to investigate preventive measures of rectal stricture after procedure for prolapse and hemorrhoids (PPH) and to intervene early.
Methods
A total of 400 patients with severe mixed hemorrhoids hospitalized in the [anonymous hospital] from January 2018 to February 2022 were randomly divided into the experimental group and control group A, B, and C, with 100 patients in each group. Experimental group: Thread-drawing during operation and anal enlargement after PPH. Group A: Thread-drawing during PPH surgery, group B: Anal enlargement after PPH, and group C: PPH alone. The anastomotic sites of the 4 groups were observed for 1-2 months and followed up for 1-3 years.
Results
The effective rate of mixed hemorrhoid treatment in the 4 groups was 100%. There was no rectal stenosis in the experimental group, 11% in group A, 7% in group B, and 14% in group C.
Conclusion
Multipoint thread-drawing and anal enlargement after PPH can avoid postoperative rectal stenosis and can strengthen anastomosis and reduce bleeding, while being a simple procedure that can be easily popularized.
JiLLiLWengLHuYHuangHWeiJ. Tissue selecting technique mega-window stapler combined with anal canal epithelial preservation operation for the treatment of severe prolapsed hemorrhoids: A study protocol for a randomized controlled trial. Medicine (Baltim). 2020;99(45):e23122. doi:10.1097/MD.0000000000023122
2.
LeventogluSMentesBBalciBKebizHC. New techniques in Hemorrhoidal disease but the same old problem: Anal Stenosis. Medicina (Kaunas)2022;58(3):362. doi:10.3390/medicina58030362
3.
ZhangGLiangRWangJKeMChenZHuangJ, et al.Network meta-analysis of randomized controlled trials comparing the procedure for prolapse and hemorrhoids, Milligan-Morgan hemorrhoidectomy and tissue-selecting therapy stapler in the treatment of grade III and IV internal hemorrhoids(Meta-analysis). Int J Surg. 2020;74:53-60. doi:10.1016/j.ijsu.2019.12.027
4.
BrisindaGVanellaSCadedduFMarnigaGMazzeoPBrandaraF, et al.Surgical treatment of anal stenosis. World J Gastroenterol. 2009;15(16):1921-1928. doi:10.3748/wjg.15.1921
5.
IidaYSaitoHTakashimaYSaitouKMunemotoY. Procedure for prolapse and hemorrhoids (PPH) with low rectal anastomosis using a PPH 03 stapler: Low rate of recurrence and postoperative complications. Int J Colorectal Dis. 2017;32(12):1687-1692. doi:10.1007/s00384-017-2908-3
6.
WangTHKiuKTYenMHChangTC. Comparison of the short-term outcomes of using DST and PPH staplers in the treatment of grade III and IV hemorrhoids. Sci Rep. 2020;10(1):5189. doi:10.1038/s41598-020-62141-5
7.
MilsomJWMazierWP. Classification and management of postsurgical anal stenosis. Surg Gynecol Obstet. 1986;163(1):60-64.
8.
LibermanHThorsonAG. How I do it. Anal stenosis. Am J Surg. 2000;179(4):325-329. doi:10.1016/s0002-9610(00)00344-5
9.
YaoLZhongYXuJXuMZhouP. Rectal stenosis after procedures for prolapse and hemorrhoids (PPH)--a report from China. World J Surg. 2006;30(7):1311-1315. doi:10.1007/s00268-005-0484-0
10.
ZhangCZhangWXuJ. Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids. Medicine (Baltim). 2022;101(11):e29100. doi:10.1097/MD.0000000000029100
11.
DowdenJEStanleyJDMooreRA. Obstructed defecation after stapled hemorrhoidopexy: A report of four cases. Am Surg. 2010;76(6):622-625.
12.
HetzerFHDemartinesNHandschinAEClavienPA. Stapled vs excision hemorrhoidectomy: Long-term results of a prospective randomized trial. Arch Surg. 2002;137(3):337-340. doi:10.1001/archsurg.137.3.337
13.
PescatoriMGagliardiG. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol. 2008;12(1):7-19. doi:10.1007/s10151-008-0391-0
14.
SturialeAFabianiBMenconiCCafaroDFuscoFBellioG, et al.Long-term results after stapled hemorrhoidopexy: A survey study with mean follow-up of 12 years [published correction appears in Tech Coloproctol. 2018 Oct 11]. Tech Coloproctol. 2018;22(9):689-696. doi:10.1007/s10151-018-1860-8
15.
LinHCHeQLShaoWJChenXLPengHXieSK, et al.Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial. Dis Colon Rectum. 2019;62(2):223-233. doi:10.1097/DCR.0000000000001261
16.
WuYFZhengBCChenQChenXDYeSSLinQY, et al.Video-Assisted Modified Ligation of the Intersphincteric Fistula Tract, an Integration of 2 Minimally Invasive Techniques for the Treatment of Parks Type II Anal Fistulas. Surg Innov. 2021;28(4):419-426. doi:10.1177/1553350620978026
17.
ZhouCLiMZhangYNiMWangYXuD, et al.Autologous adipose-derived stem cells for the treatment of Crohn's fistula-in-ano: An open-label, controlled trial. Stem Cell Res Ther. 2020;11(1):124. doi:10.1186/s13287-020-01636-4
18.
HeCMLuJGCaoYQYaoYB. [Design characteristics of clinical surgery trial based on treatment program of tunnel thread-drawing method for anal fistula: a prospective randomized controlled multicenter trial]. Zhong Xi Yi Jie He Xue Bao. 2009;7(12):1113-1118. Chinese. doi:10.3736/jcim20091204
19.
KatdareMVRicciardiR. Anal stenosis. Surg Clin North Am. 2010;90(1):137-145. Table of Contents. doi:10.1016/j.suc.2009.10.002
20.
BouchardDBrochardCVinson-BonnetBStaumontGAbramowitzLBenfredjP, et al.How to manage anal ulcerations and anorectal stenosis in Crohn's disease: algorithm-based decision making: French National Working Group Consensus 2018. Tech Coloproctol. 2019;23(4):353-360. doi:10.1007/s10151-019-01971-6
21.
EberspacherCMascagniPZeriKPFralleoneLNaldiniGMascagniD. Self-Mechanical Anal Dilatation: A Simple Trick to Minimize Postoperative Pain and Stenosis Following Hemorrhoidectomy With Radiofrequency. Front Surg. 2021;8:711958. doi:10.3389/fsurg.2021.711958
