Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 36-46
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.36
Modified procedure for prolapse and hemorrhoids: Lower recurrence, higher satisfaction
Yan-Yu Chen, Yi-Fan Cheng, Quan-Peng Wang, Bo Ye, Chong-Jie Huang, Chong-Jun Zhou, Mao Cai, Yun-Kui Ye, Chang-Bao Liu
Yan-Yu Chen, Yi-Fan Cheng, Quan-Peng Wang, Chong-Jie Huang, Chong-Jun Zhou, Mao Cai, Yun-Kui Ye, Chang-Bao Liu, Department of Anorectal Surgery, The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Bo Ye, Department of Biostatistics, School of Public Health, State University of New York at Albany, Albany, NY 12206, United States
Author contributions: Chen YY performed most of the data analysis and wrote this paper; Huang CJ , Zhou CJ and Cai M performed the clinical therapy, advised the performance of the study and provided the curative effect evaluation system; Cheng YF and Wang QP completed the postoperative follow-up; Ye B performed the final data review and was responsible for the data’s reliability; Ye YK performed the clinical treatment work; Liu CB designed the study, completed the majority of clinical treatment work and was responsible for the reliability of the paper.
Institutional review board statement: The study was reviewed and approved for publication by the Ethics Committee of the 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University.
Informed consent statement: Written informed consent was obtained from the study participants.
Conflict-of-interest statement: All of the authors have no conflict of interest related to the manuscript.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chang-Bao Liu, MD, PhD, Chief Physician, Department of Anorectal Surgery, The 2nd Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, No. 109 Xueyuanxi Street, Lucheng District, Wenzhou 325000, Zhejiang Province, China. liucbwmu@163.com
Received: July 29, 2020
Peer-review started: July 29, 2020
First decision: September 30, 2020
Revised: October 27, 2020
Accepted: November 9, 2020
Article in press: November 9, 2020
Published online: January 6, 2021
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.

M-PPH
Keywords: Hemorrhoids, Milligan-Morgan hemorrhoidectomy, Postoperative complications, Procedure for prolapse and hemorrhoids, Recurrence, Patient satisfaction

Core Tip: In total, 1163 patients were treated for severe prolapsed hemorrhoids using modified procedure for prolapse and hemorrhoids (M-PPH), conventional hemorrhoidectomy, or Milligan-Morgan hemorrhoidectomy. The short-term postoperative complications, postoperative anal dysfunction and therapeutic effects of the three treatment methods were compared. M-PPH has many advantages compared to traditional surgical treatments, including a higher degree of effectiveness, a significantly lower recurrence rate than the original PPH, and a higher rate of patient satisfaction.