Abstract
Aim
The object was to review our experience of the Procedure for Prolapse of Haemorrhoids (PPH) in the treatment of haemorrhoidal disease (HD), to assess results and document the need for reoperations and the long-term outcomes.
Methods
Eight hundred and forty patients with symptomatic grades II–IV HD, mean age 52.4 years, were surgically managed from 1/1999 to 9/2013. One hundred and fifteen displayed comorbidity of other anal pathology. All patients underwent PPH or double PPH, combined with accessory anal procedures in 104 cases. The distance from the dentate line to stapled line and the width of resected doughnut was recorded. Postoperative complications were encountered.
Results
The mean measured distance of the stapled to dentate line was 2.6cm and an incomplete/divided doughnut was found in 32 patients (3.8%). The mean hospital stay was 1.2 days. Early procedure-related complications arose that necessitated reintervention in 21 patients (2.5%). Thirty-eight patients (4.52%) developed late procedure-related complications that required surgery, with 28 (3.33%) displaying the most important recurrence. All patients were clinically examined at 1, 4 and 12 weeks, and were scheduled to be monitored annually for three years, after which they were instructed to contact us with any anorectal problem; 684 have been followed up for more than three years. Patient satisfaction at 12 weeks was high (98.33%). Quite low stapling caused severe pain or stenosis. Inadequate mucosectomy was related to stenosis or recurrence.
Conclusions
Experience of PPH in the treatment of grades II–III and selected IV HD confirms it as a safe and effective procedure with sustained favourable results. Recurrence after surgery is usually attributed to advanced disease or a too high stapled line and incomplete resected doughnut.
Περίληψη
Σκοπός
Παρουσιάζουμε την εμπειρία μας στη χειρουργική αντιμετώπιση της αιμορροΐδικής νόσου (ΑΝ) με τη μέθοδο PPH (Procedure for Prolapse and Haemorroids) και αξιολογούμε απώτερα αποτελέσματα και επανεγχειρήσεις.
Μέθοδοι
Tο διάστημα 1/1999-9/2013 840 ασθενείς μέσης ηλικίας 52.4 έτη χειρουργήθηκαν για συμπτωματική ΑΝ ΙΙ-ΙV βαθμού, ενώ 115 είχαν και άλλη συνυπάρχουσα παθολογία πρωκτού. Όλοι υποβλήθηκαν σε PPH ή διπλή PPH, 104 δε σε συμπληρωματικές πρωκτικές εγχειρήσεις. Καταγράψαμε την απόσταση οδοντωτής γραμμής από αναστόμωση και πλάτος- ακεραιότητα χειρουργικού παρασκευάσματος. Καταγράψαμε τις μετεγχειρητικές επιπλοκές.
Αποτελέσματα
Η μέση απόσταση οδοντωτής γραμμής από αναστόμωση ήταν 2.6 cm ενώ ανεπαρκής εκτομή βλεννογονικού δακτυλίου υπήρξε σε 32 ασθενείς (3.8%). Η μέση διάρκεια νοσηλείας ήταν 1.2 ημέρες. Ως έχουσες ευθεία σχέση με την PPH και που απαίτησαν επανεγχείρηση υπήρξαν επιπλοκές πρώιμες σε 21 ασθενείς (2.5%) και απώτερες σε 38 (4.52%). Υποτροπή υπήρξε σε 28 ασθενείς (3.33%). Όλοι οι ασθενείς εξετάσθησαν μετεγχειρητικά την 1η, 4η και 12η εβδομάδα, ανά έτος για 3 έτη και ακολούθως αναλόγως αναγκών, ενώ 684 παρακολουθήθηκαν για περισσότερο από τρία έτη. Την 12η εβδομάδα, το ποσοστό ικανοποίησης από την εγχείρηση ήταν υψηλό (98.33%). Η πολύ χαμηλή αναστόμωση προκάλεσε άλγος ή στένωση, η δε ανεπαρκής βλεννογονική εκτομή στένωση ή υποτροπή.
Συμπεράσματα
Η εφαρμογή της PPH στη θεραπεία της αιμορροΐδικής νόσου βαθμού ΙΙ-ΙΙΙ και επιλεκτικά ΙV είναι ασφαλής και αποτελεσματική σε μακρά διάρκεια. Η υποτροπή οφείλεται συνήθως σε προχωρημένη νόσο, υψηλή αναστόμωση και ανεπαρκή εκτομή.
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Avgoustou, C., Belegris, C., Papazoglou, A. et al. Safety and long-term duration effect of procedure for prolapse and haemorrhoids. Hellenic J Surg 87, 128–139 (2015). https://doi.org/10.1007/s13126-015-0197-2
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DOI: https://doi.org/10.1007/s13126-015-0197-2