After anorectal surgery,hemorrhoids frequently lead to chronic issues,partic-ularly in patients with mixed hemorrhoids.Liu et al investigated the outcomes of staple removal at the 3-and 9-o’clock positions following ...After anorectal surgery,hemorrhoids frequently lead to chronic issues,partic-ularly in patients with mixed hemorrhoids.Liu et al investigated the outcomes of staple removal at the 3-and 9-o’clock positions following modified stapled hemorrhoidopexy(SH)in patients with grade III or IV hemorrhoids.This study included patients who underwent standard or modified SH between January 1,2015,and January 1,2020.Key metrics assessed included hospital stay duration,blood loss,operation time,and the incidence of minor or major complications.The findings indicated that the modified SH technique is a safe option for advanced-grade hemorrhoids,resulting in a lower rate of postoperative anal stenosis compared to standard SH.Notably,this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments.While the modified SH demonstrates immediate benefits,further research is necessary to evaluate long-term effects.Despite its advantages,the study’s limited sample size restricts the generalizability of the findings,underscoring the need for larger,long-term studies to validate these results.Clinically,the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis,a common concern following typical surgeries.If confirmed by larger trials,this procedure may become the preferred surgical approach for hemorrhoids.In conclusion,the work of Liu et al signifies a meaningful advancement in hemorrhoid surgery,enhancing patient safety and outcomes.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the...BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the removal of the circumferential staples of the anastomosis,followed by the creation of a hand-sewn anastomosis.Numerous studies have reported modified SH procedures to improve outcomes.We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.AIM To compare outcomes of staple removal at the 3-and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.METHODS This was a single-center,retrospective,observational study.Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015,and January 1,2020,were included.The operation time,blood loss,length of hospital stay,and incidence of minor or major complic-ations were recorded.RESULTS Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015 and January 1,2020,were included.Operation time,blood loss,length of hospital stay,and incidence of minor or major complications were recorded.We investigated 187 patients(mean age,50.9 years)who had undergone our modified SH and 313 patients(mean age,53.0 years)who had undergone standard SH.In the modified SH group,54%of patients had previously undergone surgical intervention for hemorrhoids,compared with the 40.3%of patients in the standard SH group.The modified SH group included five(2.7%)patients with anal stenosis,while 21(6.7%)patients in the standard SH group had complications of anal stenosis.There was a significant relationship between the rate of postoperative anal stenosis and the modified SH:0.251(0.085-0.741)and 0.211(0.069-0.641)in multiple regression analysis.The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.CONCLUSION The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.展开更多
Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal fistulas.There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery.However...Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal fistulas.There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery.However,the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken.Incidentally,there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period.In this article,we discuss the challenges faced while interpreting the postoperative MRI,the timing of the postoperative MRI,the utility of MRI in the postoperative period for the management of anal fistulas,the importance of the active involvement and experience of the treating clinician in interpreting MRI scans,and the latest advancements in the field.展开更多
文摘After anorectal surgery,hemorrhoids frequently lead to chronic issues,partic-ularly in patients with mixed hemorrhoids.Liu et al investigated the outcomes of staple removal at the 3-and 9-o’clock positions following modified stapled hemorrhoidopexy(SH)in patients with grade III or IV hemorrhoids.This study included patients who underwent standard or modified SH between January 1,2015,and January 1,2020.Key metrics assessed included hospital stay duration,blood loss,operation time,and the incidence of minor or major complications.The findings indicated that the modified SH technique is a safe option for advanced-grade hemorrhoids,resulting in a lower rate of postoperative anal stenosis compared to standard SH.Notably,this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments.While the modified SH demonstrates immediate benefits,further research is necessary to evaluate long-term effects.Despite its advantages,the study’s limited sample size restricts the generalizability of the findings,underscoring the need for larger,long-term studies to validate these results.Clinically,the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis,a common concern following typical surgeries.If confirmed by larger trials,this procedure may become the preferred surgical approach for hemorrhoids.In conclusion,the work of Liu et al signifies a meaningful advancement in hemorrhoid surgery,enhancing patient safety and outcomes.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal hemorrhoids.Postoperative anal stenosis is a critical complication of SH.A remedy for this involves the removal of the circumferential staples of the anastomosis,followed by the creation of a hand-sewn anastomosis.Numerous studies have reported modified SH procedures to improve outcomes.We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.AIM To compare outcomes of staple removal at the 3-and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.METHODS This was a single-center,retrospective,observational study.Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015,and January 1,2020,were included.The operation time,blood loss,length of hospital stay,and incidence of minor or major complic-ations were recorded.RESULTS Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015 and January 1,2020,were included.Operation time,blood loss,length of hospital stay,and incidence of minor or major complications were recorded.We investigated 187 patients(mean age,50.9 years)who had undergone our modified SH and 313 patients(mean age,53.0 years)who had undergone standard SH.In the modified SH group,54%of patients had previously undergone surgical intervention for hemorrhoids,compared with the 40.3%of patients in the standard SH group.The modified SH group included five(2.7%)patients with anal stenosis,while 21(6.7%)patients in the standard SH group had complications of anal stenosis.There was a significant relationship between the rate of postoperative anal stenosis and the modified SH:0.251(0.085-0.741)and 0.211(0.069-0.641)in multiple regression analysis.The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.CONCLUSION The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.
文摘Magnetic resonance imaging(MRI)is considered the gold standard for the evaluation of anal fistulas.There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery.However,the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken.Incidentally,there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period.In this article,we discuss the challenges faced while interpreting the postoperative MRI,the timing of the postoperative MRI,the utility of MRI in the postoperative period for the management of anal fistulas,the importance of the active involvement and experience of the treating clinician in interpreting MRI scans,and the latest advancements in the field.
