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Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction.
World J Clin Cases. 2021 Jan 06; 9(1):36-46.WJ

Abstract

BACKGROUND

Hemorrhoidal prolapse is a common benign disease with a high incidence. The treatment procedure for prolapse and hemorrhoids (PPH) remains an operative method used for internal hemorrhoid prolapse. Although it is related to less pos-operative pain, faster recovery and shorter hospital stays, the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy (MMH). We have considered that recurrence could be due to shortage of the pulling-up effect. This issue may be overcome by using lower purse-string sutures [modified-PPH (M-PPH)].

AIM

To compare the therapeutic effects and the patients' satisfaction after M-PPH, PPH and MMH.

METHODS

This retrospective cohort study included 1163 patients (M-PPH, 461; original PPH, 321; MMH, 381) with severe hemorrhoids (stage III/IV) who were admitted to The 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from 2012 to 2014. Early postoperative complications, efficacy, postoperative anal dysfunction and patient satisfaction were compared among the three groups. Established criteria were used to assess short- and long-term postoperative complications. A visual analog scale was used to evaluate postoperative pain. Follow-up was conducted 5 years postoperatively.

RESULT

Length of hospital stay and operating time were significantly longer in the MMH group (8.05 ± 2.50 d, 19.98 ± 4.21 min; P < 0.0001) than in other groups. The incidence of postoperative anastomotic bleeding was significantly lower after M-PPH than after PPH or MMH (1.9%, 5.1% and 3.7%; n = 9, 16 and 14; respectively). There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH (15%, 8% and 10%; n = 69, 30 and 32; respectively). There was a significantly lower rate of recurrence after M-PPH than after PPH (8.7% and 18.8%, n = 40 and 61; P < 0.0001). The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups (1.3% and 4.3%, n = 5 and 20; P = 0.04). Patient satisfaction was significantly greater after M-PPH than after other surgeries.

CONCLUSION

M-PPH has many advantages for severe hemorrhoids (Goligher stage III/IV), with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction.

Authors+Show Affiliations

Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.Department of Biostatistics, School of Public Health, State University of New York at Albany, Albany, NY 12206, United States.Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.Department of Anorectal Surgery, The 2 Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China. liucbwmu@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33511170

Citation

Chen, Yan-Yu, et al. "Modified Procedure for Prolapse and Hemorrhoids: Lower Recurrence, Higher Satisfaction." World Journal of Clinical Cases, vol. 9, no. 1, 2021, pp. 36-46.
Chen YY, Cheng YF, Wang QP, et al. Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction. World J Clin Cases. 2021;9(1):36-46.
Chen, Y. Y., Cheng, Y. F., Wang, Q. P., Ye, B., Huang, C. J., Zhou, C. J., Cai, M., Ye, Y. K., & Liu, C. B. (2021). Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction. World Journal of Clinical Cases, 9(1), 36-46. https://doi.org/10.12998/wjcc.v9.i1.36
Chen YY, et al. Modified Procedure for Prolapse and Hemorrhoids: Lower Recurrence, Higher Satisfaction. World J Clin Cases. 2021 Jan 6;9(1):36-46. PubMed PMID: 33511170.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction. AU - Chen,Yan-Yu, AU - Cheng,Yi-Fan, AU - Wang,Quan-Peng, AU - Ye,Bo, AU - Huang,Chong-Jie, AU - Zhou,Chong-Jun, AU - Cai,Mao, AU - Ye,Yun-Kui, AU - Liu,Chang-Bao, PY - 2020/07/29/received PY - 2020/10/27/revised PY - 2020/11/09/accepted PY - 2021/1/29/entrez PY - 2021/1/30/pubmed PY - 2021/1/30/medline KW - Hemorrhoids KW - Milligan-Morgan hemorrhoidectomy KW - Patient satisfaction KW - Postoperative complications KW - Procedure for prolapse and hemorrhoids KW - Recurrence SP - 36 EP - 46 JF - World journal of clinical cases JO - World J Clin Cases VL - 9 IS - 1 N2 - BACKGROUND: Hemorrhoidal prolapse is a common benign disease with a high incidence. The treatment procedure for prolapse and hemorrhoids (PPH) remains an operative method used for internal hemorrhoid prolapse. Although it is related to less pos-operative pain, faster recovery and shorter hospital stays, the postoperative recurrence rate is higher than that of the Milligan-Morgan hemorrhoidectomy (MMH). We have considered that recurrence could be due to shortage of the pulling-up effect. This issue may be overcome by using lower purse-string sutures [modified-PPH (M-PPH)]. AIM: To compare the therapeutic effects and the patients' satisfaction after M-PPH, PPH and MMH. METHODS: This retrospective cohort study included 1163 patients (M-PPH, 461; original PPH, 321; MMH, 381) with severe hemorrhoids (stage III/IV) who were admitted to The 2nd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from 2012 to 2014. Early postoperative complications, efficacy, postoperative anal dysfunction and patient satisfaction were compared among the three groups. Established criteria were used to assess short- and long-term postoperative complications. A visual analog scale was used to evaluate postoperative pain. Follow-up was conducted 5 years postoperatively. RESULT: Length of hospital stay and operating time were significantly longer in the MMH group (8.05 ± 2.50 d, 19.98 ± 4.21 min; P < 0.0001) than in other groups. The incidence of postoperative anastomotic bleeding was significantly lower after M-PPH than after PPH or MMH (1.9%, 5.1% and 3.7%; n = 9, 16 and 14; respectively). There was a significantly higher rate of sensation of rectal tenesmus after M-PPH than after MMH or PPH (15%, 8% and 10%; n = 69, 30 and 32; respectively). There was a significantly lower rate of recurrence after M-PPH than after PPH (8.7% and 18.8%, n = 40 and 61; P < 0.0001). The incidence of postoperative anal incontinence differed significantly only between the MMH and M-PPH groups (1.3% and 4.3%, n = 5 and 20; P = 0.04). Patient satisfaction was significantly greater after M-PPH than after other surgeries. CONCLUSION: M-PPH has many advantages for severe hemorrhoids (Goligher stage III/IV), with a low rate of anastomotic bleeding and recurrence and a very high rate of patient satisfaction. SN - 2307-8960 UR - https://www.unboundmedicine.com/medline/citation/33511170/Modified_procedure_for_prolapse_and_hemorrhoids:_Lower_recurrence_higher_satisfaction_ L2 - https://www.wjgnet.com/2307-8960/full/v9/i1/36.htm DB - PRIME DP - Unbound Medicine ER -
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