AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they unde...AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.展开更多
AIM:To compare the effects and postoperative complications between tissue selecting therapy stapler(TST)and Milligan-Morgan hemorrhoidectomy(M-M).METHODS:Four hundred and eighty patients with severe prolapsing hemorrh...AIM:To compare the effects and postoperative complications between tissue selecting therapy stapler(TST)and Milligan-Morgan hemorrhoidectomy(M-M).METHODS:Four hundred and eighty patients with severe prolapsing hemorrhoids,who were admitted to the Shenyang Coloproctology Hospital between 2009and 2012,were randomly divided into observation(n=240)and control(n=240)groups.Hemorrhoidectomies were performed with TST in the observation group and with the M-M technique in the control group.The therapeutic effects,operation security,and postoperative complications in the two groups were compared.The immediate and long-term complications were assessed according to corresponding criteria.Pain was assessed on a visual analogue scale.The efficacy was assessed by specialized criteria.The follow-up was conducted one year after the operation.RESULTS:The total effective rates of the observation and control groups were 99.5%(217/218)and 98.6%(218/221)respectively;the difference was not statistically significant(P=0.322).Their were significant differences between observation and control groups in intraoperative blood loss(5.07±1.14 vs 2.45±0.57,P=0.000),pain(12 h after the surgery:5.08±1.62 vs 7.19±2.01,P=0.000;at first dressing change:2.64±0.87 vs 4.34±1.15,P=0.000;first defecation:3.91±1.47 vs 5.63±1.98,P=0.001),urine retention(n=22 vs n=47,P=0.001),anal pendant expansion after the surgery(2.35±0.56 vs 5.16±1.42,P=0.000),operation time(18.3±5.6 min vs 29.5±8.2 min,P=0.000),and the length of hospital stay(5.3±0.6 d vs 11.4±1.8 d,P=0.000).Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence(n=3 vs n=16,P=0.003),difficult bowel movement(n=1 vs n=9,P=0.011),intractable pain(n=2 vs n=12,P=0.007),and anal discharge(n=3 vs n=23,P=0.000).CONCLUSION:TST for severe prolapsing hemorrhoids is a satisfactory technique for more rapid recovery,lower complication rates,and higher operation security.展开更多
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 ...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.展开更多
文摘AIM:To identify a more effective treatment protocol for circumferential mixed hemorrhoids.METHODS:A total of 192 patients with circumferential mixed hemorrhoids were randomized into the treatment group,where they underwent Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection,or the control group,where traditional external dissection and internal ligation were performed.Postoperative recovery and complications were monitored.RESULTS:The time to wound healing was 12.96 ± 2.25 d in the treatment group shorter than 19.58 ± 2.71 d in the control group.Slight pain rate was 58.3% in the treatment group higher than 22.9% in the control group;moderate pain rate was 33.3% in the treatment group lower than 56.3% in the control group severe pain rate was 8.4% in the treatment group lower than 20.8% in the control group.No edema rate was 70.8% in the treatment group higher than 43.8% in the control group;mild local edema rate was 26% in the treatment group lower than 39.6% in the control group obvious local edema was 3.03% in the treatment group lower than 16.7% in the control group.No stenosis rate was 85.4% in the treatment group higher than 63.5% in the control group;moderate stenosis rate was 14.6% in the treatment group Lower than 27.1% in the control group severe anal stenosis rate was 0% in the treatment group lower than 9.4% in the control group.CONCLUSION:Milligan-Morgan hemorrhoidectomy with anal cushion suspension and partial internal sphincter resection is the optimal treatment for circumferential mixed hemorrhoids and can be widely applied in clinical settings.
文摘AIM:To compare the effects and postoperative complications between tissue selecting therapy stapler(TST)and Milligan-Morgan hemorrhoidectomy(M-M).METHODS:Four hundred and eighty patients with severe prolapsing hemorrhoids,who were admitted to the Shenyang Coloproctology Hospital between 2009and 2012,were randomly divided into observation(n=240)and control(n=240)groups.Hemorrhoidectomies were performed with TST in the observation group and with the M-M technique in the control group.The therapeutic effects,operation security,and postoperative complications in the two groups were compared.The immediate and long-term complications were assessed according to corresponding criteria.Pain was assessed on a visual analogue scale.The efficacy was assessed by specialized criteria.The follow-up was conducted one year after the operation.RESULTS:The total effective rates of the observation and control groups were 99.5%(217/218)and 98.6%(218/221)respectively;the difference was not statistically significant(P=0.322).Their were significant differences between observation and control groups in intraoperative blood loss(5.07±1.14 vs 2.45±0.57,P=0.000),pain(12 h after the surgery:5.08±1.62 vs 7.19±2.01,P=0.000;at first dressing change:2.64±0.87 vs 4.34±1.15,P=0.000;first defecation:3.91±1.47 vs 5.63±1.98,P=0.001),urine retention(n=22 vs n=47,P=0.001),anal pendant expansion after the surgery(2.35±0.56 vs 5.16±1.42,P=0.000),operation time(18.3±5.6 min vs 29.5±8.2 min,P=0.000),and the length of hospital stay(5.3±0.6 d vs 11.4±1.8 d,P=0.000).Moreover TST showed significant reductions compared to M-M in the rates of long-term complications such as fecal incontinence(n=3 vs n=16,P=0.003),difficult bowel movement(n=1 vs n=9,P=0.011),intractable pain(n=2 vs n=12,P=0.007),and anal discharge(n=3 vs n=23,P=0.000).CONCLUSION:TST for severe prolapsing hemorrhoids is a satisfactory technique for more rapid recovery,lower complication rates,and higher operation security.
文摘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.
