Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction

BACKGROUND Hemorrhoidal prolapse is a common benign disease with a high incidence.The treatment procedure for prolapse and hemorrhoids(PPH)remains an operative method used for internal hemorrhoid prolapse.Although it is related to less posoperative pain,faster recovery and shorter hospital stays,the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy(MMH).We have considered that recurrence could be due to shortage of the pulling-up effect.This issue may be overcome by using lower purse-string sutures[modified-PPH(M-PPH)].AIM To compare the therapeutic effects and the patients’satisfaction after M-PPH,PPH and MMH.METHODS This retrospective cohort study included 1163 patients(M-PPH,461;original PPH,321;MMH,381)with severe hemorrhoids(stage III/IV)who were admitted to The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from 2012 to 2014.Early postoperative complications,efficacy,postoperative anal dysfunction and patient satisfaction were compared among the three groups.Established criteria were used to assess short-and long-term postoperative complications.A visual analog scale was used to evaluate postoperative pain.Follow-up was conducted 5 years postoperatively.RESULT Length of hospital stay and operating time were significantly longer in the MMH group(8.05±2.50 d,19.98±4.21 min;P<0.0001)than in other groups.The incidence of postoperative anastomotic bleeding was significantly lower after MPPH than after PPH or MMH(1.9%,5.1%and 3.7%;n=9,16 and 14;respectively).There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH(15%,8%and 10%;n=69,30 and 32;respectively).There was a significantly lower rate of recurrence after M-PPH than after PPH(8.7%and 18.8%,n=40 and 61;P<0.0001).The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups(1.3%and 4.3%,n=5 and 20;P=0.04).Patient satisfaction was significantly greater after M-PPH than after other surgeries.CONCLUSION M-PPH has many advantages for severe hemorrhoids(Goligher stage III/IV),with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.

Evaluation of the clinical efficacy and safety of TST33 mega hemorrhoidectomy for severe prolapsed hemorrhoids

BACKGROUND The pathogenesis of hemorrhoids is mainly anal cushion prolapse.Although the traditional treatment has a certain curative effect,it is not ideal.The remission rate of postoperative symptoms is low.Even if temporary remission is achieved,patients with hemorrhoids easily relapse after 1-2 years.The new technique of using staplers to treat prolapsed hemorrhoids has good therapeutic effects in clinical practice.AIM To explore the effect of TST33 mega stapler prolapse and hemorrhoid mucosal resection in the treatment of patients with severe prolapsed hemorrhoids.METHODS A total of 204 patients with severe prolapse hemorrhoids who were admitted to the department of anorectal in our hospital from April 2018 to June 2020 were selected,and the patients were randomly divided into group A and group B with 102 cases in each group using a randomized controlled clinical research program.Patients in Group A were treated with a TST33 mega stapler and hemorrhoid mucosal resection to treat prolapse,and patients in Group B were treated according to the Procedure for Prolapse and Hemorrhoids;the operation time,intraoperative blood loss,hospital stay,the difference in operation time,intraoperative blood loss,hospitalization time,pain degree before and after operation,degree of anal edema,anal Wexner score,and surgical complications were compared between the two groups of patients.RESULTS The operation time,intraoperative blood loss and hospitalization time in Group A were significantly lower than those in Group B(P<0.05).The cure rate of Group A was 98.04%,compared with 95.10%cure rate of Group B,and the difference was not statistically significant(P>0.05).The visual analogue scale(VAS)at 12 h and 24 h postoperatively in Group A were significantly lower than those in Group B(P<0.05).The comparison of the VAS scores between Group A and Group B at 48 h,72 h and 96 h postoperatively revealed that the difference was not statistically significant(P>0.05).One day postoperatively,the degree of perianal edema in Group A was compared with that in Group B,and the difference was not statistically significant(P>0.05).Seven days postoperatively,the degree of perianal edema in Group A was significantly lower than that in Group B(P<0.05).The comparison of anal Wexner scores between the two groups preoperatively and at 1 mo,3 mo and 6 mo postoperatively showed that the difference was not statistically significant(P>0.05).The Wexner scores of the two groups at 1 mo,3 mo and 6 mo postoperatively were significantly lower than the scores preoperatively(P<0.05).The postoperative complication rate of Group A was 2.94%lower than that of Group B(11.76%),which was statistically significant(P<0.05).CONCLUSION TST33 mega anastomotic hemorrhoidectomy treatment for patients with severe prolapse hemorrhoids,leads to less postoperative pain,the rapid recovery of perianal edema and has fewer complications.

Clinical Experience Sharing Of 218 Cases without Hemorrhage after Procedure for Prolapse and Hemorrhoids

Objective:To summarize the experience without hemorrhage after PPH of 218 patients with mixed hemorrhoid.Methods:PPH(Procedure for prolapse and hemorrhoids)was performed routinely.During operation,it is paid attention that the hemorrhoid artery should be completely mutilated,the anastomat should be squeezed before and after the anastomosis,the anastomosis should be carefully examined,the hemostasis should be completely performed,and relevant hemostasis measures should be taken after the operation.Results:None of the 218 patients had postoperative hemorrhage.Conclusion:Relevant measures can be taken after operation to prevent the occurrence of postoperative hemorrhage.

Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females

BACKGROUND Internal rectal prolapse(IRP)is one of the most common causes of obstructive constipation.The incidence of IRP in women is approximately three times that in men.IRP is mainly treated by surgery,which can be divided into two categories:Abdominal procedures and perineal procedures.This study offers a better procedure for the treatment of IRP.AIM To compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair(IPFLR)combined with a procedure for prolapse and hemorrhoids(PPH)and the laparoscopic IPFLR alone in the treatment of IRP in women.METHODS This study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014.The patients were divided into groups A and B.Group A had 63 patients who underwent laparoscopic IPFLR alone,and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH.The degree of internal rectal prolapse(DIRP),Wexner constipation scale(WCS)score,Wexner incontinence scale(WIS)score,and Gastrointestinal Quality of Life Index(GIQLI)score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.RESULTS All laparoscopic surgeries were successful.The general information,number of bowel movements before surgery,DIRP,GIQLI score,WIS score,and WCS score before surgery were not significantly different between the two groups(all P>0.05).The WCS score,WIS score,GIQLI score,and DIRP in each group 6 mo,and 2 years after surgery were significantly better than before surgery(P<0.001).In group A,the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery(P<0.001),and the GIQLI score progressively improved from 6 mo to 2 years after surgery(P<0.05).In group B,the DIRP,WCS score and WIS score significantly improved from 6 mo to 2 years after surgery(P<0.05),and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery(P<0.05).The WCS score,WIS score,GIQLI score,and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery(all P<0.001,Bonferroni)except DIRP at 2 years after surgery.There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery(P=0.011).There was no significant difference in postoperative grade I-III complications between the two groups(P=0.822).CONCLUSION Integral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.