Mari Francesco Saverio, Masoni Luigi, Cosenza Umile Michele, Favi Francesco, Berardi Giammauro, Dall'Oglio Anna, Pindozzi Fioralba, Brescia Antonio
Unit of Oneday-Day Surgery, Department of Surgery of Sant'Andrea Hospital, University Sapienza of Rome, Rome, Italy.
Am Surg. 2012 Nov;78(11):1255-60.
Postoperative staple-line bleeding after stapled hemorrhoidopexy represents a major issue of this procedure, especially in the day surgery setting. In this study we assess the possible benefit of using circular bioabsorbable staple-line reinforcement to reduce the risk of hemorrhage when performing stapled hemorrhoidopexy in a day surgery setting. Patients with symptomatic II to III grade hemorrhoidal disease were randomly assigned into two groups. In Group A we performed a stapled hemorrhoidopexy using PPH33-03(®) with Seamguard(®), a bioabsorbable staple-line reinforcement; in Group B, we used only a PPH33-03(®) stapler. We evaluated the intraoperative and postoperative staple-line bleeding and, secondarily, the duration of surgery, need for additional hemostatic stitches, and presence of postoperative complications. One hundred patients were enrolled in the study. Group A patients showed a statistically significant decrease of intraoperative bleeding (4 vs 42% in Group B) and hemostatic stitch placement (5.7 vs 42%) with the consequent reduction in mean operative time, postoperative pain, and tenesmus. There were no differences between the two groups in hemorrhoidal disease control or postoperative late complications. The use of bioabsorbable staple-line reinforcement while performing stapled hemorrhoidopexy may allow improvement of the safety of this procedure, especially in a day surgery setting.
吻合器痔上黏膜环切术（PPH）术后吻合口出血是该手术的一个主要问题，尤其是在日间手术环境中。在本研究中，我们评估了在日间手术环境下进行吻合器痔上黏膜环切术时，使用可生物吸收的环形吻合口加固材料以降低出血风险的潜在益处。将有症状的Ⅱ至Ⅲ度痔病患者随机分为两组。A组使用带Seamguard®的PPH33-03®吻合器进行吻合器痔上黏膜环切术，Seamguard®是一种可生物吸收的吻合口加固材料；B组仅使用PPH33-03®吻合器。我们评估了术中及术后吻合口出血情况，其次评估了手术时长、额外止血缝线的需求以及术后并发症的发生情况。100名患者纳入本研究。A组患者术中出血（4% vs B组的42%）和止血缝线放置（5.7% vs 42%）有统计学显著减少，随之平均手术时间、术后疼痛和里急后重均有所降低。两组在痔病控制或术后远期并发症方面无差异。在进行吻合器痔上黏膜环切术时使用可生物吸收的吻合口加固材料可能会提高该手术的安全性，尤其是在日间手术环境中。
