The Comparison of a C-Shaped Partial Stapled Hemorrhoidopexy (C-PSH) Versus Circular Stapled Hemorrhoidopexy (CSH) in Patients with IV Grade Hemorrhoid: A Retrospective Study

Aims The aims of this study were to present a C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of IV grade hemorrhoid and to assess the clinical outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). Methods Conventional CSH kit matched with an intestinal spatula was used for performing C-PSH. One hundred and fifty eight patients who suffered IV grade hemorrhoid and underwent C-PSH or CSH at Hangzhou Third hospital between December 2017 and July 2019 were retrospected. Intraoperative and postoperative outcomes in both groups were collected and analyzed. Results Operative time, estimated blood loss and hospital stay were similar in both two groups (p values were 0.238, 0.563 and 0.101 respectively). Pain scores on the first defecation, 1st, 2nd, 3rd and 7th postoperative days in the C-PSH group were respectively lower than those in the CSH group, and the numeric rating scale (NRS) scores were 3.29±1.52 vs. 4.23±1.99 (p=0.001), 3.82±1.49 vs. 4.63±1.17 (p<0.001), 3.12±1.51 vs. 3.71±1.85 (p=0.030), 2.67±1.52 vs. 3.37±1.54 (p=0.005) and 1.34±0.92 vs.1.84±1.14 (p=0.003). Fecal urgency incidences in the C-PSH group were lower than those in the CSH group on the 1st, 2nd, 3rd and 7th postoperative days, and the incidences occurred in the C-PSH group vs. CSH group were 44.7% vs. 61.0% (p=0.041), 30.3% vs. 46.3% (p=0.038), 25.0% vs. 43.9% (p=0.013) and 13.2% vs. 35.4% (p=0.001) respectively. Overall postoperative complications rate occurred in the CSH group was higher than that in the C-PSH group, (16/82 vs. 6/76, p=0.035). Six patients suffered from anal stenosis in the CSH group and no patient suffered from stenosis in the C-PSH group (p=0.047). One year recurrence rate in the C-PSH group and CSH group was 8.0% (6/75) vs. 6.3% (5/79), (p=0.687). Conclusions The C-PSH seems to be an efficacy and safety technique in treating IV grade hemorrhoid. It has advantages in alleviating postoperative pain, fecal urgency and anal stenosis compared with CSH. It could be an alternative technique in the treatment of IV grade hemorrhoid.

Evolution of Surgical Management of Hemorrhoidal Disease: An Historical Overview

Hemorrhoidal disease (HD) is the symptomatic enlargement and/or distal displacement of the normal hemorrhoidal cushions and is one of the most frequent diseases in colorectal surgery. Several surgical or office-based therapies are currently available, with the aim of being a more tailored approach. This article aimed to elucidate the historical evolution of surgical therapy for HD from ancient times, highlighting the crucial steps, controversies, and pioneers in the field. In contrast with the previous literature on the topic that is often updated to the 1990s, with the introduction of stapled hemorrhoidopexy and transanal hemorrhoidal dearterialization, this article describes all new surgical and office-based treatments introduced in the first 20 years of the 2000s.

Stapled Hemorrhoidopexy: “Mucosectomy or Not Only Mucosectomy, This Is the Problem”

Introduction: Stapled hemorrhoidopexy was originally defined as a rectal mucosectomy. The aims of our retrospective, single-center study were to demonstrate if the excised specimen comprises only the mucosa or more wall rectal layers and if the latter excision should be considered a technical mistake with an increase in complications.Materials and Methods: We histopathologically analyzed surgical samples from patients who underwent stapled hemorrhoidopexy performed between 2014 and 2019. Patients were divided into three groups, according to the stapler used: Group A (single PPH®), Group B (double PPH®), and Group C (CPH34 HV™). We evaluated the actual wall layers included in the stapled rectal ring. For every specimen, we reconstructed the history of the corresponding patient and the incidence of complications.Results: Of the 137 histological slides available, 13 were only mucosectomies (9.5%), and 124 presented also the submucosa and muscularis propria (90.5%)−50/58 patients in Group A, 28/28 in Group B, and 46/51 in Group C. No statistically significant difference in the rate of complications was found when stratifying patients according to the thickness of the resection [mucosectomy (M) or “full thickness” (FT)].Discussion: Stapled hemorrhoidopexy is not a simple mucosectomy but a resection of the rectal wall with almost all its layers. This concept defines the entity of the surgical procedure and excludes a direct correlation with an increased rate of complications.

