Narayanaswamy Chetty Y V, Sreevathsa M R, Chowdari G Akhil, Rao Koteshwara
Department of General Surgery, Ramaiah Medical College, Mathikere, Bangaluru, Karnataka, India.
Surg J (N Y). 2022 Aug 24;8(3):e199-e207. doi: 10.1055/s-0042-1743520. eCollection 2022 Jul.
Stapled hemorrhoidopexy is widely practiced worldwide since its introduction to the world of proctology and replaced conventional hemorrhoidectomy in treating hemorrhoids. The technique of executing the procedure dictates the outcomes and complications. Here, we attempted to establish the cause of postoperative complications and attributed them to the presence of muscle of fibers in the excised doughnut specimens. A prospective observational analysis of histopathological specimens obtained from patients who underwent stapled hemorrhoidopexy using procedure for prolapse and hemorrhoids-03 circular staplers in the department of surgery of a tertiary care hospital in southern India was performed, and the correlation between the presence or absence of muscle fibers in the specimens and postoperative complications was evaluated. The patients were followed up for 12 months after the procedure. In this study, 155 patients, including 54, 91, and 10 patients with Grade 2, Grade 3, and Grade 4 hemorrhoids, respectively, were included. Group A consisted of 19 patients with muscle fibers on the specimens, whereas Group B consisted of 139 patients without muscle fibers on the specimens. Early complications within 7 days after the procedure were as follows: 21 and 0.7% of the patients in Groups A and B, respectively, presented with postoperative pain with a visual analog scale score of more than 4; 47 and 6% of the patients in Groups A and B, respectively, presented with urinary retention; 26 and 2% of the patients in Groups A and B, respectively, presented with bleeding; and 21 and 2.9% of the patients in Groups A and B, respectively, presented with fecal urgency. A significant association was found between the presence of muscle fibers and early complications ( < 0.001). Late complications, such as proctalgia and bleeding, accounting for 36.8 and 6.6% in Groups A and B, respectively, were significantly associated with the presence of muscle fibers in histopathology ( < 0.001). Meanwhile, other late complications, such as incontinence, stenosis, and recurrence, exhibited no association ( > 0.05). The technique in taking purse-string sutures and the depth of the suture bite above the dentate line carry the utmost importance in preventing postoperative complications. Therefore, surgeons should refine their technique of appropriate depth to avoid incorporation of muscle fibers while executing the procedure.
吻合器痔上黏膜环切术自引入直肠外科领域以来，在全球范围内广泛应用，并在治疗痔疮方面取代了传统的痔切除术。手术操作技术决定了手术效果和并发症。在此，我们试图确定术后并发症的原因，并将其归因于切除的环形标本中存在肌纤维。
对印度南部一家三级护理医院外科接受使用吻合器痔上黏膜环切术-03环形吻合器进行吻合器痔上黏膜环切术患者的组织病理学标本进行前瞻性观察分析，并评估标本中肌纤维的有无与术后并发症之间的相关性。术后对患者进行了12个月的随访。
本研究纳入了155例患者，其中分别有54例、91例和10例患有2级、3级和4级痔疮。A组由19例标本中有肌纤维的患者组成，而B组由139例标本中无肌纤维的患者组成。术后7天内的早期并发症如下：A组和B组分别有21例（占0.7%）和0例患者术后疼痛视觉模拟评分超过4分；A组和B组分别有47例（占6%）和2例患者出现尿潴留；A组和B组分别有26例（占2%）和2例患者出现出血；A组和B组分别有21例（占2.9%）和2例患者出现便急。发现肌纤维的存在与早期并发症之间存在显著关联（<0.001）。晚期并发症，如直肠疼痛和出血，在A组和B组中分别占36.8%和6.6%，与组织病理学中肌纤维的存在显著相关（<0.001）。同时，其他晚期并发症，如失禁、狭窄和复发，未显示出相关性（>0.05）。
荷包缝合技术和齿状线以上缝合的深度在预防术后并发症方面至关重要。因此，外科医生应改进其适当深度的技术，以避免在手术过程中纳入肌纤维。
