Our Experience of Stapler Hemorrhoidopexy in the Treatment of Hemorrhoids.

Yıl 2020, Cilt: 4 Sayı: 3, 82 - 87, 12.12.2020

Muhammed Gömeç Hüseyin Özden

https://doi.org/10.46332/aemj.773538

Öz

Purpose: Hemorrhoid surgeries performed with stapler hemorrhoidopexy are frequently preferred in the treatment of patients with stage III-IV hemorrhoids, with less pain and shorter hospital stay. The aim of this study is to evaluate our clinical experiences in patients underwent SH.

Material and Method: Hospital records of 26 patients with stage III-IV hemorrhoids treated with SH procedure be-tween June 2018 and October 2019 at a secondary center were retrospectively analyzed. Demographic data of patients, accompanying anal diseases, duration of surgery and hospital stay, postoperative pain, complications and early recur-rence rates were reviewed.

Results: A total of 26 patients was included in the study, 18 males (69%) and 8 females (31%). The mean age of the patients was 36,4 years (age range: 18-64). The mean operation time was 14 minutes and the mean hospital stay after the operation was 2.8 days. Bleeding was observed in one patient (3.8%), urinary retention in 2 (7.7%) and skin tag (7.7%) in 2. Recurrence was observed in one patient in the first six months. None of the patients had tenesmus, ab-scess, incontinence, rectovaginal fistula, or anal stenosis.

Conclusion: SH is a minimally invasive, feasible technique that can be used to treat stage III-IV hemorrhoids and can provide effective treatment in a single session. However, we believe that the choice of surgical procedures is important since complications such as recurrence and bleeding are rarely seen in the early and late periods.

Anahtar Kelimeler

Hemorrhoids, longo procedure, minimal invasive

Hemoroid Tedavisinde Stapler Hemoroidopeksi Deneyimlerimiz.

Öz

Amaç: Stapler hemoroidopeksi (Longo prosedürü) ile yapılan hemoroid ameliyatları, daha az ağrı ve daha kısa hasta-nede kalış süresi ile özellikle evre III-IV hemoroidli hastaların tedavisinde sık tercih edilebilen bir cerrahi yöntemdir. Bu çalışmanın amacı kliniğimizde stapler hemoroidopeksi (SH) yöntemi ile tedavi etmiş olduğumuz hastalarla ilgili klinik deneyimlerimizi değerlendirmektir.

Araçlar ve Yöntem: İkinci basamak bir devlet hastanesinde Haziran 2018 ile Ekim 2019 tarihleri arasında SH yönte-mi uygulanarak tedavi edilen evre III-IV hemoroidli 26 hastanın tıbbi kayıtları retrospektif olarak incelendi. Hastala-rın demografik verileri, eşlik eden anal bölge hastalıkları, ameliyat ve hastanede yatış süreleri, postoperatif dönemde gelişen ağrıları, komplikasyonları ve erken dönem nüks oranları değerlendirildi.

Bulgular: Çalışmaya dahil edilen 26 hastanın 18'i erkek (%69), 8'i kadındı (%31). Hastalar 18-64 yaş aralığında ve ortalama yaş 36,4 olarak hesaplandı. Ortalama ameliyat süresi 14 dakika ve ameliyat sonrası ortalama hastanede kalış süresi 2.8 gündü. Bir hastada kanama (% 3,8), 2 hastada idrar retansiyonu (% 7,7) ve 2 hastada deri katlantısı (skin tag) (% 7,7) görüldü. 1 hastada ilk 6 ayda nüks izlendi. Hiçbir hastada tenesmus, apse, inkontinans, rektovajinal fistül veya anal darlık görülmedi.

Sonuç: Stepler hemoroidopeksi, evre III-IV hemoroid hastalarını tedavi etmek için kullanılan, tek seansta etkili bir tedavi ortaya koyabilen, minimal invaziv, uygulanabilir bir tekniktir. Ancak erken ve geç dönemde nüks ve kanama gibi komplikasyonlar nadir de olsa görülebildiğinden cerrahi prosedür seçiminin önemli olduğu kanaatindeyiz.  

