Hemorroidopexia por grampeamento parcial: aspectos clínicos e impacto sob a fisiologia anorretal

Abstract

RESUMO Objetivo: avaliar o impacto na fisiologia anorretal da hemorroidopexia por grampeamento parcial, das complicações relacionadas à técnica cirúrgica, dor e sangramento pós-operatório e recidiva de doença hemorroidária após um ano de cirurgia. Métodos: estudo prospectivo, descritivo, em pacientes consecutivos, portadores de doença hemorroidária do tipo mista ou interna, com componente interno classificado como grau III ou IV, submetidos à hemorroidopexia por grampeamento parcial. Resultados: foram estudados 17 pacientes, dos quais 82% apresentavam hemorroidas internas grau III, e 18% grau IV. A média de tempo operatório foi de 09:09 minutos (07:03 a 12:13 minutos). A mediana de dor no pós-operatório imediato avaliada pela escala numérica de dor foi de 1 (0 a 7). A mediana de retorno ao trabalho foi de nove dias (4 a 19). Nenhum paciente apresentou estenose de canal anal e 76% ficaram satisfeitos com a cirurgia com 90 dias de pós-operatório. Comparando-se os dados manométricos pré-operatórios e após 90 dias, nenhuma das variáveis avaliadas apresentou diferença com significância estatística. Não houve recidiva da doença hemorroidária com um ano de acompanhamento pós-operatório. Conclusão: a hemorroidopexia por grampeamento parcial não demonstrou impacto na fisiologia anorretal, apresentando baixos níveis de complicações e de dor pós-operatória, e sem recidivas após um ano de acompanhamento.

Recovery to Usual Activity After Outpatient Anorectal Surgery

“…These numbers may be regarded as high but may also be easily understood because of the limitation for carrying heavy loads at work after cholecystectomy and inguinal hernia repair. However, return to work was described after 4-19 days after outpatient anorectal surgery [13,14]. This is in contrast to the present study where one out of 3 patients only was not able to return to work at POD30.…”

Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial

“…Our preliminary data had shown similar clinical efficacy between the PSH and CSH procedures for advanced hemorrhoidal prolapse over a medium-term follow-up with less postoperative pain and fewer cases of initial fecal urgency in the PSH-treated patients. 12 The PSH procedure showed little impact on anorectal physiology with low complications, consistent with the finding by Soares et al 13 Favorable outcomes with PSH have been reported in short-term follow-up case series. 13–15 However, a head-to-head comparison between PSH and CSH in randomized trial has not been made, and information on long-term outcomes is lacking.…”

“…12 The PSH procedure showed little impact on anorectal physiology with low complications, consistent with the finding by Soares et al 13 Favorable outcomes with PSH have been reported in short-term follow-up case series. 13–15 However, a head-to-head comparison between PSH and CSH in randomized trial has not been made, and information on long-term outcomes is lacking. Our choice of a noninferiority trial design was based on the expectation that the PSH procedure is noninferior to CSH with fewer postoperative complications.…”

Symptoms in Dilating Venous Disease

“…Hemorrhoidal veins are typically characterized by dilated, thin-walled vessels within the submucosal arteriovenous plexus [ 55 ]. Typical complaints associated with HD include pain, bleeding, pruritis, burning, and swelling [ 56 ]. Patients that have symptomatic internal hemorrhoids may complain of itching, bleeding, pain, burning, prolapse, mucus discharge, moisture, swelling or difficulty with perianal hygiene [ 57 ].…”