Universidade de São Paulo, Gastroenterology - São Paulo (SP), Brazil.
Universidade Municipal de São Caetano do Sul, Gastroenterology - São Caetano do Sul (SP), Brazil.
Arq Bras Cir Dig. 2022 Nov 25;35:e1696. doi: 10.1590/0102-672020220002e1696. eCollection 2022.
Since its introduction, stapled hemorrhoidopexy has been increasingly indicated in the management of hemorrhoidal disease.
Our primary end point was to evaluate the incidence of recurrent disease requiring another surgical intervention. On a secondary analysis, we also compared pain, complications, and patient's satisfaction after a tailored surgery.
We retrospectively reviewed 196 patients (103 males and 93 females) with a median age of 47.9 years (range, 17-78) who were undergoing stapled hemorrhoidopexy alone (STG; n=65) or combined surgery (CSG; n=131, stapled hemorrhoidopexy associated with resection).
Complications were detected in 11 (5.6%) patients (4.6% for STG vs. 6.1% for CSG; p=0.95). At the same time, symptoms recurrence (13.8% vs. 8.4%; p=034), reoperation rate for complications (3.1% vs. 3.0%; p=1.0), and reoperation rate for recurrence (6.1% vs. 4.6%; p=1.0) were not different among groups. Grade IV patients were more commonly managed with simultaneous stapling and resection (63% vs. 49.5%), but none of them presented symptoms recurrence nor need reoperation due to recurrence. Median pain score during the first week was higher in CSG patients (0.8 vs. 1.7). After a follow-up of 24.9 months, satisfaction scores were similar (8.6; p=0.8).
Recurrent symptoms were observed in 10% of patients, requiring surgery in approximately half of them. Even though the association of techniques may raise pain scores, a tailored approach based on amplified indication criteria and combined techniques seems to be an effective and safe alternative, with decreased relapse rates in patients suffering from more advanced hemorrhoidal disease. Satisfaction scores after hemorrhoidopexy are high.
自引入以来，吻合器痔上黏膜环切术（stapled hemorrhoidopexy）在痔病的治疗中应用越来越广泛。
我们的主要终点是评估需要再次手术干预的复发病例的发生率。在二次分析中，我们还比较了经过定制手术后的疼痛、并发症和患者满意度。
我们回顾性分析了 196 例患者（男 103 例，女 93 例），中位年龄为 47.9 岁（范围，17-78 岁），他们单独接受吻合器痔上黏膜环切术（STG；n=65）或联合手术（CSG；n=131，吻合器痔上黏膜环切术联合切除）。
11 例（5.6%）患者出现并发症（STG 为 4.6%，CSG 为 6.1%；p=0.95）。同时，症状复发率（13.8%比 8.4%；p=0.34）、并发症再手术率（3.1%比 3.0%；p=1.0）和复发再手术率（6.1%比 4.6%；p=1.0）在各组之间无差异。IV 级患者更常采用同时吻合和切除（63%比 49.5%），但无一人因复发出现症状复发或需要再次手术。CSG 患者在术后第一周的疼痛评分中位数较高（0.8 比 1.7）。经过 24.9 个月的随访，满意度评分相似（8.6；p=0.8）。
10%的患者出现症状复发，其中约一半需要手术。尽管联合技术可能会增加疼痛评分，但基于扩大的适应证标准和联合技术的定制方法似乎是一种有效且安全的替代方法，可降低患有更严重痔病患者的复发率。痔上黏膜环切术后的满意度评分较高。
