Braini A, Narisetty P, Favero A, Calandra S, Calandra A, Caponnetto F, Digito F, Da Pozzo F, Marcotti E, Porebski E, Rovedo S, Terrosu G, Torricelli L, Stuto A
1U.O. Chirurgia 2, Az. Ospedaliera S. Maria degli Angeli, Pordenone, Italy.
Surg Innov. 2013 Dec;20(6):553-8. doi: 10.1177/1553350612472988. Epub 2013 Jan 20.
Longo's technique (or PPH technique) is well known worldwide. Meta-analysis suggests that the failure due to persistence or recurrence is close to 7.7%. One of the reasons for the recurrence is the treatment of the advanced hemorrhoidal prolapse with a single stapling device, which is not enough to resect the appropriate amount of prolapse.
We describe the application of "Double PPH Technique" (D-PPH) to treat large hemorrhoidal prolapses. We performed a multicentric, prospective, and nonrandomized trial from July 2008 to July 2009, wherein 2 groups of patients with prolapse and hemorrhoids were treated with a single PPH or a D-PPH. Results were compared. The primary outcome was evaluation of safety and efficacy of the D-PPH procedure in selected patients with large hemorrhoidal prolapse.
In all, 281 consecutive patients suffering from hemorrhoidal prolapse underwent surgery, of whom 74 were assigned intraoperatively to D-PPH, whereas 207 underwent single PPH. Postoperative complications were 5% in both groups (P = .32), in particular: postoperative major bleeding 3.0% in PPH versus 4.1% D-PPH (P = .59); pain 37.9 % PPH versus 27.3% D-PPH (mean visual analog scale [VAS] = 2.5 vs 2.9, respectively; P = .72); and fecal urgency 2.1% PPH versus 5.7% D-PPH (P = .8). Persistence of hemorrhoidal prolapse at 12-month follow-up was 3.7% in the PPH group versus 5.9% in the D-PPH group (P = .5).
Our data support the hypothesis that an accurate intraoperative patient selection for single (PPH) or double (D-PPH) stapled technique will lower in a significant way the incidence of recurrence after Longo's procedure for hemorrhoidal prolapse.
龙氏技术（或吻合器痔上黏膜环切术）在全球范围内广为人知。荟萃分析表明，因持续存在或复发导致的失败率接近7.7%。复发的原因之一是使用单个吻合器装置治疗晚期痔脱垂，这不足以切除适量的脱垂组织。
我们描述了“双吻合器痔上黏膜环切术”（D-PPH）治疗巨大痔脱垂的应用。我们于2008年7月至2009年7月进行了一项多中心、前瞻性、非随机试验，其中两组痔脱垂患者分别接受单次PPH或D-PPH治疗。对结果进行了比较。主要结局是评估D-PPH手术在选定的巨大痔脱垂患者中的安全性和有效性。
共有281例连续的痔脱垂患者接受了手术，其中74例术中被分配接受D-PPH，而207例接受单次PPH。两组术后并发症发生率均为5%（P = 0.32），具体如下：术后大出血，PPH组为3.0%，D-PPH组为4.1%（P = 0.59）；疼痛，PPH组为37.9%，D-PPH组为27.3%（平均视觉模拟评分[VAS]分别为2.5和2.9；P = 0.72）；以及便急，PPH组为2.1%，D-PPH组为5.7%（P = 0.8）。PPH组在12个月随访时痔脱垂持续存在的比例为3.7%，D-PPH组为5.9%（P = 0.5）。
我们的数据支持这样一种假设，即术中准确选择单次（PPH）或双次（D-PPH）吻合器技术的患者，将显著降低龙氏痔脱垂手术后的复发率。
