming-Yen Tsai
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Hsiang Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung
| | - Wen-Chi Chen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, Graduate Institute of Integrated Medicine, College of Chinese Medicine, College of Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung
- Departments of Urology, Chinese Medicine, Medical Research, and Obstetrics and Gynecology, Management Office for Health Data, China Medical University Hospital
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Jeong H, Hwang S, Ryu KO, Lim J, Kim HT, Yu HM, Yoon J, Lee JY, Kim HR, Choi YG. Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III-IV Prolapsing Hemorrhoids. Ann Coloproctol 2017; 33:28-34. [PMID: 28289661 PMCID: PMC5346778 DOI: 10.3393/ac.2017.33.1.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/02/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III-IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. METHODS We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. RESULTS Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. CONCLUSION PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III-IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids.
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Affiliation(s)
| | - Sunghwan Hwang
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Kil O Ryu
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Jiyong Lim
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Hyun Tae Kim
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Hye Mi Yu
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Jihoon Yoon
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Ju-Young Lee
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Hyoung Rae Kim
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
| | - Young Gil Choi
- Department of Surgery, Busan Hang-Un Hospital, Busan, Korea
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Lin HC, Luo HX, Zbar AP, Xie SK, Lian L, Ren DL, Wang JP. The tissue selecting technique (TST) versus the Milligan–Morgan hemorrhoidectomy for prolapsing hemorrhoids: a retrospective case–control study. Tech Coloproctol 2014; 18:739-44. [DOI: 10.1007/s10151-014-1187-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 02/19/2014] [Indexed: 01/24/2023]
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12
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Abstract
We describe a technique for the management of prolapsing hemorrhoids, with the aim to minimize the risk of anal stricture and rectovaginal fistula and to reduce the impact of the stapling technique on rectal compliance. This modified procedure was successfully applied in China, and preliminary data showed promising outcomes (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A117).
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Khubchandani IT. H.-C. Lin, D.-L. Ren, Q.-L. He, H. Peng, S.-K. Xie, D. Su, X.-X. Wang: Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol 2012; 16:345; discussion 347-8. [PMID: 22936580 DOI: 10.1007/s10151-012-0866-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/27/2022]
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14
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Ren DL, Lin HC. Reply to invited comment on “Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III–IV prolapsing hemorrhoids: a two-year prospective controlled study” by I. Khubchandani. Tech Coloproctol 2012. [DOI: 10.1007/s10151-012-0864-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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