LONG TERM RESULTS AFTER STAPLED HEMORRHOIDOPEXY ALONE AND COMPLEMENTED BY EXCISIONAL HEMORRHOIDECTOMY: A RETROSPECTIVE COHORT STUDY

IS IT POSSIBLE TO OPTIMIZE STAPLED HEMORRHOIDOPEXY OUTCOMES BY ENLARGING OPERATIVE CRITERIA INDICATIONS? RESULTS OF A TAILORED PROCEDURE WITH ASSOCIATED RESECTION IN A COMPARATIVE PERSONAL SERIES

BACKGROUND

Since its introduction, stapled hemorrhoidopexy has been increasingly indicated in the management of hemorrhoidal disease.

AIM

Our primary end point was to evaluate the incidence of recurrent disease requiring another surgical intervention. On a secondary analysis, we also compared pain, complications, and patient's satisfaction after a tailored surgery.

METHODS

We retrospectively reviewed 196 patients (103 males and 93 females) with a median age of 47.9 years (range, 17-78) who were undergoing stapled hemorrhoidopexy alone (STG; n=65) or combined surgery (CSG; n=131, stapled hemorrhoidopexy associated with resection).

RESULTS

Complications were detected in 11 (5.6%) patients (4.6% for STG vs. 6.1% for CSG; p=0.95). At the same time, symptoms recurrence (13.8% vs. 8.4%; p=034), reoperation rate for complications (3.1% vs. 3.0%; p=1.0), and reoperation rate for recurrence (6.1% vs. 4.6%; p=1.0) were not different among groups. Grade IV patients were more commonly managed with simultaneous stapling and resection (63% vs. 49.5%), but none of them presented symptoms recurrence nor need reoperation due to recurrence. Median pain score during the first week was higher in CSG patients (0.8 vs. 1.7). After a follow-up of 24.9 months, satisfaction scores were similar (8.6; p=0.8).

CONCLUSION

Recurrent symptoms were observed in 10% of patients, requiring surgery in approximately half of them. Even though the association of techniques may raise pain scores, a tailored approach based on amplified indication criteria and combined techniques seems to be an effective and safe alternative, with decreased relapse rates in patients suffering from more advanced hemorrhoidal disease. Satisfaction scores after hemorrhoidopexy are high.

Effectiveness of Mayinglong Musk Hemorrhoid Ointment on Wound Healing and Complications after Internal Hemorrhoid Ligation and External Hemorrhoidectomy

Objective

To investigate the effect of Mayinglong Musk Hemorrhoids Ointment on wound healing and complications after internal hemorrhoid ligation and external hemorrhoidectomy.

Methods

This is a retrospective study. A total of 100 patients with mixed hemorrhoids who were treated in our hospital from August 2019 to October 2020 were recruited and assigned to an operation group (n = 50, internal hemorrhoid ligation, and external hemorrhoidectomy) or a combined group (n = 50, use of Mayinglong Musk Hemorrhoid Ointment after internal hemorrhoid ligation and external hemorrhoidectomy). The wound-healing effect, wound-healing time, visual analog scale (VAS), anal function, and complications were compared between the two groups.

Results

The combined group exhibited a significantly higher total effective rate of wound healing when compared with the operation group (p < 0.05). The patients in the combined group experienced remarkably faster wound healing than the operation group (p < 0.05). The visual analog scale (VAS) score of the combined group was significantly lower than that of the operation group (p < 0.05). The combined group obtained superior anal function than the operation group (p < 0.001).

Conclusion

Mayinglong Musk Hemorrhoid Ointment combined with internal hemorrhoid ligation and external hemorrhoidectomy in the treatment of mixed hemorrhoids yields remarkable outcomes. It improves the wound healing outcomes, accelerates wound healing, relieves postoperative pain, enhances anal function, and reduces the occurrence of postoperative complications in the patient.

STAPLED HEMORRHOIDOPEXY: RESULTS, LATE COMPLICATIONS, AND DEGREE OF SATISFACTION AFTER 16 YEARS OF FOLLOW-UP

Stapled hemorrhoidopexy has been widely used for the treatment of hemorrhoids, but concerns about complications and recurrences after prolonged follow-up are still under debate.

Surgical technique is the main predictor of recurrence in the management of haemorrhoids

BACKGROUND

The pursuit of better management for haemorrhoidal disease (HD) is far from over, and even with the latest surgical procedures, none of the treatment options is close to perfect. The aims of this study were to review our experience with patients treated for symptomatic HD, compare the different treatment strategies in terms of complication and recurrence rates and determine predictors of recurrence.

METHODS

A total of 1958 patients who underwent a procedure for HD performed by a single colorectal consultant surgeon between 2000 and 2015 were reviewed.

RESULTS

The treatment performed was rubber band ligation (RBL) in 73%, excisional haemorrhoidectomy (EH) in 16% and stapled haemorrhoidopexy (SH) in 11%. After a mean follow-up of 42.1 months, 242 patients (12%) developed recurrence. Logistic regression analysis of multiple factors showed that treatment received was a significant predictor of recurrence. RBL had the lowest post-operative complication rate but had the highest recurrence rate. EH had the lowest recurrence rate. SH had the highest complication rate but with similar recurrence rates to EH. Complications included pain, anal fissure, bleeding and urinary retention.

CONCLUSION

Low-grade HD can initially be treated with RBL with good results. Although conventional EH remains a mainstay operation for recurrent and complicated HD, SH can also be considered in selected cases particularly when performed by a surgeon with adequate experience. Treatment should be tailored to the individual based on patient preference, suitability, degree of haemorrhoids and symptomatology.

PPH AND BIOLOGICAL GLUE IN PATIENTS WITH HIGH RISK OF BLEEDING IN STAPLED HEMORRHOIDOPEXY

Background:

Stapled hemorrhoidopexy is a common treatment for grade 3 hemorrhoids. Patients with conditions that increase the risk of bleeding, as cardiac stents usage with clopidogrel bissulfate and liver cirrhosis, should receive an extra care in surgical procedures due to the high risk of bleeding. For this reason and for patients with third degree hemorrhoids we propose the use of stapled hemorrhoidopexy followed by the use of biological glue.

Aim:

Assess surgical outcomes in patients with hemorrhoids and high risk of bleeding submitted to stapled hemorrhoidopexy followed by biological glue.

Methods:

Between 2005 and 2015, 22 patients were analyzed, in a retrospective cohort study.

Results:

From 22 patients submitted to stapled hemorrhoidopexy followed by the use of biological glue, only one (4.5%) presented bleeding in the surgical postoperative. Patients do not have any other complications and pain in the postoperative period. The median (IQR) operation duration was 55 (12) min and the median (IQR) length of hospital stay after surgery was 3 (2) days.

Conclusion:

Patients with high risk of bleeding submitted to stapled hemorrhoidopexy followed by the use of biological glue presented very low rates of bleeding in the postoperative period.