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)

Zhang, Guoxing; Liang, R W; Wang, Jing; Ke, Minhui; Chen, Zuqing; Hou, Juan; Shi, Rong

doi:10.1016/j.ijsu.2019.12.027

Cited by 33 publications

(26 citation statements)

References 26 publications

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“…Chronic constipation, alcohol abuse, consumption of irritating foods, and the sedentary lifestyle of the modern population are usually considered to be the main causes of hemorrhoids [ 2 ]. The anastomosis procedure for prolapse and hemorrhoids (PPH) uses the “PPH anastomosis” to cure hemorrhoids by circumferential excision of the prolapsed rectal mucosal band above the hemorrhoid [ 3 ]. It can preserve the normal physiological function of the anus to the greatest extent without removing the anal cushion and has the advantages of less trauma and faster recovery, so it can be rapidly promoted in clinical use [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications

Zeng

Lin

2021

Evidence-Based Complementary and Alternative Medicine

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Surgery is now the main clinical treatment for hemorrhoids, and the procedure for prolapse and hemorrhoids (PPH) is the commonly used procedure. The key to evaluating the efficacy of surgery includes the quality of postoperative wound healing and the occurrence of complications, so it is especially important to enhance the postoperative rehabilitation of hemorrhoids. This study investigates the method of postoperative treatment with Kangfuxin solution fumigation bath to explore the role of this method in the efficacy of patients after hemorrhoid PHH surgery and its effect on postoperative complications. It will accumulate some relevant information to improve the efficacy of hemorrhoid surgery and postoperative complications and open new ideas for further postoperative rehabilitation of other diseases in the anal area. A total of 106 patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery. After surgery, they were randomly divided into a control group treated with warm water sitz bath and an observation group treated with Kangfuxin solution fumigation bath, with 53 cases in each group. We observed all patients’ postoperative pain, bleeding, and perianal edema on a daily basis after surgery; we recorded the time of wound healing and hospital stay. The maximum anal squeeze pressure (MASP), anal defecation diastole pressure (ADDP), anal resting pressure (ARP), and the length of the high-pressure zone (HPZ) were used as observation indicators to evaluate the anal function of the patients before and after treatment. The results of the evaluation of the efficacy of patients after the treatment period showed that the total effective rate of treatment in the observation group (92.45%) was significantly higher than that of the control group (77.36%). The postoperative recovery showed that the wound healing time, hospitalization time, pain, bleeding, and edema scores at 3 and 5 days after surgery were lower in the observation group than in the control group; MASP and ARP increased in both groups after treatment compared to before treatment, with more increase in the observation group. The results suggest that patients with hemorrhoids after PPH should pay attention to postoperative care and rehabilitation. It also reveals that the application of Kangfuxin solution fumigation treatment has a significant effect, which can effectively reduce the patient’s wound healing and hospital stay, while improving the patient’s anal function and reducing postoperative complications, and is worthy of clinical promotion and application.

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Section: Introductionmentioning

confidence: 99%

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications

Zeng

Lin

2021

Evidence-Based Complementary and Alternative Medicine

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“…The observation group used modified TST to remove internal hemorrhoids. TST surgery is a new type of surgical technique developed on the basis of PPH surgery 30 . In TST the mucosa is not resected annularly, but only through a specially opened anus Mirrors (single, double, and triple openings) selectively remove the prominent mucosa of the hemorrhoids while retaining the normal mucosa between the resected mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…New surgeries and surgical instruments were designed and include LigaSure TM , Harmonic ® and Starion TM,4.24 . Hemorrhoidal staples include stapler hemorrhoidal mucosal ring incision and staple surgery (PPH), selective superior hemorrhoidal mucosal nailing (TST), transanal stapler rectal resection (STARR) 29 , 30 .…”

Section: Introductionmentioning

confidence: 99%

A New Mixed Surgical Treatment for Grades Iii and Iv Hemorrhoids: Modified Selective Hemorrhoidectomy Combined With Complete Anal Epithelial Retention

Huang

et al. 2021

ABCD, arq. bras. cir. dig.

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Background: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. Aim: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. Methods: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. Results: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. Conclusions: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.

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“…Tissue selecting technique (TST) is a surgical method based on the PPH and combined with the theory of 'segmented dentate ligation' in traditional Chinese medicine. 13 TST can depend on the number and size of haemorrhoid nucleus to select the scope of haemorrhoid mucosa resection, and realise the modern minimally invasive concept. 13 A meta-analysis showed that the recurrence rate of TST was the lowest when compared with the PPH and MMH.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…13 TST can depend on the number and size of haemorrhoid nucleus to select the scope of haemorrhoid mucosa resection, and realise the modern minimally invasive concept. 13 A meta-analysis showed that the recurrence rate of TST was the lowest when compared with the PPH and MMH. 13 However, TST inherits the defect of PPH that pathological anal cushion is not handled and the 'suspension' effect of TST is inferior to that of PPH.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation for the treatment of circumferential mixed haemorrhoids: a protocol for single-blind randomised controlled study

Huang

et al. 2021

BMJ Open

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IntroductionThis protocol designed a randomised controlled trial (RCT) to evaluate the effectiveness, safety and prognostic outcomes of modified tissue selecting technique (M-TST) combined with complete anal canal epithelial preservation (CACP) among patients with circumferential mixed haemorrhoids.Methods and analysisThis study will be single-blinded, and recruit 348 patients who are admitted to the Changshu Hospital Affiliated to Nanjing University of Chinese Medicine and fulfil the inclusion criteria from January 2022 to December 2022. Patients will be randomly assigned to the treatment group and the control group in a 1:1 ratio. The statistician will be blinded for the allocation. The treatment group will receive M-TST combined with CACP (M-TST–CACP), while the control group will receive the procedure for prolapse and haemorrhoids. The two groups will receive the same preoperative and postoperative care. The primary outcome will be recurrence rate. The secondary outcomes will be operation time, intraoperative bleeding, incontinence, pain, postoperative complications (severe bleeding, perianal oedema, urinary retention, faecal urgency, skin tags and anal stenosis), prolapse, recovery time, quality of life, Haemorrhoid Severity Score, and Symptom Severity Score.Ethics and disseminationThis protocol has been approved by the Clinical Ethics Committee of the Changshu Hospital Affiliated to Nanjing University of Chinese Medicine (approval no. 202102001).Trial registration numberChiCTR2100042750.

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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)

Cited by 33 publications

References 26 publications

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications

A New Mixed Surgical Treatment for Grades Iii and Iv Hemorrhoids: Modified Selective Hemorrhoidectomy Combined With Complete Anal Epithelial Retention

Modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation for the treatment of circumferential mixed haemorrhoids: a protocol for single-blind randomised controlled study

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