Tomasicchio Giovanni, Martines Gennaro, Lantone Giuliano, Dibra Rigers, Trigiante Giuseppe, De Fazio Michele, Picciariello Arcangelo, Altomare Donato Francesco, Rinaldi Marcella
Surgical Unit "M. Rubino", Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy.
Front Surg. 2021 Aug 16;8:708051. doi: 10.3389/fsurg.2021.708051. eCollection 2021.
Single or double prolapsed pile instead of full muco-hemorrhoidal prolapse is a common finding in patients with symptomatic III or IV degree hemorrhoids. For this selected group of patients, relief of symptoms could be achieved by managing the single/double prolapsed piles instead of performing traditional hemorrhoidectomy. The aim of this single-center study was to evaluate the safety and medium- and long-term effectiveness of an outpatient tailored Milligan-Morgan hemorrhoidectomy (MMH) performed under local anesthesia (LA). Clinical records of 202 patients submitted to outpatient tailored MMH, under LA and without anal dilation, treated between 2013 and 2020, were retrospectively reviewed using a prospectively maintained database and completed by a telephone interview or outpatient consultation. Postoperative pain score, the need for painkillers, postoperative complications and symptoms recurrence, return to working activities, and patient grading assessment scale were recorded. Thirty-five (17%) out of 202 patients recruited were lost to the follow-up. One hundred and fifty-two and 15 patients underwent a single and double pile hemorrhoidectomy, respectively. With regard to postoperative outcomes, visual analogue scale (VAS) decreased from a median value of 4 [interquartile range (IQR) 2-6] on the day of surgery to 1 (IQR 0-4) on the 10th postoperative day ( < 0.001). Sixty-one patients (37%) needed oral painkillers during the 1st week after surgery. There was no mortality or major postoperative complication. Bleeding requiring hospital readmission was reported in seven (4%) patients, and one patient underwent emergency surgery with no need for blood transfusion. No postoperative urinary retention, anal incontinence, or stricture occurred in the series. During the median follow-up of 39 (IQR 12-60) months, 26 patients (16%) reported symptoms of recurrence but only six underwent traditional MMH. Recovery to normal activity occurred within a median period of 6 days (IQR 3-10) and the Clinical Patient Grading Assessment Scale (CPGAS) at 1 year after surgery was reported to be a "good deal better." Tailored MMH performed under LA in an ambulatory setting can be considered a safe and effective technique with high compliance and satisfaction of patients.
有症状的Ⅲ度或Ⅳ度痔疮患者中，常见的是单个或双个内痔脱垂而非完全的黏膜痔脱垂。对于这一特定患者群体，通过处理单个/双个脱垂痔核而非进行传统痔切除术，可实现症状缓解。本单中心研究的目的是评估在局部麻醉下进行的门诊定制Milligan-Morgan痔切除术（MMH）的安全性及中长期有效性。回顾性分析了2013年至2020年间接受门诊定制MMH、在局部麻醉下且未行肛门扩张治疗的202例患者的临床记录，该数据库为前瞻性维护，并通过电话随访或门诊复诊进行补充。记录术后疼痛评分、止痛药使用需求、术后并发症及症状复发情况、恢复工作活动情况以及患者分级评估量表。202例入组患者中有35例（17%）失访。152例和15例患者分别接受了单个和双个痔核切除术。关于术后结果，视觉模拟评分（VAS）从手术当天的中位数4[四分位间距（IQR）2 - 6]降至术后第10天的1（IQR 0 - 4）（<0.001）。61例患者（37%）在术后第1周需要口服止痛药。无死亡病例或严重术后并发症。7例（4%）患者出现需再次入院治疗的出血情况，1例患者接受了急诊手术，无需输血。该系列中未发生术后尿潴留、肛门失禁或肛门狭窄。在中位随访39个月（IQR 12 - 60）期间，26例患者（16%）报告有复发症状，但仅6例接受了传统MMH。恢复正常活动的中位时间为6天（IQR 3 - 10），术后1年的临床患者分级评估量表（CPGAS）显示“好多了”。在门诊环境下局部麻醉下进行的定制MMH可被视为一种安全有效的技术，患者依从性和满意度高。
