Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2024; 16(9): 2787-2795
Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.2787
Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience
Yu-Hong Liu, Tzu-Chiao Lin, Chao-Yang Chen, Ta-Wei Pu
Yu-Hong Liu, Tzu-Chiao Lin, Chao-Yang Chen, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 105, Taiwan
Ta-Wei Pu, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei 105, Taiwan
Author contributions: Liu YH is the first author, wrote the observational study report, completed the literature review; Pu TW performed the final editing and preparation of the paper for approval; Chen CY and Lin TC were part of the surgical team; and all authors have read and approved the final manuscript.
Institutional review board statement: This study protocol was reviewed and approved by the Institutional Review Board of the Taiwan Adventist Hospital (approval No. 110-E-6).
Informed consent statement: The need for written informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ta-Wei Pu, MD, Chief Doctor, Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, No. 131 Jiankang Road, Songshan District, Taipei 105, Taiwan. tawei0131@gmail.com
Received: March 14, 2024
Revised: May 22, 2024
Accepted: July 29, 2024
Published online: September 27, 2024
Processing time: 187 Days and 21.7 Hours
Abstract
BACKGROUND

Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.

AIM

To compare outcomes of staple removal at the 3- and 9-o’clock positions during modified SH in patients with mixed hemorrhoids.

METHODS

This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded.

RESULTS

Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.

CONCLUSION

The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.

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

Core Tip: Postoperative anal stenosis is a critical complication of stapled hemorrhoidopexy (SH). In this study, we report our 5-year experience of the outcomes of our modified SH technique. We found that the modified SH method is safe and effective for treating patients with grade III and IV protruding hemorrhoids. The postoperative anal stenosis rate after our modified SH was lower than that after standard SH, particularly among patients who had previously undergone interventions for hemorrhoids.