Stapled haemorrhoidopexy for haemorrhoids in combination with lateral internal sphincterotomy for fissure-in-ano

S3-Leitlinie: Analfissur

Die Analfissur ist eine der häufigsten Pathologien, welche sich dem Proktologen präsentiert. Entsprechend ist es wichtig, verlässliche Leitlinien dazu zu entwickeln. Die aktuelle Leitlinie wurde anhand eines systematischen Literaturreview von einem interdisziplinären Expertengremium diskutiert und verabschiedet.

Die akute Analfissur, soll auf Grund ihrer hohen Selbstheilungstendenz konservativ behandelt werden. Die Heilung wird am besten durch die Einnahme von Ballaststoff reicher Ernährung und einer medikamentösen Relaxation durch Kalziumkanal-Antagonisten (CCA) unterstützt. Zur Behandlung der chronischen Analfissur (CAF), soll den Patienten eine medikamentöse Behandlung zur „chemischen Sphinkterotomie“ mittels topischer CCA oder Nitraten angeboten werden. Bei Versagen dieser Therapie, kann zur Relaxation des inneren Analsphinkters Botulinumtoxin injiziert werden. Es ist belegt, dass die operativen Therapien effektiver sind. Deshalb kann eine Operation schon als primäre Therapie oder nach erfolgloser medikamentöser Therapie erfolgen. Die Fissurektomie, evtl. mit zusätzlicher Botulinumtoxin Injektion oder Lappendeckung, ist die Operation der Wahl. Obwohl die laterale Internus Sphinkterotomie die CAF effektiver heilt, bleibt diese wegen dem höheren Risiko für eine postoperative Stuhlinkontinenz eine Option für Einzelfälle.

The role of hemorrhoidopexy in the management of 3rd degree hemorrhoids

INTRODUCTION

Hemorrhoidopathy is a very common benign surgical pathology. Hemorrhoids are divided into 4 stages, depending on symptoms and degree of prolapse. Hemorrhoidopexy is a technique developed for the treatment of 3rd degree hemorrhoids, but its application has been extended to the treatment of 4th degree hemorrhoids as well. Nevertheless, recent studies identify weaknesses of the PPH in the treatment of 4th degree hemorrhoids.

PATIENTS

One hundred and twenty-six consecutive patients with 3rd degree hemorrhoids underwent stapled hemorrhoidopexy. All procedures were performed under general anesthesia with the patient in lithotomy position. A phosphate enema was given to the patient 2 h before the procedure, and cephalosporine and metronidazole were administered at anesthesia induction. Most patients were discharged the day after the operation. All patients were reassessed at 1, 6 weeks, 6 and 12 months after the procedure.

RESULTS

The mean operating time was 16.3 min. Of all patients, 5.8% complained of mild rectal pain for a post-operative period of 5-12 days, 5.8% developed post-operative urinary retention, managed with catheterization, 13.3% experienced fecal urgency while 5.8% experienced gas incontinence, which subsided 2-8 weeks from surgery. The mean hospital stay was 1.2 days. Most patients returned to daily activities within 2-5 days. Ninety-five percent of patients returned for their follow-up visits. Recurrence of the disease occurred in 8 patients (6.6%). It was managed conservatively in 2 patients, 3 underwent redo hemorrhoidopexy and 3 underwent classic hemorrhoidectomy.

CONCLUSION

According to our results, stapled hemorrhoidopexy seems to be a safe, pain-free and, in the long-term, effective technique for the treatment of 3rd degree hemorrhoids.

Our criteria for PPH procedure in one day surgery practice

Background

The aim of this report is to analyse our results and to underline our criteria for day surgery practice.

Patients and methods

Our patients are selected according to ASA criteria. Occasionally, the patients with some risk factors are selected but only when their concomitant diseases are well controlled.

Results

We have treated 673 patients with the third and early fourth degree haemorrhoids. We have had patients with several minor problems causing no influence on the success of the procedure. Good haemostasis, preventing postoperative bleeding, is the most important factor.

Conclusion

Among proctological procedures in haemorrhoid treatment, the PPH technique has firm and well-accepted position even in ambulatory surgery.