Stapled Hemorrhoidopexy and Milligan Morgan Hemorrhoidectomy in the Cure of Fourth-Degree Hemorrhoids: Long-Term Evaluation and Clinical Results

Mattana, Claudio; Coco, Claudio; Manno, Alberto; Verbo, Alessandro; Rizzo, Gianluca; Petito, Luigi; Sermoneta, Daniel

doi:10.1007/s10350-007-0294-6

Cited by 70 publications

(44 citation statements)

References 26 publications

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“…In some studies comparing these two methods, no statistically significant difference was determined. 2,26,32 In a study done by Jayaraman et al by considering 12 studies, they reported high recurrence rates in the long term after stapled hemorrhoidopexy particularly in 4 th degree hemorrhoid cases. 33 In our study, low recurrence rate was attributed to small number of 4 th degree hemorrhoid cases operated.…”

Section: Discussionmentioning

confidence: 99%

Stapled hemorrhoidopexy: clinical results for 65 cases

Pergel

Yücel²,

Aydın³

et al. 2012

J Clin Exp Invest

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ÖZETAmaç: Hemoroidal hastalık sebebiyle stapler hemoroidopeksi uyguladığımız hastalarımızın sonuçlarını sunmak ve literatür eşliğinde tartışmak. Gereç ve yöntem:Ocak 2009-Nisan 2011 tarihleri arasında 3-4. derece hemoroidal hastalık tanısı konan ve Longo yöntemiyle hemoroidopeksi uygulanan hastalar çalışmaya dahil edildi. Tüm veriler prospektif toplanıp retrospektif olarak incelendi. Hastalar; demografik özellikler, başvuru sırasındaki şikayetler, ameliyat sonrası komplikasyonlar açısından değerlendirildi. Bulgular:Toplam 65 hastadan 43 (% 66)'ü erkek, 22 (% 34)'si kadındı. Ortalama yaş 38±11.9 (23-76) yıl idi. Olguların en sık başvuru şikayetleri sıklık sırasına göre kanama, şişlik, kaşıntı, ağrı, kabızlık şeklinde idi. Elli sekiz (% 89) hastada 3. derece, 7 (%11) hastada 4. derece hemoroid mevcuttu. Ortalama ameliyat süresi 37.6±8.1(24-55) dakika, ortalama yatış süresi 27±7.8 (20-76) saat idi. Toplam 17 (% 26) hastada bir ya da daha fazla komplikasyon gelişti. Komplikasyon olarak 13 (% 20) hastada kanama, 6 (%9)'sında ağrı, 2 (% 3)'sinde idrar retansiyonu, 3 (% 5)'ünde tenezm, 1 (% 2)'inde eksternal hemoroidal tromboz, 4 (%6)'ünde ise nüks saptandı. Sonuç:Stapler hemoroidopekside ağrının az ve iyileşme sürecinin hızlı olması nedeniyle hastalar günlük aktivitelerine erken dönebilmektedirler. Bu yöntemin başarısında uygun hasta seçimi ve tekniğin doğru uygulanmasının önemli olduğunu düşünmekteyiz. Özellikle 3.derece hemoroidal hastalıkta Longo tekniği klasik yöntemlere alternatif olarak önerilebilir.Anahtar kelimeler: Hemoroidal hastalık, stapler hemoroidopeksi, Longo yöntemi ABSTRACT Objectives: To present results of our patients underwent stapled hemorrhoidopexy due to hemorrhoidal disease and discuss in accompaniment with the literature. Material and methods:The patients, who diagnosed by 3 rd -4 th degree hemorrhoidal disease and underwent hemorrhoidopexy with Longo method between January, 2009 and April, 2011, were included. All data were prospectively collected and retrospectively examined. The patients were evaluated in terms of demographic properties, complaints on admission, and postoperative complications.Results: Forty-three (66%) of 65 patients were male, 22 (34%) were female. The mean age was 38±11.9 (range:23-76) years. The most frequent complaints were bleeding, swelling, itching, pain, constipation respectively. Third degree hemorrhoid was present in fifty-eight (89%) patients, 4 th degree hemorrhoid was in 7 (11%) patients. The mean operation duration was 37.6±8.1(range:24-55) minutes, the mean hospitalization duration was 27±7.8 (range:20-76) hours. One or more complication developed in total 17 (26%) patients. As complication, bleeding was determined in 13 (20%) patients, pain was in 6 (9%), urinary retention was in 2 (3%), tenesmus was in 3 (5%), external hemorrhoidal thrombosis was in 1 (2%), and recurrence was in 4 (6%). Conclusions:The patients can return their daily activities early with stapled hemorrhoidopexy because of less pain and quick recovery period. We consider that appropriate p...

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Section: Discussionmentioning

confidence: 99%

Stapled hemorrhoidopexy: clinical results for 65 cases

Pergel

Yücel²,

Aydın³

et al. 2012

J Clin Exp Invest

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“…According to some authors, recurrent rectal prolapse was significantly more frequent in patients with fourth-degree hemorrhoids, so that they may not represent an appropriate indication for stapled hemorrhoidopexy [49,50,76]. Actually, in patients with only third-degree hemorrhoids, recurrence is similar in both stapled hemorrhoidopexy and conventional hemorrhoidectomy [77].…”

Section: Resultsmentioning

confidence: 99%

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

Picchio¹,

Greco²,

Filippo

et al. 2014

Indian J Surg

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Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with conservative therapies, especially for Grade III and IV hemorrhoids. In this review, we present and discuss the results of the most diffuse surgical techniques for hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorrhoids, with closure (Fergusson's technique) or without closure (Milligan-Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes a significant postoperative pain because of wide external wounds in the innervated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postoperative pain and faster return to normal activities. In the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conventional hemorrhoidectomy. Double stapler hemorrhoidopexy may be an alternative to simple stapled hemorrhoidopexy to reduce the recurrence in advanced hemorrhoidal prolapse. Transanal hemorrhoidal deartertialization was showed to be as effective as stapled hemorrhoidopexy in terms of treatment success, complications, and incidence recurrence. However, further high-quality trials are recommended to assess the efficacy and safety of this technique.

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“…Recently, however, few authors have raised some serious questions about the long term results of this technique and its generalized applications over almost all grades of the prolapsing hemorrhoids. [10][11][12] This trial has clearly addressed these issues in a systematic way.…”

Section: Discussionmentioning

confidence: 99%

“…2 Although the short term benefits have been clearly documented in multiple clinical trials comparing these two techniques; questions have been raised regarding long term outcome of this newer approach. [10][11][12] Recent studies including a recent meta-analysis suggest that long term recurrence rates are higher with stapled hemorrhoidectomy as opposed to the conventional hemorrhoidectomy. [10][11][12] This study is a prospective randomized trial comparing the patients undergoing stapled hemorrhoidectomy vs. conventional hemorrhoidectomy to answer particular questions regarding its efficacy and failure rates on a longterm follow up.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12] Recent studies including a recent meta-analysis suggest that long term recurrence rates are higher with stapled hemorrhoidectomy as opposed to the conventional hemorrhoidectomy. [10][11][12] This study is a prospective randomized trial comparing the patients undergoing stapled hemorrhoidectomy vs. conventional hemorrhoidectomy to answer particular questions regarding its efficacy and failure rates on a longterm follow up. To our knowledge this is the largest trial till now comparing the long term outcomes spanning over 5 years of follow up.…”

Section: Introductionmentioning

confidence: 99%

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