Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatmen
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ORIGINAL SCIENTIFIC REPORT
Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatment Luis Antonio Hidalgo-Grau1 • Encarna Piedrafita-Serra1,2 • Neus Ruiz-Edo1 Sara Llorca-Carden˜osa1 • Adolfo Heredia-Budo´1 • Oscar Estrada-Ferrer1 • Xavier Sun˜ol-Sala1
•
Socie´te´ Internationale de Chirurgie 2020
Abstract Objectives To know the influence of the stapled line height (SLH) in the recurrence rate and the postoperative disturbances in stapled anopexy (SA) for the treatment of hemorrhoids. Design Simple randomized double-blind controlled clinical trial. Randomization with closed-envelope technique in two groups with two different SLH. Setting Colorectal Surgery Unit. Department of General Surgery. Hospital de Mataro´ (Barcelona, Spain). Participants 119 patients with the diagnosis of symptomatic third- and fourth-grade hemorrhoids were included. Intervention SA was performed with two different SLH: group A, 4.5 cm (58 patients) and group B, 6 cm (61 patients) from the external anal verge. Postoperative disturbances were evaluated by a colorectal surgeon who was blind for the randomization and pain was measured (visual analogic scale) one week and 3 months after surgery. Mean operative time, number of hemostatic stitches performed and resected mucosal area were considered as well. Mean follow-up was 11.05 ± 1.6 years. Results Differences between the operative time and resected mucosa-submucosa area were not found. The patients of group A needed a significantly higher number of stitches for intraoperative bleeding control along the stapled line. We did not found differences between both groups in terms of postoperative pain neither anorectal disturbances. At the follow-up, persistence of symptomatology was 10.41% in group A and 10.71% in group B, without statistically significance. Neither mortality nor undesirable effects occurred in the series. Conclusions SLH do not influence the recurrence rate neither the postoperative evolution in SA. Trial registration Clinical Trials NCT03383926.
Introduction Excisional hemorrhoidectomy has been the standard surgical treatment for hemorrhoidal disease since MilliganMorgans report in 1937 [1]. Recurrence rates after & Encarna Piedrafita-Serra [email protected] 1
Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataro´, Barcelona, Spain
2
Department of Surgery and Morphological Sciences, Universitat Auto´noma de Barcelona, Barcelona, Spain
hemorrhoidectomy are low, but the procedure is associated with postoperative pain, discomfort and lengthened recovery times [2, 3]. Efforts have been directed to the avoidance of the above-mentioned issues. One of the new surgical techniques is stapled anopexy (SA). SA, also referred to as stapled hemorrhoidopexia, which was first described in 1995 by Longo et al. [4]. Based on Thompson and Hass’s theory [5, 6], the purpose of SA is to reduce mucosal prolapse and to restore prolapsed hemorrhoids to their anatomical position through a mucosal cuff exc
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