Stapler Method in Hemorrhoids and Mucosal Prolapses: Review

Yıl 2008, Cilt: 2 Sayı: 3, 410 - 416, 20.11.2008

Emre Ergül

Öz

Hemorrhoids are vascular cushions in the anal canal that are present from birth. They form a spongy bolster and prevent damage to the anal sphincters during defecation. Hemorrhoidal tissues are part of the normal anatomy of the distal rectum and anal canal. Hemorrhoids and mucosal prolapses are the most treated pathologies at surgical daily practice. Heredity, anatomic specialties, climate and nutritional environments, job, age, infections, pregnancy, a lot of physical exercise, chronic cough, chronic constipation, dressing tight clothes and portal hypertension were suspected for the etiology of these disorders. Internal hemorrhoids are classified in 4 types: 1° hemorrhoids occasionally bleed, 2° hemorrhoids not only bleeds but also protruding through the anus and spontaneously get reducted, 3° hemorrhoids not only bleeds but also protruding through the anus and can be manually reducted, 4° hemorrhoids not only bleeds but also protruding through the anus and can not be reducted. We aimed to review the final scientific knowledge about these disorders. An extensive Medline search, textbooks, scientific reports and scientific journals are the data sources. We also reviewed reference lists in all articles retrieved in the search as well as those of major texts regarding hemorrhoids and mucosal prolepsus. There are a lot of treatment strategies which were described. These are palliative treatment, scleroteraphy, elastic ligation, crio-coagula-tion, foto-coagulation, excisional hemorrhoidectomy and stapler. Stapler is an easy, cheap and effective technique at the treatment of hemorrhoids and mucosal prolapses.

Anahtar Kelimeler

Cerrahi stapler; hemoroid; fızyopatoloji; klinik protokoller Hemoroid, Mukozal Prolapsusta, Hemoroid

Hemoroid ve Mukozal Prolapsusta Stapler Yöntemi

Öz

Hemoroidler doğumdan itibaren var olan damarsal yastıkçıklardır. Dışkılama sırasında anal sfınkterin yaralanmasını önlerler. Hemoroidal doku normal rektum ve anal kanal anatomisinin bir parçasıdır. Hemoroid ve mukozal prolapsus hastaları genel cerrahide poliklinik muayenesinde en sık karşılaşılan hasta grubudur. Bu grup hastalıkların etiyolojisinde kalıtım, anatomik özellik, iklim ve beslenme alışkanlıkları, meslek, yaş, enfeksiyöz nedenler, gebelik, aşırı egzersiz, kronik öksürme ve ıkınma, sıkı elbise ve iç çamaşır giymek ve portal hipertansiyon suçlanmaktadır. Internal hemoroidler 4 tiptir: 1° hemoroidler kanama yapar, 2° hemoroidler kanar ve prolabe olur, spon-tan olarak redükte olurlar, 3° hemoroidler kanar ve prolabe olur, manuel olarak redükte olurlar, 4° hemoroidler kanar ve inkarsere olurlar ve redükte edilemezler. Bu çalışmada bu önemli ve sık rahatsızlığın patofizyolojisi ve tedavisinde kabul görmüş protokoller ve yenilikleri değerlendirerek bulunduğumuz yeri tanımlamaya çalıştık. Bu amaçla tüm literatür ve belli başlı kaynak kitaplar tarandı. En geniş içerikli bilgi en kısa şekilde özetlenerek derlendikten sonra yazıya döküldü. Tüm bu değerlendirmelerin sonucunda kabul görmüş skleroterapi, elastik ligasyon, krio-koagulas-yon, foto-koagulasyon, eksizyonel hemoroidektomi gibi bazı protokollerin yanında hemoroid ve mukozal prolapsusun, stapler ile tedavisi; basit ve öğrenmesi kolay gibi görünmektedir. Maliyetin yüksekliği bir dezavantaj olmasına rağmen, hastanede kalma ve ameliyat süresinin kısa olması, ameliyat sonrası ağrı ve komplikasyonlarının daha az olması nedeniyle alternatif bir yaklaşım gibi görünmektedir.

Samet YALÇIN, Emre ERGÜL, Ali Erkan UÇAR, Birol KORUKLUOĞLU, Ahmet KUŞDEMİR,

Anahtar Kelimeler

Cerrahi stapler; hemoroid; fızyopatoloji; klinik protokoller Hemoroid, Mukozal Prolapsusta, Hemoroid

Kaynakça

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