Surgical approach for lower postoperative anal stenosis

Abstract

After anorectal surgery, hemorrhoids frequently lead to chronic issues, particularly in patients with mixed hemorrhoids. Liu et al investigated the outcomes of staple removal at the 3- and 9-o’clock positions following modified stapled hemorrhoidopexy (SH) in patients with grade III or IV hemorrhoids. This study included patients who underwent standard or modified SH between January 1, 2015, and January 1, 2020. Key metrics assessed included hospital stay duration, blood loss, operation time, and the incidence of minor or major complications. The findings indicated that the modified SH technique is a safe option for advanced-grade hemorrhoids, resulting in a lower rate of postoperative anal stenosis compared to standard SH. Notably, this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments. While the modified SH demonstrates immediate benefits, further research is necessary to evaluate long-term effects. Despite its advantages, the study’s limited sample size restricts the generalizability of the findings, underscoring the need for larger, long-term studies to validate these results. Clinically, the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis, a common concern following typical surgeries. If confirmed by larger trials, this procedure may become the preferred surgical approach for hemorrhoids. In conclusion, the work of Liu et al signifies a meaningful advancement in hemorrhoid surgery, enhancing patient safety and outcomes.

Keywords: Hemorrhoids; Prolapse; Postoperative anal stenosis; Modified stapled hemorrhoidopexy; Anal canal

Core Tip: The groundbreaking study by Liu et al reveals that stapled hemorrhoidopexy (SH) is a successful surgical treatment for hemorrhoids. A modified SH technique that lowers the likelihood of stenosis is described. The authors completed this altered treatment in patients over 5 years, with minimal stenosis rates, recurrence, and other problems. This implies that the modified approach would be preferable to normal SH to reduce the probability of complications. Despite multiple limitations, such as a small sample size, the study highlights the importance of the modified SH technique in reducing complications of anal stenosis after SH and improving quality and safety for affected patients, while suggesting supplementary research and innovative treatment approaches.