Division of colorectal surgery, Department of surgery, Taipei Medical University Shuang-Ho Hospital, Taipei City, Taiwan.
Department of surgery, school of medicine, college of medicine, Taipei Medical University, Taipei City, Taiwan.
Sci Rep. 2020 Mar 23;10(1):5189. doi: 10.1038/s41598-020-62141-5.
Stapled hemorrhoidopexy has a few advantages such as less postoperative pain and faster recovery compared with conventional hemorrhoidectomy. There are two major devices used for stapled hemorrhoidopexy, PPH stapler (Ethicon EndoSurgery) and DST stapler (Covidien). This study was conducted to investigate the postoperative outcomes among patients with grade III and IV hemorrhoids who underwent hemorrhoidopexy with either of these two devices. A total of 242 consecutive patients underwent stapled hemorrhoidopexy with either PPH stapler (110 patients) or DST stapler (132 patients) at a single center in 2017. We performed a retrospective case-control study to compare the short-term postoperative outcomes and the complications between these two groups. After matching the cases in terms of age, gender, and the grade of hemorrhoids, there were 100 patients in each group (PPH versus DST). There were no significant differences in the postoperative visual analog scale (VAS) score and analgesic usage. Among complications, the incidence of anorectal stricture was significantly higher in the DST group (p = 0.02). Evaluation of the mucosal specimen showed that the total surface area, the muscle/mucosa ratio and the surface area of the muscle were also significantly higher in the DST group (p = 0.03). Further analysis of the DST group demonstrated that patients with anorectal stricture after surgery are younger than patients without anorectal stricture, and higher muscle/mucosa ratio (p = 0.03) and a higher surface area of the muscle (p = 0.03) also measured in the surgical specimen. The two devices provide similar outcomes of postoperative recovery. Patients who underwent DST stapled hemorrhoidopexy had a higher incidence rate of stricture, larger area of muscle excision, and higher muscle/mucosa ratio in the surgical specimen. Further investigation is warranted for a better understanding of the correlation between muscle excision and anorectal stricture.
吻合器痔上黏膜环切术（PPH）与传统痔切除术相比，具有术后疼痛较轻、恢复较快等优点。吻合器痔上黏膜环切术有两种主要器械，即吻合器（Ethicon EndoSurgery 生产的 PPH 吻合器）和切割吻合器（Covidien 生产的 DST 吻合器）。本研究旨在比较两种器械治疗 III 度和 IV 度痔的术后效果。2017 年，我们在一家单中心医院对 242 例连续接受吻合器痔上黏膜环切术的患者进行了回顾性病例对照研究，其中 110 例患者采用 PPH 吻合器，132 例患者采用 DST 吻合器。我们将患者按照年龄、性别和痔的严重程度进行匹配，每组各 100 例（PPH 组与 DST 组）。两组术后视觉模拟评分（VAS）和镇痛药使用无显著差异。在并发症方面，DST 组的肛门直肠狭窄发生率显著高于 PPH 组（p=0.02）。对吻合口黏膜标本的评估显示，DST 组的总表面积、肌黏膜比和肌面积也显著增大（p=0.03）。进一步分析 DST 组发现，术后发生肛门直肠狭窄的患者比未发生狭窄的患者年轻，且手术标本的肌黏膜比（p=0.03）和肌面积（p=0.03）更高。两种器械的术后恢复效果相似。DST 吻合器痔上黏膜环切术组患者的吻合口狭窄发生率较高，手术标本中的肌切除面积较大，肌黏膜比和肌面积也较高。需要进一步研究以更好地了解肌切除与肛门直肠狭窄之间的关系。
