ObjectiveTo evaluate the safety of shearing fracture ligation combining procedure for prolapse and hemorrhoids （PPH） in treatment for mixed hemorrhoids via a multicenter clinical study. MethodsTwo hundred and fortysix patients with mixed hemorroids were included from four a level of firstclass hospitals, which were averagely divided into shearing fracture ligation combining PPH group, PPH group, and shearing fracture ligation group according to the order of admission. The occurrence status of rectovaginal fistula, urethrorectal fistula, postoperative bleeding, acute urinary retention, anorectal stenosis, and anal incontinence were observed. And the anal function was evaluated by the anorectal pressure measurement. ResultsNo rectovaginal fistula or urethrorectal fistula happened among three groups. No anorectal stenosis happened in the shearing fracture ligation combining PPH group or the PPH group. The score of anorectal stenosis and anal incontinence in these two groups were lower than those in the shearing fracture ligation group (Plt;0.05). The rate of postoperative bleeding in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group (Plt;0.05). There were acute urinary retentions happened among three groups, but without significant differences among them (Pgt;0.05). The anal canal resting pressure after operation was lower than that before operation among three groups (Plt;0.01), which in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group after operation (Plt;0.05). There were no significant differences of the rectum feeling capacity or maximum rectum capacity between the shearing fracture ligation combining PPH group and PPH group before and after operation (Pgt;0.05), but compared with the level before operation in the shearing fracture ligation group, the rectum feeling capacity obviously decreased after operation (Plt;0.05), the maximum rectum capacity obviously increased (Plt;0.05). There were no significant differences of the maxinum anal canal systolic blood pressure between before and after operation in three groups and among three groups (Pgt;0.05). ConclusionsThe operation of shearing fracture ligation combined with PPH can protect the tissue of rectal cushion, remain the normal anatomy structure of anal canal. It has better clinical effect and is much safer than other methods.
Objective
To investigate the clinical efficacy of pouched suture plus external dissection and internal ligation in the treatment of mixed hemorrhoids.
Methods
Seventy patients with Ⅲ-Ⅳ internal henmorrhoids and mixed hemorrhoids who were admitted into Jiangsu Provincial Hospital of Traditional Chinese Medicine form June 2015 to June 2016 were enrolled. The patients were randomly divided into two groups: the combined operativ group and control group. The combined operativ group in which 35 cases were treated by pouched suture plus external dissection and internal ligation, and the control group in which 35 cases were treated by external dissection and internal ligation. The wound healing time, clinical curative effect, hospital stay, the operative time and postoperative complications (postoperative pain, edema, postoperative bleeding volume, urination difficulties, residual skin tag, anorectal stenosis) between two groups were compared.
Results
No significant difference were found in the clinical curative effect, the operative time and anorectal stenosis in two groups (P>0.05). The visual analogue scale (VAS) scores and the edema scores of the combined operativ group on the first day, the third day, and the fifth day after operation were lower than those of control group, the difference was statistically significant (P<0.05), while there were no statistically significant on the seventh day after operation in two groups (P>0.05) . The wound healing time, hospital stay, postoperative bleeding volume, urination difficulties, and residual skin tag in the combined operativ group were significantly shorter or lower than those in the control group (P<0.05).
Conclusion
Pouched suture plus external dissection and internal ligation has the advantages of less pain, fewer complications and quicker recovery, it also meets the modern concept of minimally invasive, so it is worthy of popularization and application.
ObjectiveTo investigate the curative effect of C-shaped mucosal resection and anastomosis above the dentate line in the treatment of mixed hemorrhoids and its effect on anal function. MethodsA total of 78 patients with degree Ⅳ mixed hemorrhoids treated in Nanjing Liuhe District People’s Hospital from June 2015 to February 2018 were retrospectively collected. The patients were divided into control group (n=39) and observation group (n=39) according to treatment methods. Patients of the control group received traditional procedure for prolapse and hemorrhoids operation, while patients of the observation group received C-shaped mucosal resection and anastomosis above the dentate line. The perioperative indexes (operation time, intraoperative blood loss, hospital stay, etc.), subjective function evaluation indexes (Wexner constipation score, Kirwan grade, etc.), clinical efficacy and recurrence rate were compared between the two groups. The random walking model was used to evaluate the clinical curative effect. ResultsThe intraoperative blood loss [(27.9±3.4) mL vs. (43.2±5.2) mL, P<0.001], 24 h visual analogue scale score [(4.2±1.5) points vs. (5.6±1.5) points, P<0.001], duration of first defecation pain [(22.1±3.2) min vs. (34.2±5.0) min, P<0.001], the time of carrying blood [(4.1±0.4) d vs. (5.7±0.6) d, P<0.001], and the time of edema [(3.2±0.6) d vs. (4.7±0.9) d, P<0.001] in the observation group were shorter (lower) than those in the control group. The difference between pre-and post-operation of Wexner constipation score [(13.2±2.4) points vs. (11.7±2.1) points, P=0.004], resting pressure [(23.1±4.9) mmHg vs. (17.8±3.4) mmHg, P<0.001] and maximum squeeze pressure [(33.5±7.3) mmHg vs. (23.1±5.6) mmHg, P<0.001] in the observation group were significantly higher than those in the control group. There was a long-term correlation between changes in random fluctuating power rate values of Wexner constipation score, Kirwan grade, rectoanal inhibitory reflex positive rate, resting pressure, maximum squeeze pressure and the surgical procedure received by the patient of the two groups. The total effective rate [97.4% (38/39) vs. 66.7% (26/39)] and non-recurrence rate [92.3% (36/39) vs. 76.9% (29/39)] in the observation group were higher than those in the control group, while there was no significant difference in the incidence of total complications between the two groups [5.1% (2/39) vs. 12.8% (5/39), P=0.235)]. ConclusionCompared with PPH, C-shaped mucosal resection and anastomosis above the dentate line for the treatment of degree Ⅳ mixed hemorrhoids can improve the therapeutic effect, reduce postoperative recurrence, maintain anal function and facilitate the recovery of patients.
