COMPARISON OF EXCISIONAL STAPLER HEMORRHOIDOPEXY METHOD(SH) AND NON-EXCISIONAL ARTERIAL DETECTION LIGATION METHOD(ADL); ONE YEAR FOLLOW-UP

Öz

Giriş: Hemoroidal hastalık alt rektum ve anüs bölgesinin kronik bir hastalığıdır ve ıkınma sırasında artan basınç nedeniyle oluşur. Dünya çapında milyonlarca insanda hemorhoidal hastalık mevcuttur. Hastalığın evresi ile hastaların semptomları paralellik göstermediği için iki farklı cerrahi yöntemin sonuçlarını değerlendirdik; arteriyel tespit ligasyonu (ADL) ve stapler hemoroidopexy (SH). Gereç ve Yöntemler: 2021-2022 yılları arasında hemoroid nedeniyle opere edilen hastalar arasında gerçekleştirilmiş retrospektif bir çalışmadır. Sonuç: Evre II, III ve IV olan erişkin hastalar dahil edildi. 60 hasta içeren SH ve ADL grupları oluşturuldu. Hastaların ameliyat sonrası ağrı şikayetleri (VAS) ve normal günlük aktiviteleri (KATZ) incelendi. Bu çalışmada istatistiksel analizler NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, ABD) paket programı ile yapılmıştır. Hastaların 50'si kadın, 70'i erkekti. SH ve ADL gruplarının yaş ve cinsiyet dağılımları arasında fark yoktu (p=0,231, p=0,711). 1. gün VAS değerleri SH grubunda ADL grubuna göre istatistiksel olarak anlamlı yüksek bulundu (p=0,003). Her iki grubun günlük aktiviteleri incelendiğinde giyinme(p=0,042) ve tuvalete gitme (p=0,012) aktiviteleri SH grubunda daha düşüktü. Ağrı değerlendirmeleri açısından ise gruplar arasında istatistiksel olarak anlamlı fark vardı (SH; p= 0,0001, ADL; p=0,0001). Tartışma: Her iki yöntem incelendiğinde iki tekniğin başarı oranı benzerdi ve ADL yöntemi anorektal bölge anatomisini ciddi komplikasyon riski olmadan en az etkilemektedir.

Anahtar Kelimeler

• hemorrhoids
• treatment
• stapler hemorrhoidopexy
• arterial detection liagtion

Comparison of Excisional Stapler Hemorrhoidopexy Method and Non-Excisional Arterial Detection Ligation Method; One Year Follow-Up

Abstract

Abstract Aim: Hemorrhoidal disease is a chronic disease of the lower rectum and anus occurs due to increased pressure during straining. Millions of people in the world suffer from this disease. Since the stage of the disease and the symptoms of the patients do not show parallelism, we evaluated the results of two different surgical methods; arterial detection ligation (ADL) and stapler hemorrhoidopexy (SH). Methods: A retrospective study among patients who were operated for hemorrhoids between 2021-2022. Results: Adult patients with Grades II, III and IV were included. SH and ADL groups containing 60 patients were formed. Pain complaints (VAS) and normal daily activities (KATZ) of patients after surgery were examined. In this study, statistical analyzes were performed with NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) package program. 50 of the patients were female and 70 were male. There was no difference between the age and gender distributions of the SH and ADL groups (p=0.231, p=0.711). On the 1st day VAS values in the SH group were found to be statistically significantly higher than the ADL group (p=0.003). When the daily activities of both groups were examined, the dressing (p=0.042) and toileting (p=0.012) activities in the SH group were lower. On the other hand, there was a statistically significant difference within the groups (SH; p= 0,0001, ADL; p=0,0001) related to the pain assessments. Conclusions: When both methods were examined, the success rate of two techniques was similar and ADL least affects the anatomy of the anorectal region without serious complication risk.

Keywords

• Hemorrhoids
• treatment
• Stapler hemorrhoidopexy (SH)
• Arterial detection ligation (ADL)

Kaynakça

1. 1.Kaidar -Person O, Person B, Wesner SD. Hemorrhoidal disease: a compre¬hensive review. J Am Coll Surg. 2007; 204(1): 102-17. https://doi.org/10.1016/j.jamcollsurg
2. 2.Perry KR, Geibel J. Hemorrhoids. May 31, 2022 https://emedicine.medscape.com/article/775407-print;1-21.
3. 3.Gerjy R, Lindhoff-Larson A, Nystrom PO. Grade of prolapse and symptoms of hemorrhoids are poorly correlated: result of a classification algoritm in 270 patients. Colorectal Dis. 2008; 10(7): 694-700. https://doi.org/10.1111/j.1463-1318.2008.01498.x
4. 4.Nelson H, Cima RR. Anus. In: Townsend, Beauchamp, Evers, Mattox,eds. Sabiston Textbook of Surgery. 18thed. Saunders Elsevier 2008: 1433-62.
5. 5.Arbman G, Krook H, Haapaniemi S. Closed vs. open hemorrhoidectomy-is there any difference? Dis Colon Rectum. 2000; 43(1): 311-34. https://doi.org/10.1007/BF02237240
6. 6.Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular -suturing device: a new procedure. Proceedings of the Sixth World Congress of Endoscopic Surgery, Rome, Italy; 1998:777.
7. 7.Jaiswal CSS, Gupta MD, Davera SLS. Stapled hemorrhoidopexy-Initial expe¬rience from a general surgery center. Medical Journal Armed Forces Indıa. 2013; 69(2): 119-23. https://doi.org/10.1016/j.mjafi.2012.08.015
8. 8.Faucherson JL, Voirin D, Abba J. Rectal perforation with life-threatening peritonitis following stapled hemorrhoidopexy. Br J Surg. 2012; 99(6): 746-53. https://doi.org/10.1002/bjs.7833

