Coloproctology Unit, Department of Surgery, University Hospital of Elche, Elche, Spain.
Dis Colon Rectum. 2011 May;54(5):609-14. doi: 10.1007/DCR.0b013e3182092e51.
The aim of this prospective controlled trial was to evaluate the long-term clinical and manometric results of stapled hemorrhoidopexy performed by expert surgeons in a selected group of patients for the treatment of chronic hemorrhoids.
This study took place in the outpatient clinic and at the Day Surgery Unit attached to the University Hospital of Elche.
From March 2003 to May 2005, 200 consecutive patients with third-degree hemorrhoids and treated with double-pursestring stapled hemorrhoidopexy with a PPH33-03 stapler were included in the study.
Demographic, manometric, and clinical features were analyzed, as well as the variables related to surgery, postoperative course, and follow-up. Manometry was repeated at the 6-month, 1-year, and 5-year follow-up.
Median follow-up was 110 months. Four patients (2%) reported daily rectal bleeding. One patient with active rectal bleeding was taken for reoperation within the first 12 postoperative hours. Seventy percent of patients reported pain ≤ 2 on the first postoperative day, 85% on the fourth postoperative day, and 95% on the seventh postoperative day. Pain was measured with a linear analog scale from 0 to 10 (0 = no pain; 10 = unbearable pain). Seventeen patients (8.5%) reported tenesmus during the first week. Eight patients (4%) reported persistent pain: in 5 patients, the pain resolved within the next 6 months; 2 patients presented with anal fissure; and 1 patient required the removal of the staples. Two patients (1%) reported residual soiling at the 5-year revision. Fourteen patients (7%) experienced recurrence with symptomatic prolapse. Six (3%) underwent further surgery: stapled hemorrhoidopexy was indicated again in 2 patients, and 4 patients underwent a Milligan-Morgan open hemorrhoidectomy, because they did not have a uniform prolapse. Six patients required treatment with rubber band ligation. There were no statistically significant differences between preoperative and postoperative manometric values.
The new PPH33-03 stapler, the learning process of the modified surgical procedure, and the correct selection of patients will overcome the main objections to stapled hemorrhoidopexy.
本前瞻性对照试验的目的是评估在专家外科医生为治疗慢性痔疮而选择的一组患者中进行吻合器痔上黏膜环切术（stapled hemorrhoidopexy）的长期临床和测压结果。
本研究在埃尔切大学医院的门诊和日间手术病房进行。
2003 年 3 月至 2005 年 5 月，我们对 200 例接受双荷包吻合器痔上黏膜环切术（使用 PPH33-03 吻合器）治疗的 3 度痔患者进行了研究。
分析了患者的人口统计学、测压和临床特征，以及与手术、术后过程和随访相关的变量。在术后 6 个月、1 年和 5 年时进行了重复测压。
中位随访时间为 110 个月。4 例患者（2%）报告每天直肠出血。1 例有活动性直肠出血的患者在术后 12 小时内接受了再次手术。70%的患者在术后第 1 天报告疼痛≤2，85%在第 4 天，95%在第 7 天。疼痛使用 0 到 10 的线性模拟量表进行测量（0 = 无痛；10 = 无法忍受的疼痛）。17 例患者（8.5%）在第 1 周报告有肛门坠胀感。8 例患者（4%）报告持续疼痛：5 例患者的疼痛在接下来的 6 个月内缓解；2 例患者出现肛裂；1 例患者需要移除吻合钉。2 例患者（1%）在 5 年随访时报告有残留污物。14 例患者（7%）出现有症状的脱垂复发。6 例（3%）再次接受手术：2 例患者再次行吻合器痔上黏膜环切术，4 例患者行 Milligan-Morgan 开放性痔切除术，因为他们没有出现统一的脱垂。6 例患者需要接受橡皮圈套扎治疗。术前和术后的测压值无统计学差异。
新型 PPH33-03 吻合器、改良手术程序的学习过程和患者的正确选择将克服对吻合器痔上黏膜环切术的主要反对意见。
