Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8178-8183
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8178
Procedure for prolapse and hemorrhoids vs traditional surgery for outlet obstructive constipation
Ming Lu, Bo Yang, Yang Liu, Qing Liu, Hao Wen
Ming Lu, Bo Yang, Yang Liu, Qing Liu, Hao Wen, Department of General Surgery, First Affiliated Teaching Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Author contributions: Lu M is the principal surgeon and wrote the manuscript; Yang B reviewed the literature; Liu Y and Liu Q observed the indexes of the patients; and Wen H designed the study and revised and finalized the manuscript to be published.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Xinjiang Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hao Wen, Chief Physician, Professor, Doctoral Tutor, Department of General Surgery, First Affiliated Teaching Hospital of Xinjiang Medical University, No. 137 Liyushan South Road, Urumqi 830054, Xinjiang Uygur Autonomous Region, China. wenhao@163.com
Telephone: +86-991-4366594 Fax: +86-991-4366594
Received: November 30, 2014
Peer-review started: November 30, 2014
First decision: January 8, 2015
Revised: February 2, 2015
Accepted: March 18, 2015
Article in press: March 19, 2015
Published online: July 14, 2015
Processing time: 225 Days and 17.3 Hours
Abstract

AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.

METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study. The patients with rectal prolapse hemorrhoids with outlet obstruction-induced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids (PPH) (n = 54) or conventional surgery (n = 54; control group). Short-term (operative time, postoperative hospital stay, postoperative urinary retention, postoperative perianal edema, and postoperative pain) and long-term (postoperative anal stenosis, postoperative sensory anal incontinence, postoperative recurrence, and postoperative difficulty in defecation) clinical effects were compared between the two groups. The short- and long-term efficacies of the two procedures were determined.

RESULTS: In terms of short-term clinical effects, operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group (24.36 ± 5.16 min vs 44.27 ± 6.57 min, 2.1 ± 1.4 d vs 3.6 ± 2.3 d, both P < 0.01). The incidence of postoperative urinary retention was higher in the PPH group than in the control group, but the difference was not statistically significant (48.15% vs 37.04%). The incidence of perianal edema was significantly lower in the PPH group (11.11% vs 42.60%, P < 0.05). The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery were significantly lower in the PPH group (2.9 ± 0.9 vs 8.3 ± 1.1, 2.0 ± 0.5 vs 6.5 ± 0.8, and 1.7 ± 0.5 vs 5.0 ± 0.7, respectively, all P < 0.01). With regard to long-term clinical effects, the incidence of anal stenosis was lower in the PPH group than in the control group, but the difference was not significant (1.85% vs 5.56%). The incidence of sensory anal incontinence was significantly lower in the PPH group (3.70% vs 12.96%, P < 0.05). The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group, but the differences were not significant (11.11% vs 16.67% and 12.96% vs 24.07%, respectively).

CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.

Keywords: Internal rectal prolapse; Outlet obstructive constipation; Procedure for prolapse and hemorrhoids; Prospective study; Randomized controlled study

Core tip: This study included 54 patients with rectal prolapse hemorrhoids and compared procedure for prolapse and hemorrhoids (PPH) with a traditional operation. The PPH group had a significantly shorter operative time, shorter hospital stay, and lower incidence of postoperative edema perianal, postoperative pain, and sensory incontinence compared to the group receiving traditional surgical treatment. PPH surgery has an obvious effect that can be widely used in clinical treatment.