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High-Volume Transanal Surgery in the Treatment of Degree-IV Hemorrhoids: Safety and Efficacy

2016; Lippincott Williams & Wilkins; Volume: 111; Linguagem: Inglês

10.14309/00000434-201610001-02537

1572-0241

Aldo Bove, Raffaella Di Renzo, Gino Palone, Manuela Bellobono, Gauro Dʼurbano, Vincenzo DʼAddetta, Giuseppe Bongarzoni,

Diverticular Disease and Complications

Introduction: According to the Longo procedure, the treatment of degree-IV hemorrhoids has shown a high frequency of recurrence in a post- hemorrhoidectomy surgery. These unsuccessful cases are due to the inability of the device to gather the entire rectal prolapse. Therefore high volume staplers were introduced to reduce frequency of recurrence. The goal of this study was to verify the results obtained with this new device in terms of safety and efficacy. Methods: 60 patients (32 males and 28 females) with degree-IV hemorrhoids had stapled hemorrhoidectomy with CPH36 from January 2014 to January 2016. Each patient showed rectal prolapse exceeding more than half of CAD. Patients affected by obstructive defecation syndrome (Wexner's score >15) or by a recurring disease were excluded from this study. The main evaluated criteria were: the length of the surgery, post-surgery complications and short and long-term results. Results: The mean operative time was 24.5 minutes (range: 18-60) during which no intraoperative complications arose. The mean volume of the prolassectomy was 12,5 mL (7-18) Post-operative pain evaluated using V.A.S. Scale was very light in 32 patients (V.A.S. 2,4), light in 27 (V.A.S. 3.8) and strong in 1 (V.A.S. 6,2). Early complications were: 1 bleeding, 1 external hemorrhoid thrombosis. Mean hospital stay was 2,2 days on a range between 2 and 5. Long-term results with a mean follow up of 14 months (6-24) have shown 1 recurrence (1.6%) and 1 case of fecal urgency. One patient was also affected by a worsening of sphincetric continence. Conclusion: According to the Longo procedure the treatment of the hemorrhoidal disease with stapled hemorrhoidectomy proved to be effective in reducing post-surgery pain and fastening the recovery process. The frequency of recurrence is nonetheless very high, especially in degree-IV hemorrhoids. The use of a high volume stapler resulted to be safe and to have reduce the frequency of recurrence by resecting a greater volume of rectal prolapse.