Do We Need Fluid Restriction After Stapled Hemorrhoidopexy? A Pilot, Double-Blinded, Randomized Controlled Trial

Background: Conventional hemorrhoidectomy leads to a high urinary retention rate and fluid restriction is commonly recommended to minimize complications. However, the need for postoperative fluid restriction among patients who have undergone stapled hemorrhoidopexy is unclear. We aimed to determine whether fluid restriction after stapled hemorrhoidopexy with/without partial external hemorrhoidectomy could reduce urinary retention and postoperative pain.Patients And Methods: In this prospective, double-blinded, randomized controlled trial, we enrolled patients who had grade III or IV hemorrhoids and underwent stapled hemorrhoidopexy with/without partial external hemorrhoidectomy; 250 mL/12 h of sterile 0.9% saline was administered to the fluid restriction group after the operation, and 1000 mL/12 h was given to the non-fluid-restriction group. We focused on the need for fluid restriction after stapled hemorrhoidopexy.Results: Fifty patients were studied in two groups. The surgical outcomes of the two groups were no different. The median subjective pain scores at 0, 8, 16, 24 h after the operation showed no significant difference between the two groups (p = 0.55 at 0 h; p = 0.38 at 8 h; p = 0.98 at 16 h; and p = 0.66 at 24 h). The mean times to first urination after the operation were 700.04 ± 455.03 min in the non-fluid-restriction group and 737.16 ± 426.32 min in the fluid-restriction group (no significant difference; p = 0.67). No postoperative urinary retention was found in either group of patients.Conclusions: Fluid restriction after stapled hemorrhoidopexy is unnecessary.Trial registration: This study was reviewed and approved by the Tri-Service General Hospital Institutional Review Board for human subjects (No. 2-106-05-063). This study also had trial registration with clinicalTrials.gov (Identifier: NCT04459039).

STAPLED HEMORRHOIDOPEXY A BETTER AND SAFER ALTERNATIVE TO OPEN HEMORRHOIDECTOMY IN THE MANAGEMENT OF GRADE III & IV HEMORRHOIDS- A HOSPITAL BASED STUDY

Background: Surgical hemorrhoidectomy is usual method for management in hemorrhoid grade III and IV. It is generally associated with postoperative pain, long hospital stay and a longer convalescence. Stapled hemorrhoidopexy is a newer minimally invasive alternative for the treatment of hemorrhoids. Aims: In this study, the above two methods were compared with respect to short term outcomes. Settings and Design: This was a prospective and randomized study. Methods: 60 patients having grade 3 or 4 hemorrhoids and who fullled the criteria were included in the study. Thirty patients underwent stapled hemorrhoidopexy and other thirty underwent open hemorrhoidectomy. All patients were reviewed immediately after surgery and at 1, 3 and6 weeks post-operatively. The two groups were compared in terms of duration of surgery, hospital stay, return to work and post-operative level of satisfaction . Statistical Analysis: The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software. Signicance was assessed at 5% level of signicance. Student t-test was used to nd the signicance of study parameters on continuous scale in parametric condition between two groups (inter group analysis) and Mann Whitney U test was used to nd the signicance of study parameters on continuous scale in non-parametric condition within each group. Chi-square/ Fisher Exact test were used to nd the signicance of study parameters on categorical scale between two groups. Results: The overall mean age of patients in our study was 41.35 ± 12.80. The majority of patients in the study were males (78.3%) and had grade 3 haemorrhoids (93.3%). Stapled hemorrhoidopexy group had shorter duration of surgery, less postoperative pain and need for analgesia, shorter duration of hospital stay and earlier return to work and a high patient satisfaction as compared with open hemorrhoidectomy group. Conclusions: Stapled hemorrhoidopexy is a minimally invasive, better and safer alternative to open hemorrhoidectomy with many short-term benets.