Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

Abstract

Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with conservative therapies, especially for Grade III and IV hemorrhoids. In this review, we present and discuss the results of the most diffuse surgical techniques for hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorrhoids, with closure (Fergusson's technique) or without closure (Milligan-Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes a significant postoperative pain because of wide external wounds in the innervated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postoperative pain and faster return to normal activities. In the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conventional hemorrhoidectomy. Double stapler hemorrhoidopexy may be an alternative to simple stapled hemorrhoidopexy to reduce the recurrence in advanced hemorrhoidal prolapse. Transanal hemorrhoidal deartertialization was showed to be as effective as stapled hemorrhoidopexy in terms of treatment success, complications, and incidence recurrence. However, further high-quality trials are recommended to assess the efficacy and safety of this technique.

Virtual reality distraction decreases pain during daily dressing changes following haemorrhoid surgery

“…1,2 Surgery has been considered to be the most effective treatment for haemorrhoids for decades. 3 Daily wound care, including dressing changes, is considered to be an important and effective part of a comprehensive postoperative treatment programme for haemorrhoids. 4,5 However, the distressing pain resulting from daily dressing changes is often significant and severe in intensity, which adversely and seriously impacts on the quality of life and rehabilitation of patients with haemorrhoids following surgery.…”

Comparison of the short-term outcomes of using DST and PPH staplers in the treatment of grade III and IV hemorrhoids

“…Anorectal stricture generally occurs within 3 months after surgery in SH 19,25 ; its incidence ranges from 0% to 5% 11,25,26 and is similar compared to that with conventional hemorrhoidectomy among current studies 25 . In the conventional hemorrhoidectomy, the pathophysiology of the anal stricture is removal of large areas of the anoderm and the hemorrhoidal rectal mucosa, without sparing adequate mucocutaneous bridges, leading to scarring and a progressive chronic stricture 25,27 . However, SH generally causes rectal strictures whose pathophysiology has not yet been clearly understood.…”

“…However, SH generally causes rectal strictures whose pathophysiology has not yet been clearly understood. The potential mechanism responsible for causing a stricture is ring dehiscence followed by submucosal inflammation, and another theory is that the stapled ring is too close in the anal canal and that the squamous skin cells react by scarring and shrinking 19,22,27 . In this study, all the five patients with anorectal stricture had a resected muscularis propria of lower rectum in the specimens and the muscle/mucosa ratio and the surface area of the resected muscle were significantly larger than those of patients without stricture.…”

Stapled versus open haemorrhoidectomy: a prospective study

“…Open haemorrhoidal surgery aims to remove the haemorrhoids by Fergusson's technique (with closure) or Milligan-Morgan procedure (without closure) of the ensuing defect. 3 Of all modalities the Milligan Morgan method of haemorrhoidectomy is considered as gold standard and is practiced all over the world. 4 It has stood the test of time in terms of complications, cost and recurrence rate.…”