The comparison of an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) versus circular stapled hemorrhoidopexy (CSH) in patients with grade IV hemorrhoids: a retrospective cohort study
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Published:2023-12-16
Issue:1
Volume:23
Page:
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ISSN:1471-230X
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Container-title:BMC Gastroenterology
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language:en
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Short-container-title:BMC Gastroenterol
Author:
He Jun,
Zhou Meng-Dan,
Wu Wen-Jing,
Liu Zhi-Yong,
Wang Dong,
Yang Guan-Gen,
Yang Qin-YanORCID,
Shen ZhongORCID
Abstract
Abstract
Objectives
The objectives of this study were to present an accessible C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of grade IV hemorrhoids and to assess long-term outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH).
Methods
Conventional CSH kits combined with an intestinal spatula were used for performing C-PSH. A total of 256 patients with grade IV hemorrhoids referred to Hangzhou Third People's Hospital between January 2016 and June 2017 were obtained: 122 (47.7%) with C-PSH, and 134 (52.3%) with CSH. After propensity score matching, 222 patients (111 in C-PSH group and 111 in CSH group) were ultimately analyzed. The primary outcome was the five-year recurrence rate of hemorrhoids. Secondary outcomes included intraoperative outcomes, postoperative outcomes and complications.
Results
The operative time in the C-PSH group was slightly longer than that in the CSH group (p < 0.01). The vertical length of rectal mucosa specimen in the C-PSH group was shorter than that in the CSH group (p < 0.01). Compared with the CSH group, fecal urgency incidence and numeric rating scale (NRS) score at first defecation were lower in the C-PSH group (p < 0.05). Major complication rate in the CSH group was higher than that in the C-PSH group (p = 0.03). Five-year recurrence rate between the C-PSH group and CSH group was comparable (p > 0.05). Multivariate Cox regression analysis revealed that constipation was an independent prognostic factor for hemorrhoidal recurrence.
Conclusions
The accessible C-PSH seems to be a safe and effective technique in managing grade IV hemorrhoids. It has advantages in alleviating postoperative pain at first defecation, fecal urgency and major complications compared with CSH. It could be an alternative technique in the treatment of grade IV hemorrhoids.
Funder
Zhejiang Medical Health Science and Technology Project
Zhejiang Basic Public Welfare Research Project
Public Welfare Program Foundation from the Science and Technology Bureau of Zhejiang Province
General Program Foundation from the Hangzhou City Health Bureau
Publisher
Springer Science and Business Media LLC
Subject
Gastroenterology,General Medicine
Reference25 articles.
1. Riss S, Weiser FA, Schwameis K, Riss T, Mittlbock M, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27:215–20.
2. Mott T, Latimer K, Edwards C. Hemorrhoids: diagnosis and treatment options. Am Fam Physician. 2018;97:172–9.
3. JC G,. Surgery of the anus rectum and colon. London: Bailliere Tindall; 1980. p. 93–149.
4. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum. 1992; 35: 477–481.
5. Lin HC, He QL, Ren DL, Peng H, Xie SK, et al. Partial stapled hemorrhoidopexy: a minimally invasive technique for hemorrhoids. Surg Today. 2012;42:868–75.