9. 9.Eberspacher C, Magliocca FM, Pontone S, et al. Stapled Hemorrhoidopexy. Front. Surg. Sec. Visceral Surgery. 2021; 12(8): 1-5. https://doi.org/10.3389/fsurg.2021.655257
10. 10.Ripetti V, Caricato M, Arullani A. Rectal perforation, retropneumoperito¬neum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations. Dis Colon Rec¬tum. 2002; 45(2): 268-70. https://doi.org/10.1007/s10350-004-6159-3
11. 11.Molloy RG, Kingsmore D. Life threatening pelvic sepsis after stapled hem¬orrhoidectomy. Lancet 2000; 4;355(9206): 810. https://doi.org/10.1016/S0140-6736(00)02208-X 12.Ciprani S, Pescatori M. Acute rectal obstruction after PPH stapled hemor¬rhoidectomy. Colorectal Dis. 2002; 4(5): 367-70. https://doi.org/10.1046/j.1463-1318.2002.00409
12. 13.Slawik S, Kenefick N, Greenslade GI, Dixon AR. A prospective evaluation of stapled haemorrhoidopexy/rectal mucosectomy in the management of 3rd and 4th degree hemorrhoids. Colorectal Dis. 2007; 9(4): 352-6. https://doi.org/10.1111/j.1463-1318.2006.01163.x
13. 14.Lan p, Wu X, Zhou X, et al. The safety and efficacy of stapled hemor-rhoidopexy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis. 2006; 21(2): 172-8. https://doi.org/10.1007/s00384-005-0786-6
14. 15.Law WL, Tung HM, Chu KW, et al. Ambulatory stapled hemorrhoidec-tomy: a safe and feasible surgical technique. Hong Kong Med J. 2003; 9(2):103-7.
15. 16.Nystrom PO, Quist N, Rahaave D. Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for hemorrhoidal pro¬lapsed. Br J Surg. 2010; 97(2):167-76. https://doi.org/10.1002/bjs.6804
16. 17.Lumb KJ, Colquhoun PH, Malthaner R, et al. Stapled versus Conventional Surgery for Hemorrhoids (Review). The Cochrane Library. 2006. https://doi.org/10.1002/14651858.CD005393.pub2
17. 18.Giordano P, Overton J, Madeddu F, et al . Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum. 2009; 52(9): 1665 https://doi.org/10.1007/DCR.0b013e3181af50f4
18. 19.Sohn N, Aronoff JS, Cohen FS, et al. Transanal hemorrhoidal dearterializa¬tion is an alternative to operative hemorrhoidectomy. Am J Surg. 2001; 182(5): 515-9. https://doi.org/10.1016/s0002-9610(01)00759-0
19. 20.Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum. 2007; 50(6): 878-92. https://doi.org/10.1007/s10350-006-0852-3
20. 21.Elmer SE, Nygren JO, Lenander CE. A randomized trial of transanal hem-orrhoidal dearterialization with anopexoy compared with anopexy com-pared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum. 2013; 56(4): 484-90. https://doi.org/10.1097/DCR.0b013e31827a8567
21. 22.Ratto C, Parello A, Veronese E, et al. Doppler-guided transanal haemor-rhoidal dearterialization for hemorrhoids: results from a multicenter trial. Colorectal Dis. 2015; 17(1): 10-9. https://doi.org/10.1111/codi.12779 23.Jeong WJ, Cho SW, Noh KT, et al. One year follow-up results of Doppler-guided hemorrhoidal artery ligation and rectoanal repair in 97 consecutive patients. J Korean Soc Coloproctol. 2011; 27(6): 298-302. https://doi.org/10.3393/jksc.2011.27.6.298
22. 24.Faucheron JL, Poncet G, Voirin D, et al. Doppler-guided hemorrhoidal ar¬tery ligation and rectoanal repair (HAL-RAR) for treatment of grade IV hem¬orrhoids: long term results in 100 consecutive patients. Dis Colon Rectum. 2011; 54(2):226-31. https://doi.org/10.1007/DCR.0b013e318201d31c
23. 25.Zenger S, Gurbuz B, Can U, et al. A new technique of doppler dearteriali-zation for hemorhoidal disease: arterial detection ligation(ADL). Surgery To¬day. 2021; 51(4): 612-18. https://doi.org/10.1007/s00595-020-02164-7