recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Evolución de síntomas a corto plazo y grado de satisfacción del paciente tras hemorroidectomía convencional / Evolution of short-term symptoms and degree of patient satisfaction after conventional hemorrhoidectomy

Resumen Introducción La hemorroidectomía es el tratamiento de elección para las hemorroides sintomáticas, reservado para pacientes con hemorroides grado III o IV o sin respuesta a tratamiento conservador. Existen diversas técnicas quirúrgicas, cuyo grado de resolución de síntomas y satisfacción por parte del paciente posee resultados variados. Objetivos Evaluar al corto plazo la sintomatología y grado de satisfacción de los pacientes operados de hemorroidectomía convencional en el Complejo Asistencial Dr. Sótero del Río. Materiales y Métodos Se realizó una encuesta telefónica retrospectiva a pacientes operados de hemorroidectomía convencional durante junio de 2015 a enero de 2016. Se preguntó por síntomas en el preoperatorio, al mes y a los 6 o más meses posoperados. Se evaluó sangrado, prurito, dolor, sensación de prolapso e incontinencia. El análisis estadístico consideró los resultados según los 5 síntomas evaluados y luego dicotomizados según relevancia clínica. Se consideró un valor p significativo < 0,01. Resultados Cuarenta y tres pacientes respondieron la encuesta, con una mediana de edad de 55 años (17-80). La mediana de evaluación fue de 8 meses (6-12). Considerando los síntomas: sangrado, prurito, dolor y prolapso, 35 pacientes (79%) presentaban 3 o más síntomas preoperatorios considerados significativos. La persistencia al seguimiento varía entre un 9 a un 28%. En el análisis estadístico con síntomas dicotomizados, existe una disminución estadísticamente significativa al mes y a los 6 o más meses posoperados. Discusión La hemorroidectomía convencional es bien evaluada por los pacientes en relación a una resolución significativa de síntomas de la enfermedad hemorroidal.

Background Hemorrhoidectomy is the treatment of choice for symptomatic hemorrhoids, reserved for patients with grade III or IV hemorrhoids or no response to conservative treatment. There are several surgical techniques, whose degree of resolution of symptoms and patient satisfaction has varied results. Objectives To evaluate in the short term the symptomatology and degree of satisfaction of patients undergoing conventional hemorrhoidectomy in Complejo Asistencial Dr. Sótero del Río. Material and Methods A retrospective telephone survey was applied to patients undergoing conventional hemorrhoidectomy from June 2015 to January 2016. The survey includes questions about symptoms in the pre-operative, at the month and at 6 or more months post-operated. Bleeding, pruritus, pain, prolapsed sensation and incontinence were evaluated. The statistical analysis considered the results according to the 5 symptoms evaluated in the survey and then dichotomized according to clinical relevance. A significant p value < 0.01 was considered. Results 43 patients answered the survey, with a median age of 55 years (17-80). The median evaluation was 8 months (6-12). Considering the symptoms: bleeding, pruritus, pain and prolapse, 35 patients (79%) had 3 or more preoperative symptoms considered significant. Persistent follow-up ranges from 9 to 28%. In the statistical analysis with dichotomized symptoms, there is a statistically significant decrease at one month and at 6 or more months post-surgery. Conclusion Conventional hemorrhoidectomy is well evaluated by patients in relation to a significant resolution of hemorrhoidal disease symptoms.

Circular Stapled Hemorrhoidectomies in the Treatment of Hemorrhoids

The circular stapled hemorrhoidectomy is a new treatment modality for hemorrhoids requiring surgical management. This study reviews the available information concerning the present results of this procedure. A medline search and a review of the literature wene conducted to identify available information on the procedure, with a special attention being given to on-going or published randomized clinical trials. The advantages of circular stapled hemorrhoidectomy were analyzed based on different areas of concern, including postoperative pain, operating time, duration of hospital stay and recovery of normal activity, postoperative wound care, and types and rates of complications. Continence status and patient satisfaction following a circular stapled hemorrhoidectomy are also reported. The circular stapled hemorrhoidectomy is safe, easy to perform, and effective in the treatment of advanced hemorrhoids with an external mucosal prolapse. Other advantages include minimal postoperative complications, easier postoperative management, and a shorter time to return to work congenial to a conventional hemorrhoidectomy. Despite the higher cost and difficult access, this study confirms the feasibility of using a circular stapled hemorrhoidectomy in the treatment of hemorrhoids. The circular stapled hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach. A longer follow-up is required to confirm the true efficacy of this surgical method.

Clinical Expriences of Circumferential Stapled Hemorrhoidectomy

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.

Clinical Expriences of Circumferential Stapled Hemorrhoidectomy

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.

Clinical Results of Conventional Versus Circular Stapled Hemorrhoidectomy

PURPOSE: A circular stapled hemorrhoidectomy involves the simultaneous excision of hemorrhoids and wound closure without perianal dissection, thereby eliminating a potential contamination of the anal wound. This study was designed to investigate whether a closed hemorrhoidectomy using the circular stapled technique offers any advantage over the conventional technique. METHODS: Twenty-three patients with prolapsed symptomatic hemorrhoids were treated by either a conventional (n=13) (conventional group) or a circular stapled (n=11) hemorrhoidectomy (stapled group). The operation time was recorded and the excised tissue was examined histologically. The pain score, any complications, the number of days before returning to normal activity and the patients' satisfaction were recorded. A follow up was done using a questionnaire or by telephone interview a week after the operation, and satisfaction was checked a month after the operation. RESULTS: The conventional operation was quicker to perform (mean 23.1 min vs 26.8 min), but did not reach a significant value (P>0.05). In the stapled group, the analgesic requirement was less than for the conventional group (4.4 times vs 6.9 times), but again did not reach a significant value (P>0.05). There were 4 cases of postoperative complications in the conventional group (30.7%) and 3 cases in the stapled group (27.3%) with no significant difference between two groups (P>0.05). The mean pain score was lower in the stapled group (3.5 vs 4.8)(P0.05). CONCLUSION: A circular stapled hemorrhoidectomy is an effective treatment for third and forth degree prolapsed hemorrhoids, offering the significant advantages of reduced postoperative pain and an earlier return to normal activity.