Proctological and Perineal Surgical Unit, Cisanello University Hospital, Via Paradisa 2, Pisa, Italy.
Colo-proctological Surgical Unit, S. Maria dei Battuti Hospital, Conegliano, Italy.
Tech Coloproctol. 2018 Sep;22(9):689-696. doi: 10.1007/s10151-018-1860-8. Epub 2018 Oct 4.
Hemorrhoidal prolapse is a common benign disease. The introduction of circular-stapled hemorrhoidopexy as an alternative to the conventional hemorrhoidectomy led to a new spectrum of postoperative outcomes and complications. The aim of the present study was to evaluate long-term results after stapled hemorrhoidopexy.
All the patients who had stapled hemorrhoidopexy using a PPH03 stapler, from January 2003 to December 2005, were retrospectively collected in a dedicated database. Between March and May 2016, all the patients were asked by phone to complete a questionnaire. The study evaluated anatomical recurrence, symptom recurrence and frequency, and satisfaction after surgery. The postoperative complications recorded were hemorrhage, hematoma, urinary retention, anastomotic stenosis, persistent anal pain, tenesmus, and impaired anal continence evaluated also with the Faecal Incontinence Severity Index score.
One hundred and ninety four patients were identified and 171 completed the questionnaire. The mean follow-up was 12 ± 0.8 years (range 11-13 years). Anatomical self-reported prolapse recurrence was 40.9% (n = 70). In 75.6% (n = 129) of patients, the severity and frequency of symptoms improved. The overall complication rate was 56.7% (n = 40) with a serious adverse event rate of 8.7% (n = 15). The overall tenesmus rate was 38.2% (n = 65) and the overall impaired continence rate was 39.1% (n = 67). Medical therapy was still required occasionally by 40.3% (n = 69) of the patients and 9.3% (n = 16) of the patients underwent surgery for recurrence. Patient satisfaction rate was good (≥ 3 on a scale of 1 to 5) in 81.2% (n = 139) of cases.
The study showed that stapled hemorrhoidopexy using the first-generation devices is safe and feasible but associated with a high recurrence and incontinence rate. More stringent selection criteria in association with the use of large volume devices can lead to better results in the future.
痔脱垂是一种常见的良性疾病。环状吻合器痔固定术（stapled hemorrhoidopexy）作为传统痔切除术的替代方法，带来了一系列新的术后结果和并发症。本研究旨在评估吻合器痔固定术后的长期疗效。
从 2003 年 1 月至 2005 年 12 月，使用 PPH03 吻合器行吻合器痔固定术的所有患者均被纳入一个专用数据库中。2016 年 3 月至 5 月，通过电话询问所有患者完成问卷调查。本研究评估了术后解剖学复发、症状复发和频率，以及手术治疗后的满意度。记录的术后并发症包括出血、血肿、尿潴留、吻合口狭窄、持续性肛门疼痛、直肠刺激症状和肛门失禁，采用粪便失禁严重程度指数（Faecal Incontinence Severity Index score）评分评估肛门失禁。
共 194 例患者被确定，171 例完成了问卷调查。平均随访时间为 12±0.8 年（范围 11-13 年）。自我报告的解剖学复发率为 40.9%（n=70）。75.6%（n=129）的患者症状严重程度和频率均得到改善。总的并发症发生率为 56.7%（n=40），严重不良事件发生率为 8.7%（n=15）。总的直肠刺激症状发生率为 38.2%（n=65），总的肛门失禁发生率为 39.1%（n=67）。仍有 40.3%（n=69）的患者偶尔需要药物治疗，9.3%（n=16）的患者因复发而再次手术。在 139 例（n=139）患者中，患者满意度良好（评分 1-5 分，≥3 分）。
本研究表明，第一代吻合器痔固定术是安全可行的，但复发和失禁率较高。未来更严格的选择标准并结合使用大容量吻合器可能会获得更好的结果。
