Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years

Sturiale, Alessandro; Fabiani, Bernardina; Menconi, Claudia; Cafaro, Danilo; Fusco, Ferdinando; Visconte, Michele Schiano di; Naldini, Gabriele

doi:10.1007/s10151-018-1860-8

Cited by 36 publications

(47 citation statements)

References 33 publications

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“…In Group C, the success rate results to be higher if compared with the already published data ranging from 83.3 to 88.2% 27 with a considerably lower early and longterm postoperative complications rate. 19,[28][29][30][31] The success rate of Group D is consistent with those reported about excisional surgery, around 95%, 32 with a lower postoperative complications and reoperation rates. [7][8][9] However, despite the published review, some long-term studies showed poor global success rates for all HD treatments, such as 65% for CSH, 9 73% for excisional surgery, and 70% for THD.…”

Section: Discussionsupporting

confidence: 86%

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

Naldini¹,

Caminati²,

Sturiale³

et al. 2020

Surg J (N Y)

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Introduction The introduction and diffusion of new techniques for hemorrhoidal surgery have made it clear how much Goligher classification is inadequate in the modern times, lacking in any correlation between anatomical and clinical features to a surgical procedure. The aim of the study was to evaluate if the application of a new classification of hemorrhoidal diseases might lead to an improvement in the postoperative surgical outcomes. Methods From January 2014 to December 2015, all patients undergoing surgery for hemorrhoidal disease were enrolled. The procedures performed were based upon a new anatomical/clinical–therapeutic classification (A/CTC) considering these items: anatomical presentation, symptom types and frequency, associated diseases, and available surgical treatments and their related contraindications. The new classification identified four groups: A (outpatient), B, C, and D (surgical approaches). The overall outcomes were assessed and then stratified by surgical groups. These data were then analyzed in comparison with the published data about all the surgical procedures performed. Results A total of 381 patients underwent surgery and they were stratified as follows: Group B (39), C (202), and D (140). Group B underwent Doppler-guided dearterialization with mucopexies or tissue selective therapy, Group C stapled procedures, and Group D hemorrhoidectomy. The mean follow-up was 30 months. The overall outcomes were: success rate 92.4%, recurrences 7.6%, postoperative complications 4.8%, long-term complications 5.4%, and reoperation rate 2.7%. The success rates stratified by groups were: B, 85%); C, 91.4%; and D, 95.7%. Conclusion The A/CTC proved to be useful in stratifying the patients and choosing the proper treatment for each case. This classification seems to improve the outcome of different surgical procedures if compared with those already published.

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Section: Discussionsupporting

confidence: 86%

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

Naldini¹,

Caminati²,

Sturiale³

et al. 2020

Surg J (N Y)

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“…55 patients reported the recurrence of at least one hemorrhoidal symptom and 17 patients required a further surgical treatment. Large capacity stapling devices may lead to better results, but this remains unclear [103,104].…”

Section: Sh Is An Effective Technique For the Treatment Of Hd When Cmentioning

confidence: 99%

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

et al. 2020

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Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication. The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE. These guidelines are inclusive and not prescriptive. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.

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“…It is believed that such complications derive from technical error where excessive muscle is incorporated in the 'doughnut' resulting in a full-thickness (or near full-thickness) staple line with consequent risk of anastomotic leakage; for this reason, it has been suggested that submucosal injection of saline at the planned purse-string site might reduce the risk of incorporating excessive muscle into the stapler housing [78]. Finally, distressing new symptoms such as tenesmus affect up to one-third of patients long-term [79], and are probably related to the mucosal stimulation of the staple metallic foreign bodies which sometimes require a second operation to remove.…”

Section: Stapled Haemorrhoidopexymentioning

confidence: 99%

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

Young

2020

Ann Coloproctol

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The treatment of haemorrhoids remains challenging: multiple treatment options supported by heterogeneous evidence are available, but patients rightly demand a tailored approach. Evidence for newer surgical techniques that promise to be less painful has been conflicting. We review the current evidence for management options in patients who present with varying haemorrhoidal grades. A review of the English literature was performed utilizing MEDLINE/PubMed, Embase, and Cochrane databases (31 May 2019). The search terms (haemorrhoid OR haemorrhoid OR haemorrhoids OR haemorrhoids OR “Hemorrhoid”[Mesh]) were used. First- and second-degree haemorrhoids continue to be managed conservatively. The easily repeatable and cost-efficient rubber band ligation is the preferred method to address minor haemorrhoids; long-term outcomes following injection sclerotherapy remain poor. Conventional haemorrhoidectomies (Ferguson/Milligan-Morgan/Ligasure haemorrhoidectomy) still have their role in third- and fourth-degree haemorrhoids, being associated with lowest recurrence; nevertheless, posthaemorrhoidectomy pain is problematic. Stapled haemorrhoidopexy allows quicker recovery, albeit at the costs of higher recurrence rates and potentially serious complications. Transanal Haemorrhoidal Dearterialization has been promoted as nonexcisional and less invasive, but the recent HubBLe trial has questioned its overall place in haemorrhoid management. Novel “walk-in-walk-out” techniques such as radiofrequency ablations or laser treatments will need further evaluation to define their role in modern-day haemorrhoid management. There are numerous treatment options for haemorrhoids, each with their own evidence-base. Newer techniques promise to be less painful, but recurrence rates remain an issue. The balance continues to be sought between long-term efficacy, minimisation of postoperative pain, and preservation of anorectal function.

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Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years

Cited by 36 publications

References 33 publications

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

Improvement in Hemorrhoidal Disease Surgery Outcomes Using a New Anatomical/Clinical–Therapeutic Classification (A/CTC)

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

Still a Case of “No Pain, No Gain”? An Updated and Critical Review of the Pathogenesis, Diagnosis, and Management Options for Hemorrhoids in 2020

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