ObjectiveTo investigate the effect of external dissection and internal ligation, plus partial internal sphincterotomy in the treatment of mixed hemorrhoids.
MethodsDuring January 2010 to January 2012, 364 patients with mixed hemorrhoids selected for surgery were divided into two groups based on whether the patients should accept the treatment of partial internal sphincterotomy. We observed the curative effect of the two groups, including anal pain, bleeding, edema, average healing days and the anorectal stenosis after operation.
ResultsThere were statistical differences between the two groups in terms of anal pain, complication rate and hospital stay (P<0.01). The curative effect of the group treated with partial internal sphincterotomy was better than that of the other group.
ConclustionExternal dissection and internal ligation, plus partial internal sphincterotomy is a better choice in the treatment of mixed hemorrhoids, which can relieve postoperative symptoms, reduce complications and shorten treatment course.
ObjectiveTo investigate the clinical effect and the incidence of postoperative complications of Milligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids.MethodsProspectively collected 120 patients with annular mixed hemorrhoids who received treatment from the Department of Colorectal Surgery of Bazhong Hospital of Traditional Chinese Medicinel during the April, 2016 to October, 2018. All of the 120 patients with annular mixed hemorrhoids were randomly divided into the experimental group and the control group, with 60 patients in each one group. Patients in the experimental group was treated with Milligan-Morgan hemorrhoids combined with reducing tension of alary incision, while patients in the control group with conventional Milligan-Morgan hemorrhoid.ResultsIn the experimental group, 49 cases were cured, 11 cases showed obvious effect; in the control group, 39 cases were cured, 20 cases showed obvious effect, and 1 case was effective. The curative effect in experimental groups was better than that of the control group (Z=–2.090, P=0.037), and the effective rates of these two group were both 100% in total. The mean healing time was (19±3) d (14–21 d) in the experimental group and (21±3) d (14–24 d) in the control group, respectively, which was better in the experimental group (Z=–13.636, P<0.001). Experimental group with lower score of wound pain, hemafecia, and anal margin edema, which were much better than control group on 1 d and 3 d after operation (P<0.05). There was no statistically significant differences on incidence of uroschesis and recurrence rate between the two groups (P>0.05).ConclusionsMilligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids has good clinical effect and deserves clinical application.
ObjectiveTo explore the analgesic effect of local infiltration anesthesia with liposome bupivacaine (LB) injection after Milligan-Morgan hemorrhoidectomy through a multicenter, double-blind, randomized controlled study. MethodsA prospective study was conducted on 240 patients with mixed hemorrhoids admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou Hospital for Largeintestinal and Anal Diseases, and Puyang People’s Hospital between December 2023 and June 2024. Patients were randomly divided into an observation group (receiving LB injection) and a control group (receiving methylene blue injection) using a random number table. Postoperative outcomes including anal pain scores, insomnia scores, postoperative wound edema scores, urination, time to first defecation, pain during first defecation, perianal sensory recovery time, hospital stay, need for additional analgesic medication, and postoperative complications were compared between the two groups. ResultsAmong 240 patients, 238 completed the study and were included in the analysis, with 119 patients in the observation group and 119 in the control group. ① There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). ② Postoperative anal pain scores at 6 h, 12 h, 24 h, 48 h, 72 h, and 5 d were lower in the observation group than that in the control group (P<0.05). ③ Postoperative insomnia scores on days 1, 2, 3, and 5 were lower in the observation group compared with the control group (P<0.05). ④ Postoperative edema scores on days 3, 5, and 7 were lower in the observation group than that in the control group (P<0.001). ⑤ The observation group showed superior outcomes compared to the control group in the following parameters: postoperative 24 h urination score [0 vs. 0, Z=–2.528, P=0.011], time to first defecation [2 d vs. 2 d, Z=–2.638, P=0.008], pain score at first defecation [3 vs. 5, Z=–9.846, P<0.001], time to recovery of perianal sensation [2 d vs. 1 d, Z=–4.977, P<0.001], hospital stay [6 d vs. 11 d, Z=–12.170, P<0.001], supplemental analgesic medication need at 7 d postoperation [20.2% (24/119) vs. 80.7% (96/119), χ2 = 87.132, P<0.001]. No statistically significant differences were observed between the two groups in the incidence of complications such as: postoperative nausea [6.7% (8/119) vs. 8.4% (10/119), χ2 = 0.240, P=0.624], vomiting [5.0% (6/119) vs. 7.6% (9/119), χ2 = 0.640, P=0.424], dizziness [1.7% (2/119) vs. 4.2% (5/119), χ2=1.325, P=0.250]. ConclusionLocal infiltration anesthesia with LB after Milligan-Morgan hemorrhoidectomy significantly reduces postoperative pain, insomnia, and edema, shortens hospital stays, and accelerates postoperative recovery.
