Liu Xie, Sheng Bo, Zhang Jianbo, Wang Jijian, Yu Jun, Zhang Guanggang, Dai Fengshun, Su Heng, Xu Jingsong, Hu Wei, Li Tong, Zhu Peng
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
Department of General Surgery, The People's Hospital of Chongqing City, Chongqing, 400014, China.
Heliyon. 2024 Mar 20;10(7):e28465. doi: 10.1016/j.heliyon.2024.e28465. eCollection 2024 Apr 15.
Grade IV circular hemorrhoids are difficult to treat. We aim to describe the modified whitehead hemorrhoidectomy procedure and to assess the effectiveness and safety of this procedure for grade IV circular hemorrhoid patients.
Patients with grade Ⅳ circular hemorrhoids who underwent modified Whitehead hemorrhoidectomy and partial hemorrhoidectomy for fourth-degree circular mixed hemorrhoids were retrospectively reviewed. Clinical data were extracted from the database at our institution, and long-term postoperative complications were assessed through repeated outpatient examinations and telephonic communication.
A total of 205 patients were included in this study. The mean operative time was 59.2 ± 13.8 min. The average hospital stay was 4.6 ± 1.0 days. For postoperative complications, 66 (32.2%) patients had urinary retention, 10 (4.9%) patients had a sense of incomplete rectal emptying, 5 (2.4%) patients had anal incontinence, and 6 (2.9%) patients had wound infection. For long-term postoperative complications, 3 (1.5%) patients experienced mild to moderate anal stricture, 2 (1%) patients experienced mucosal ectropion, they all had smooth recoveries, and none of them needed secondary surgery. None of these patients had a hemorrhoid recurrence. A total of 205 patients who received modified Whitehead hemorrhoidectomy and 161 who received partial hemorrhoidectomy were included. There were no residual hemorrhoids in patients who received modified Whitehead hemorrhoidectomy, and none had hemorrhoid recurrence. Fifty-eight patients who received partial hemorrhoidectomy had hemorrhoidal residues, and 19 patients experienced hemorrhoid recurrence. After modified Whitehead hemorrhoidectomy, 3 patients developed anal stenosis, and 2 had mucosal ectropion. Four patients developed anal stricture after partial hemorrhoidectomy, and none had mucosal ectropion. They all had smooth recoveries, and none of them needed a secondary surgery. For the mean duration of surgery, postoperative bleeding, postoperative pain, wound infection, sense of incomplete rectal emptying, anal incontinence, and urinary retention, no statistically significant differences were found between the two groups.
Compared with partial hemorrhoidectomy, modified whitehead hemorrhoidectomy is an effective and safe surgical procedure and does not significantly increase the risk of anal stenosis and mucosal ectropion for grade IV circular hemorrhoid patients. Prospective randomized controlled trials are needed to verify our results.
Ⅳ度环状痔难以治疗。我们旨在描述改良白海德痔切除术，并评估该手术对Ⅳ度环状痔患者的有效性和安全性。
回顾性分析接受改良白海德痔切除术及Ⅳ度环状混合痔部分痔切除术的Ⅳ度环状痔患者。从我们机构的数据库中提取临床数据，并通过反复门诊检查和电话沟通评估术后长期并发症。
本研究共纳入205例患者。平均手术时间为59.2±13.8分钟。平均住院时间为4.6±1.0天。术后并发症方面，66例（32.2%）患者出现尿潴留，10例（4.9%）患者有直肠排空不全感，5例（2.4%）患者出现肛门失禁，6例（2.9%）患者出现伤口感染。术后长期并发症方面，3例（1.5%）患者出现轻度至中度肛门狭窄，2例（1%）患者出现黏膜外翻，他们恢复顺利，均无需二次手术。这些患者均无痔复发。共纳入205例行改良白海德痔切除术的患者和161例行部分痔切除术的患者。行改良白海德痔切除术的患者无残留痔，且无痔复发。58例行部分痔切除术的患者有痔残留，19例患者出现痔复发。改良白海德痔切除术后，3例患者出现肛门狭窄，2例出现黏膜外翻。部分痔切除术后4例患者出现肛门狭窄，无黏膜外翻。他们恢复顺利，均无需二次手术。在平均手术时长、术后出血、术后疼痛、伤口感染、直肠排空不全感、肛门失禁和尿潴留方面，两组间未发现统计学上的显著差异。
与部分痔切除术相比，改良白海德痔切除术是一种有效且安全的手术方法，对于Ⅳ度环状痔患者，不会显著增加肛门狭窄和黏膜外翻的风险。需要进行前瞻性随机对照试验来验证我们的结果。
