Coloproctological Center of Georgia, Tbilisi, Georgia.
Dis Colon Rectum. 2011 Sep;54(9):1162-9. doi: 10.1097/DCR.0b013e318221ea50.
Recurrence and/or complications after 3-quadrant hemorrhoidectomy or stapled hemorrhoidopexy still remain a challenging problem. This challenge is even greater for massive hemorrhoidal thrombosis leading to edema, ulceration, and/or gangrene. To address this challenge, we developed a further modification of the Whitehead procedure termed circumferential excisional hemorrhoidectomy. The proposed procedure allows access to a submucoanodermal/skin workspace that provides a "view from inside" the hemorrhoidal disease, and therefore facilitates the precise excision of even each hemorrhoidal vein while preserving the overlying normal tissues.
This study aimed to describe the circumferential excisional hemorrhoidectomy procedure and to demonstrate its results in patients presenting with total hemorrhoidal thrombosis. DESIGN, SETTINGS, PATIENTS: This prospective, descriptive study was conducted with 294 consecutive patients who underwent urgent circumferential excisional hemorrhoidectomy at our coloproctological center from January 1996 to June 2009.
Circumferential excisional hemorrhoidectomy involves the stripping and excision of hemorrhoids from the submucoanodermal space with reconstruction of the anal canal by the use of an undermined irregular/zigzag-shaped mucoanodermal flap and accurately trimmed skin.
The main outcome measures were the surgical outcomes and complications.
The mean patient age was 41.7 for both sexes. There were 215 men and 79 women. The mean operative time was 26.4 (range, 17-43) minutes. In terms of postoperative complications, there were 39 (13.2%) urinary retentions, 1 (0.3%) fecal impaction, and 3 (1%) delayed complete wound epithelization. The mean hospital stay was 3.1 (range, 2-5) days, and the mean time off from work was 10 (range, 7-18) days. At the fifth week after surgery, digital rectal examination revealed easily dilated mild stricture in 26 (8.8%) patients. At a mean follow-up of 6.8 (range, 2-14) years, 271 (92.2%) accessible patients were actually symptom-free.
This study did not have a control group.
Circumferential excisional hemorrhoidectomy is an anatomically safe surgical procedure with a low rate of complications and no recurrences, even after a long-term follow-up.
经 3 象限痔切除术或吻合器痔固定术治疗后仍存在复发和/或并发症，这仍然是一个具有挑战性的问题。对于巨大的痔血栓形成导致的水肿、溃疡和/或坏疽，这一挑战更大。为了解决这一挑战，我们对 Whitehead 手术进行了进一步的改良，称为环形切除痔切除术。该手术方法可进入黏膜下层/皮肤工作空间，提供“从内部观察”痔病的视角，因此便于精确切除每个痔静脉，同时保留上方的正常组织。
本研究旨在描述环形切除痔切除术的手术过程，并展示其在全痔血栓形成患者中的效果。
设计、地点、患者：这是一项前瞻性、描述性研究，纳入了 1996 年 1 月至 2009 年 6 月期间在我们肛肠中心接受紧急环形切除痔切除术的 294 例连续患者。
环形切除痔切除术涉及从黏膜下层空间剥离和切除痔，通过使用一个挖空的不规则/锯齿形黏膜下皮瓣和准确修剪的皮肤来重建肛管。
主要观察指标为手术结果和并发症。
患者的平均年龄为 41.7 岁（男女均有）。其中 215 例为男性，79 例为女性。平均手术时间为 26.4 分钟（范围为 17-43 分钟）。术后并发症方面，有 39 例（13.2%）出现尿潴留，1 例（0.3%）出现粪便嵌塞，3 例（1%）出现完全伤口愈合延迟。平均住院时间为 3.1 天（范围为 2-5 天），平均停工时间为 10 天（范围为 7-18 天）。术后第 5 周，26 例（8.8%）患者直肠指检显示易扩张的轻度狭窄。在平均 6.8 年（范围为 2-14 年）的随访中，271 例（92.2%）可随访的患者实际上无症状。
本研究没有对照组。
环形切除痔切除术是一种解剖学上安全的手术方法，并发症发生率低，无复发，即使在长期随访后也是如此。
