Page 34 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
A Prospective Study of Outcomes of Patients with

Hemorrhoids after Minimal Invasive Procedure for

Hemorrhoids

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Tapan Atulkumar Shah , Jatinkumar Bipinchandra Modi , Jaimin Dipakkumar Shah , Rajesh Shah , Divyata Vasa ,
Yagnik Katara 6
Received on: 30 April 2022; Accepted on: 20 May 2022; Published on: 07 December 2022
AbstrAct
Introduction: Hemorrhoids are commonly reported anorectal diseases in which veins in the rectum and anal canal get swollen and inflamed,
which causes discomfort and bleeding. Within the normal anal canal, there are specialized, highly vascularized cushion-forming discrete masses
of thick submucosa containing blood vessels, smooth muscle, and elastic and connective tissue. They are located in the left-lateral, right-anterior,
and right-posterior quadrants of the canal to aid in anal continence. The term hemorrhoids should be restricted to clinical situations in which
these cushions are abnormal and cause symptoms. Hemorrhoids are a result of sliding downward of these cushions. Hemorrhoids result from
disruption of the anchoring and flatting action of musculus submucosa and (Tretiz’s muscle) its richly intermingled elastic fibers. Conventional
hemorrhoidectomy is the open surgical procedure in which the hemorrhoid pedicle is ligated by transfixing suture. Stapled hemorrhoidopexy
(SH) was introduced by Longo that requires no external incision, instead, hemorrhoidal tissue is lifted into ring of tissue with suture and a stapler
removes the hemorrhoids, effectively cutting off blood flow to the tissue.
Aims and objectives: The current study defines the efficacy of stapled hemorrhoidopexy and its consequences.
Materials and methods: It is an institutional prospective study, including patients on which stapled hemorrhoidopexy was done from 4th
January, 2019 to 6th December, 2020, who consented to be a part of the study. These patients were followed up through regular visits to the
OPD every week for the first month, every 15 days for the next 2 months, and later via telephonic conversations up to a period of 6 months post
surgery. Stapled hemorrhoidopexy was performed as per the procedure. Patients were discharged after successful completion of the operation.
All clinical variables were collected from a standardized questionnaire evaluation obtained through office follow-up.
Results: Total 166 patients: 142 males and 24 females underwent SH (male:female ratio was 5.92:1). The mean age being 44.75 ± 12.99 years.
After operation, patients were discharged on postoperative days 1–4; the mean being 1.67 ± 0.66 days. None of the patients had bleeding in
the immediate post or period up to 1 month. Nine patients (5.4%) complained of pain in the immediate postoperative period, 1 had grade III
hemorrhoids, 2 had grade II hemorrhoids, 2 had bleeding per rectally with grade II internal hemorrhoids, 1 had interno-external piles, 1 had
prolapsed piles, 2 had thrombosed piles. In total, 3 had edema in the early postoperative period, 1 had interno-external piles, 1 had prolapsed
piles, and 1 had thrombosed piles.
After 1 month, 4 (2.40%) had complained of bleeding per rectally, and none of the patients developed incontinence at the 6-month follow-up.
Two patients had a recurrence of reports that had interno-external piles. Two patients who had developed peri-purse-string hematoma
developed partial stricture in the long run.
The mean blood loss during surgery was 44.39 ± 8.08 mL, the mean duration of surgery was 25.13 ± 3.24 min, and the mean duration of patients
returning to work after surgery was 5.08 ± 1.17 days. The overall success rate was 98.2%.
Conclusion: Stapled hemorrhoidopexy represents a relatively simple and fast operation with less blood loss during surgery, especially when
compared with other traditional procedures. The cost of minimal invasive procedure for hemorrhoids (MIPH) gun was the only major limitation.
Keywords: Hemorrhoid, Minimal invasive procedure for hemorrhoids, Stapled hemorrhoidopexy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1541

IntroductIon 1–6 Department of General Surgery, AMC MET Medical College,
Hemorrhoids are commonly reported anorectal diseases in which Sheth Lallubhai Gorthandas Municipal General Hospital, Maninagar,
veins in the rectum and anal canal get swollen and inflamed, Ahmedabad, Gujarat, India
which causes discomfort and bleeding. Clinical presentation of Corresponding Author: Jatinkumar Bipinchandra Modi, Department
the patient comes to hospital with grade III or IV hemorrhoids. of General Surgery, AMC MET Medical College, Sheth Lallubhai
The treatment modality of hemorrhoid may be medical or Gorthandas Municipal General Hospital, Maninagar, Ahmedabad,
surgical. A surgical modality is used in patients with grade III Gujarat, India, Phone: +91 9727772479, e-mail: jatin50100@gmail.com
and IV hemorrhoids and concomitant anorectal pathology as How to cite this article: Shah TA, Modi JP, Shah JD, et al. A Prospective
well as in patients not responding to medical management. The Study of Outcomes of Patients with Hemorrhoids after Minimal Invasive
conventional surgical techniques such as Milligan–Morgan’s open Procedure for Hemorrhoids. World J Lap Surg 2022;15(3):220–223.
hemorrhoidectomy and Ferguson’s closed hemorrhoidectomy Source of support: Nil
were preferred choices for the surgery in these patients and were Conflict of interest: None
considered to be the “gold standard” till the evolvement of SH

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