Department of Surgery, Caritas-Krankenhaus St Josef, Regensburg, Germany.
Colorectal Dis. 2011 Jan;13(1):87-93. doi: 10.1111/j.1463-1318.2009.02062.x.
It was the aim of this single-surgeon series to assess the role of conversion in transanal stapling to techniques and to identify potential factors predictive of conversion.
The details of all consecutive patients who were planned for a stapled approach were prospectively recorded in a PC database. Stapling techniques (PPH03, PPH01 and ContourTranstar) were indicated for haemorrhoidal disease and internal rectal prolapse. 'Conversion' from a stapled approach was defined as an unplanned change of the surgical method to a nonstapled, traditional technique, related to indication, anatomy and technical factors. The primary outcomes were whether the procedure was performed using a stapling device only, or whether the procedure was converted. Logistic regression analysis was performed to evaluate multiple variables as potential risk factors for conversion.
In a 2-year period (May 2006-May 2008), 258 patients met the inclusion criteria and underwent transanal surgery scheduled as a stapled approach. In these 258 patients, 246 procedures were completed as a stapled procedure [that stapled haemorrhoidopexy, n = 148; stapled mucosectomy, n = 52; stapled transanal rectal resection (STARR) with PPH01, n = 38; and STARR with ContourTranstar, n = 8], giving a completion rate of 95.4%. However, 12 procedures were converted to conventional surgery (including traditional haemorrhoidectomy and the Delorme procedure), giving a conversion rate of 4.6%. The reasons for conversion were related to anatomy and to clinical findings (nonreducible haemorrhoidal prolapse), to new clinical findings not detected preoperatively (proctitis, anal fistula) and to a technical inability to insert the circular anal dilatator because of a deep anal canal. Neither univariate nor multivariate analysis identified any factor to be specifically associated with the risk of conversion.
In the era of transanal stapling procedures for haemorrhoids and anorectal prolapse, the majority of procedures can be performed using stapled techniques if strict criteria of indication and patient selection are respected. However, the current study identified a 4.6% conversion rate to traditional treatment, which has an impact on informed consent and requires the surgeon to be familiar with conventional anorectal procedures.
本单外科医生系列旨在评估经肛门吻合器技术中转开腹的作用，并确定可能预测中转的因素。
所有计划采用吻合器治疗的连续患者的详细信息均前瞻性记录在 PC 数据库中。吻合器技术（PPH03、PPH01 和 ContourTranstar）适用于痔病和直肠内脱垂。“中转”定义为因适应证、解剖和技术因素，将吻合器方法改为非吻合器、传统方法。主要结局是手术仅采用吻合器进行，还是中转开腹。采用逻辑回归分析评估多个变量作为中转的潜在危险因素。
在 2 年期间（2006 年 5 月至 2008 年 5 月），258 例患者符合纳入标准，并接受了计划采用吻合器的经肛门手术。在这 258 例患者中，246 例完成吻合器手术[吻合痔固定术，n=148；吻合黏膜切除术，n=52；吻合器直肠经肛切除术（STARR）联合 PPH01，n=38；STARR 联合 ContourTranstar，n=8]，完成率为 95.4%。然而，12 例中转开腹手术（包括传统痔切除术和 Delorme 手术），中转率为 4.6%。中转的原因与解剖和临床发现（不可还原的痔脱垂）有关，与术前未发现的新临床发现（直肠炎、肛瘘）有关，与因肛门管深而无法插入圆形肛门扩张器有关。单因素和多因素分析均未发现任何特定因素与中转风险相关。
在痔病和直肠脱垂的经肛门吻合器治疗时代，如果严格遵守适应证和患者选择标准，大多数手术可以采用吻合器技术进行。然而，本研究发现，有 4.6%的患者需要转为传统治疗，这对知情同意有影响，需要外科医生熟悉传统的肛肠手术。
