Learning curve of stapled hemorrhoidopexy

Yen, Min Hsuan; Kiu, Kee Thai; Chang, Tsu‐Chung

doi:10.1016/j.asjsur.2021.03.005

Cited by 4 publications

(5 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rst phase may correspond to the manual learning of the technique, the second phase shows a descending slope where the surgeon acquired the surgical skill and performs the procedure in a shorter time, and nally the third phase with an increase in time because more complex cases were performed. Similar ndings are reported in another publication where a different dynamic method of LC evaluation was used, the moving average analysis, and two technical variables were evaluated: operative time and muscle/mucosa ratio of the mucosectomy [20]. They found that operative time stabilized at surgery number 20, and the muscle/mucosa ratio around surgery 40.…”

Section: Discussionsupporting

confidence: 81%

“…Although this technique is highly accepted and the postoperative results are closely related to technical factors, there is little evidence in the literature on the LC or the number of surgeries a surgeon should perform in order to achieve acceptable results [20]. In a survey of 42 experts in Latin America, there was a lack of consensus on the minimum number of surgeries required to achieve pro ciency with the PPH technique [21], with a broad scatter of the results.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Learning curve of stapled hemorrhoidopexy: analysis using the cumulative summation (CUSUM) method

Balmaceda,

Affronti,

Recabarren

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Stapled hemorrhoidopexy (PPH) is a common technique for the treatment of hemorrhoidal prolapse. Although technical factors are determinant in postoperative results, there is little evidence on the learning curve of this technique. The aim of this study is to analyze the learning curve (LC) of the PPH technique using the cumulative summation method (CUSUM). Methods: Retrospective, analytical study based on a digital survey. The early cases performed by a single surgeon were chronologically ordered. Pre, intra and postoperative variables were analyzed. CUSUM curves were constructed. Results:Thirty-four patients were included. Three phases were identified by the CUSUM chart of operative time versus chronological order. The first phase had an ascending slope up to surgery number 18, the second phase had a descending slope up to surgery 36, and the third phase was ascending as of surgery number 37 (p<0,001, confidence level 70%). The CUSUM curves for postoperative variables did not show any trends along the learning curve (p<0.05). Conclusion: The learning curve of the PPH technique using the CUSUM method showed a three-phase curve in terms of operative time, with a decrease between surgeries 1-18, a stabilization in surgeries 19-36 and a new increase as of surgery 37. The CUSUM curves related to pain, complications, recurrence and patient satisfaction do not show any chronologically related trends.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Learning curve of stapled hemorrhoidopexy: analysis using the cumulative summation (CUSUM) method

Balmaceda,

Affronti,

Recabarren

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Overtime, indications criteria have been amplified, and factors related to anatomy (one or two prolapsed piles, external thrombosis), symptoms (bleeding, thrombosis), or associated diseases (obstructed defecation) were no longer considered obstacles to perform SH 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Gradually, the development of new devices turned bleeding a very rare occurrence. Furthermore, a meticulous inspection after firing may preclude the need for an easy manual suture with absorbable stiches to avoid local bleeding 19 .…”

Section: Discussionmentioning

confidence: 99%

Is It Possible to Optimize Stapled Hemorrhoidopexy Outcomes by Enlarging Operative Criteria Indications? Results of a Tailored Procedure With Associated Resection in a Comparative Personal Series

Campos

Cavalari-Mancuzo

Bustamante-Lopez

et al. 2022

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

BACKGROUND: Since its introduction, stapled hemorrhoidopexy has been increasingly indicated in the management of hemorrhoidal disease. AIM: Our primary end point was to evaluate the incidence of recurrent disease requiring another surgical intervention. On a secondary analysis, we also compared pain, complications, and patient's satisfaction after a tailored surgery. METHODS: We retrospectively reviewed 196 patients (103 males and 93 females) with a median age of 47.9 years (range, 17–78) who were undergoing stapled hemorrhoidopexy alone (STG; n=65) or combined surgery (CSG; n=131, stapled hemorrhoidopexy associated with resection). RESULTS: Complications were detected in 11 (5.6%) patients (4.6% for STG vs. 6.1% for CSG; p=0.95). At the same time, symptoms recurrence (13.8% vs. 8.4%; p=034), reoperation rate for complications (3.1% vs. 3.0%; p=1.0), and reoperation rate for recurrence (6.1% vs. 4.6%; p=1.0) were not different among groups. Grade IV patients were more commonly managed with simultaneous stapling and resection (63% vs. 49.5%), but none of them presented symptoms recurrence nor need reoperation due to recurrence. Median pain score during the first week was higher in CSG patients (0.8 vs. 1.7). After a follow-up of 24.9 months, satisfaction scores were similar (8.6; p=0.8). CONCLUSION: Recurrent symptoms were observed in 10% of patients, requiring surgery in approximately half of them. Even though the association of techniques may raise pain scores, a tailored approach based on amplified indication criteria and combined techniques seems to be an effective and safe alternative, with decreased relapse rates in patients suffering from more advanced hemorrhoidal disease. Satisfaction scores after hemorrhoidopexy are high.

show abstract

“…[2] PPH has become an effective option for the treatment of hemorrhoids because of its simplicity, short operative time, minimal pain, and quick recovery. [3,4] Therefore, this procedure has been widely used in many centers. However, in the long term, PPH surgery has a high recurrence rate of prolapse, which varies widely from different literature descriptions, ranging from approximately 4% to 26%.…”

Section: Introductionmentioning

confidence: 99%

Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids

Sun

Han

2023

Medicine

View full text Add to dashboard Cite

This study aimed to establish a clinical model to predict the risk of hemorrhoid recurrence after procedure for prolapse and hemorrhoids. The clinical data of patients who underwent stapler hemorrhoidal mucosal circumcision in Shanxi Bethune Hospital from April 2014 to June 2017 were collected retrospectively and followed up regularly after the operation. Finally, 415 patients were included, which were divided into training group (n = 290) and verification group (n = 125). Logistic regression method was used to select meaningful predictors. The prediction model was constructed with nomographs, and the model was evaluated with correction curve, receiver operating characteristic curve and C index. The decision analysis curve was used to determine the clinical utility of the nomogram. Birth history, muscle attachment, postoperative anal urgency, anal resting pressure, postoperative nutritional index, body mass index, Wexner score, and hemorrhoid grading were included in the nomogram. The area under the curve of the prediction model was 0.813 and 0.679, respectively, in the training and verification groups, and 0.839 and 0.746, respectively, for the 5-year recurrence rate. The C index (0.737) and clinical decision curve showed that the model had high clinical practical value. The prediction model of hemorrhoid recurrence risk after hemorrhoidectomy based on multiple clinical indicators can be used for individualized prediction of hemorrhoid recurrence in patients after hemorrhoidectomy, and early intervention measures can be given to individuals with a high recurrence risk to reduce the risk of recurrence.

show abstract

Learning curve of stapled hemorrhoidopexy

Cited by 4 publications

References 4 publications

Learning curve of stapled hemorrhoidopexy: analysis using the cumulative summation (CUSUM) method

Learning curve of stapled hemorrhoidopexy: analysis using the cumulative summation (CUSUM) method

Is It Possible to Optimize Stapled Hemorrhoidopexy Outcomes by Enlarging Operative Criteria Indications? Results of a Tailored Procedure With Associated Resection in a Comparative Personal Series

Establishment and validation of clinical prediction model for hemorrhoid recurrence after procedure for prolapse and hemorrhoids

Contact Info

Product

Resources

About