Anahtar Kelimeler

longo prosedürü, hemoroid, minimal invaziv

Kaynakça

• 1. Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorr-hoids: pathology, pathophysiology and aetiology. Br J Surg. 1994;81(7):946-954.
• 2. Nisar PJ, Scholefield JH. Managing haemorrhoids. BMJ. 2003;327(7419):847-851.
• 3. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 1992;35(5):477-481.
• 4. Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM. Haemorrhoidectomy with Ligasure vs conventional exci-sional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 2010;12(2):85-93.
• 5. Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: A comprehensive review. J. Am. Coll. Surg. 2007;204(1):102-117.
• 6. Panarese A, Pironi D, Vendettuoli M, et al. Stapled and conventional Milligan-Morgan haemorrhoidectomy: diffe-rent solutions for different targets. Int J Colorectal Dis 2012;27(4):483-487.
• 7. Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapler suturing device: a new procedure. Proceeding of the 6th world Congress of Endoscopic Surgery. 1998:777-784.
• 8. Kilonzo MM, Brown SR, Bruhn H, et al. Cost Effective-ness of Stapled Haemorrhoidopexy and Traditional Exci-sional Surgery for the Treatment of Haemorrhoidal Dise-ase. Pharmacoeconomics. 2018;2(3):271-280.
• 9. Majumder KR, Karmakar R. Short Term and Long Term Outcome Following Stapled Haemorrhoidopexy. Mymen-singh Med J 2019;28(4):866-871.
• 10. Riss S, Weiser FA, Schwameis K, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012;27(2):215-220.
• 11. Sturiale A, Fabiani B, Menconi C, et al. Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years. Tech Coloproctol. 2018;22(9):689-696.
• 12. Thomson WH. The nature of haemorrhoids. Br J Surg 1975;62(7):542-552.
• 13. Corman ML, Gravié JF, Hager T, et al. Stapled haemorr-hoidopexy: a consensus position paper by an international working party - indications, contra-indications and tech-nique. Int J Colorectal 2003;5(4):304-310.
• 14. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg 2008;95(2):147-160.
• 15. Thaha MA, Campbell KL, Kazmi SA, et al. Prospective randomised multi-centre trial comparing the clinical effi-cacy, safety and patient acceptability of circular stapled anopexy with closed diathermy haemorrhoidectomy. Gut. 2009;58(5):668-678.
• 16. Naldini G, Martellucci J, Moraldi L, Romano N, Rossi M. Is simple mucosal resection really possible? Considerati-ons about histological findings after stapled hemorrhoido-pexy. Int J Colorectal Dis 2009;24(5):537-541.
• 17. Festen S, Molthof H, van Geloven AA, Luchters S, Ger-hards MF. Predictors of recurrence of prolapse after pro-cedure for prolapse and haemorrhoids. Int J Colorectal 2012;14(8):989-996.
• 18. Hosseini SV, Tahamtan M, Khazraei H, Bananzadeh A, Hajihosseini F, Shahidinia SS. Effects of Stapled Hemorr-hoidopexy on Anorectal Function: A Prospective Rando-mized Controlled Trial. Iran J Med Sci 2018;43(6):581-586.
• 19. Madoff RD, Fleshman JW. American Gastroenterological Association technical review on the diagnosis and treat-ment of hemorrhoids. Gastroenterology. 2004;126(5):1463-1473.
• 20. Picchio M, Greco E, Di Filippo A, Marino G, Stipa F, Spaziani E. Clinical Outcome Following Hemorrhoid Sur-gery: a Narrative Review. Indian J Surg Oncol. 2015;77(3):1301-1307.
• 21. Ravo B, Amato A, Bianco V, et al. Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol 2002;6(2):83-88.
• 22. Ceci F, Picchio M, Palimento D, Calì B, Corelli S, Spaziani E. Long-term Outcome of Stapled Hemorrhoidopexy for Grade III and Grade IV Hemorrhoids. Dis Colon Rectum 2008;51(7):1107-1112.
• 23. Kim J-S, Vashist YK, Thieltges S, et al. Stapled hemorrho-idopexy versus Milligan–Morgan hemorrhoidectomy in circumferential third-degree hemorrhoids: long-term re-sults of a randomized controlled trial. J Gastrointest Surg. 2013;17(7):1292-1298.
• 24. Schmidt J, Dogan N, Langenbach R, Zirngibl H. Fecal urge incontinence after stapled anopexia for prolapse and hemorrhoids: a prospective, observational study. World J Surg. 2009;33(2):355-364.
• 25. Zaheer S, Reilly WT, Pemberton JH, Ilstrup D. Urinary retention after operations for benign anorectal diseases. Dis. Colon Rectum 1998;41(6):696-704.
• 26. Wilson MS, Pope V, Doran HE, Fearn SJ, Brough WA. Objective Comparison of Stapled Anopexy and Open Hemorrhoidectomy. Dis Colon Rectum 2002;45(11):1437-1444.
• 27. Lan P, Wu X, Zhou X, Wang J, Zhang L. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis 2006;21(2):172-178.