Long-Term Outcomes of Sectorial Longitudinal Augmented Prolapsectomy for Asymmetric Muco-hemorrhoidal Prolapse: An Observational Study of 433 Consecutive Patients

Purpose. Hemorrhoidal disease (HD) is a widespread condition severely influencing patients’ quality of life. Recently, the large diffusion of stapled hemorrhoidopexy has revealed a new unexpected pathological entity: the asymmetric mucosal prolapse. We aimed to assess the outcomes of the sectorial longitudinal augmented prolapsectomy (SLAP), a technique dedicated to asymmetric prolapse, in terms of HD symptoms, prolapse recurrence, and rectal stenosis. Methods. Patients affected by III–IV-degree symptomatic HD with asymmetric mucosal prolapse undergone SLAP of 1 or 2 hemorrhoidal columns (SLAP1 or SLAP2) were retrospectively assessed. The severity of hemorrhoid symptoms and fecal continence status were evaluated before and after surgery. Mean outcome was evaluation of medium–long-term outcomes as the occurrence of recurrence and anal or rectal stenosis. Secondary outcome was the evaluation of postoperative bleeding, reoperation rate, length of hospitalization, fecal urgency, and time to return to work. Results. We enrolled 433 patients (277 SLAP1 and 156 SLAP2). Hemorrhoidal symptoms recurrence was reported in 9 patients undergone SLAP1 and 4 patients undergone SLAP2, while prolapse recurrence occurred, respectively, in 4 and 2 patients. No major intraoperative complications occurred. An emergency reintervention for postoperative bleeding occurred in 13 cases undergone SLAP1 and in 5 patients treated with SLAP2. Fecal incontinence occurred in 8 and 4 cases of patients treated with SLAP1 and SLAP2. Conclusions. The combination of a simple hemorrhoidectomy to a mucosal rectal prolapsectomy should be part of every coloproctologist background. Promising and satisfying results can be achieved using SLAP for HD associated with asymmetric prolapse.

The Importance of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Predicting the Appearance of the Rectal Stenosis or Rectal Obstruction in Patients with Rectal Adenocarcinomas

The purpose of this study was to establish a correlation between markers of inflammation and the risk of rectal stenosis or obstruction, in patients with rectal adenocarcinomas. We performed a retrospective observational study on 188 patients diagnosed with rectal adenocarcinomas. We attempted to establish a correlation between the neutrophils to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR) levels and the presence of rectal stenosis or rectal obstruction. From 188 patients included in the study, 65 patients had stenotic tumors (34.57% of cases) and 10 patients had occlusive tumors (5.31% of cases). We obtained a statistically significant correlation between the blood levels of neutrophils, lymphocytes, platelets, and the existence of rectal stenosis. (p[0.05). The cutoff value of NLR that correlates with the presence of rectal stenosis was 2.5 (95% CI: 0.426-0.574, AUC: 0.500). As for PLR, the cutoff value correlated with the presence of rectal stenosis was 106,522 (95%CI: 0.428-0.575, AUC: 0.502). We established a statistically significant correlation between NLR, PLR and rectal obstruction (p[0.05). The cutoff value of the NLR that correlates with the presence of rectal obstruction was 4.633 (95%CI: 0.614-0.751, AUC: 0.685). As for PLR, the cutoff value correlated with the presence of rectal stenosis was 345.05 (95% CI: 0.673-0.803, AUC: 0.742). Our study shows that there is a statistically significant correlation between NLR and PLR and the risk of rectal obstruction in patients with adenocarcinomas. It is still necessary to conduct prospective studies on much larger lots of patients to determine the NLR and PLR values that can predict rectal stenosis as well as rectal obstruction.