ABSTRACT
AIM: The long-term results of stapled haemorrhoidopexy for prolapsed haemorrhoids were assessed using uniform methods to acquire data and pre-set definitions of failure, recurrence, residual symptoms and impaired continence. METHOD: From October 1999 to May 2005, 153 patients underwent a stapled haemorrhoidopexy and were enrolled prospectively. They were assessed preoperatively, postoperatively and at the end of the study from replies to a questionnaire about symptoms and continence. Preoperatively, manual reduction of prolapse was required in 103 patients, skin tags were found in 115 patients (circumferential in 22) and impaired continence in 63. RESULTS: In all, 145 patients completed preoperative and long-term protocols and were analysed as paired data, at a mean follow-up of 32 months. Failure to control the prolapse or recurrence was seen in 19 (13%) patients including nine reoperations for prolapse. Symptoms improved from 8.1 to 2.5 points on a 15-point scale (P = 0.001). Symptoms were not controlled in 25 (17%) patients. Continence improved from 4.7 to 2.9 points on a 15-point scale (P = 0.001). Twenty-five (17%) patients still had a continence disturbance. Altogether 51 (35%) patients had a deficient outcome with respect to prolapse, symptoms or continence. There were no major adverse events. CONCLUSION: Restoration of the anal anatomy by stapled haemorrhoidopexy resulted in a significant improvement in haemorrhoid-associated symptoms and continence but a third of patients had poor symptom control including 13% with persisting prolapse.
Subject(s)
Anal Canal/surgery , Hemorrhoids/surgery , Surgical Stapling , Adolescent , Adult , Aged , Aged, 80 and over , Anal Canal/pathology , Fecal Incontinence/epidemiology , Fecal Incontinence/etiology , Female , Follow-Up Studies , Hemorrhoids/complications , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Prolapse , Prospective Studies , Recurrence , Self Report , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The aim was to assess the feasibility of performing stapled haemorrhoidopexy under local anaesthesia. METHODS: Fifty-eight patients with haemorrhoid prolapse were randomized to receive local or general anaesthesia. The perianal block was applied immediately peripheral to the external sphincter. Submucosal block was added after applying the purse-string suture. Patients reported average and peak pain daily for 14 days using a visual analogue scale (VAS). They also completed anal symptom questionnaires before the operation and at follow-up. The surgeon assessed the restoration of the anal anatomy 3-6 months after surgery. RESULTS: The anal block was sufficient in all patients. The mean accumulated VAS score for average pain was 23.1 in the general anaesthesia group and 29.4 in the local anaesthesia group (P = 0.376); mean peak pain scores were 42.1 and 47.9 respectively (P = 0.537). Mean change in symptom load was also similar between the groups, with score differences of 7.0 in the general anaesthesia group and 6.1 in the local anaesthesia group. No patient had a recurrence of prolapse. CONCLUSION: Perianal local block is easy to apply with a high degree of acceptability among patients. Postoperative pain, restoration of anatomy and symptom resolution were similar to that of stapled haemorrhoidopexy performed under general anaesthesia. REGISTRATION NUMBER: ISRCTN19930199 (http://www.controlled-trials.com).
Subject(s)
Anesthesia, General/methods , Hemorrhoids/surgery , Nerve Block/methods , Pain, Postoperative/prevention & control , Surgical Stapling/methods , Adult , Aged , Aged, 80 and over , Anal Canal/innervation , Anal Canal/surgery , Feasibility Studies , Female , Humans , Male , Middle Aged , Patient Satisfaction , Prospective Studies , Surgical Stapling/adverse effects , Treatment OutcomeABSTRACT
PURPOSE: Haemorrhoid prolapse is an indication for surgery. A correlation between worsening anatomy and increasing symptoms is commonly assumed. We developed a classification algorithm of prolapse and external component, and evaluated its correlation to symptoms before and after surgery. METHOD: A study population comprising 180 patients operated for haemorrhoids in a multicentre randomized trial plus a validation set comprising 90 patients operated by us. The classification used three items: (i) patient self-report of prolapse requiring manual reposition; (ii) surgeon assessment of prolapse when patient negated manual reposition; (iii) surgeon assessment of external component. Patient self-reported were rated by frequency (never, 0 points; monthly, 1 point; weekly, 2 points and daily, 3 points). The algorithm yielded three grades: 1, no prolapse; 2, spontaneously reducing prolapse and 3, prolapse needing manual repositioning. The degree of external component was affixed as A, none; B, one or few tags and C, circumferential. RESULTS: Anatomical grades did not differ between the two sets of patients before or after surgery. Preoperatively, 69% had grade 3 prolapse. Postoperatively, 89% were classified as grades 1A or B. The symptom load was similar for grades 2 and 3; mean 6.5 points preoperatively and 1.8 points postoperatively. CONCLUSION: This anatomical classification, based on strict criteria, reliably staged the haemorrhoid prolapse. There was no unique preoperative symptom profile associated with any degree of prolapse with or without an external component. Restored anal anatomy relieved symptoms. The classification also defined recurrence of haemorrhoids.
