Stapler Hemoroidopeksi’de Anokutanöz Hattın 4 Kadrandan Traksiyonu Avantaj Sağlıyor mu?

Amaç: Çalışmada, 3. ve 4. derece hemoroidlerde stapler hemoroidopeksi (Longo Ameliyatı) yapılanhastalarda ano-kutanöz hattın 4 kadrandan traksiyon yapılmasının hasta sonuçlarına olan etkileriniaraştırmayı amaçladık.Gereç ve Yöntemler: 2011 ve 2017 yılları arasında 6 yıllık sürede semptomatik 3. ve 4. derecehemoroidi olan toplam 68 hastaya stapler hemoroidopeksi (SH) uygulandı. Retrospektif olarakincelendiğinde bu hastaların 28’ine standart stapler hemoroidopeksi (S-SH) ameliyatı, 40 hastayada anokütanöz hattan 4 kadrandan askı sütürleri konulduktan sonra traksiyon yapılarak staplerhemoroidopeksi (T-SH) işlemi uygulandı. Hastaların demografik verileri, anestezi tipi, operasyon vehastanede kalış süreleri, erken ve geç dönem komplikasyonları, stapler anastomoz hattının dentadline’a olan mesafeleri, analjezik ihtiyaçları retrospektif olarak incelendi ve bu iki hasta grubu arasındakarşılaştırma yapıldı.Bulgular: 68 hastanın 50’si erkekti. Hastaların ortalama yaşı 36,4 ve 49’una (%72) spinal anesteziuygulandı. Hastaların ortalama takip süresi 34 (6-70) ay idi. S-SH yapılan 28 hastanın 5’indeanaljeziklere rağmen şiddetli ağrı, 3 hastada üriner retansiyon görüldü. Bu hastaların ortalamahastanede kalış süresi 4,1 gündü. Kanama nedeniyle 1 hastaya erken dönemde anastomoz hattınasütür atılarak hemostaz sağlandı. T-SH uygulanan hastalara bakıldığı zaman analjezi (tramadol)ihtiyaçlarının çok daha az olduğu, komplikasyon olarak 1 hastada şiddetli ağrı, 1 hastada müdahalegerektirmeyen kanama, 2 hastada üriner retansiyon. T-SH uygulanan hastaların ortalama hastanedekalış süresi 2,2 gündü.Sonuç: Stapler hemoroidopeksiʼde anokutanöz hattın 4 kadrandan traksiyon yapılması özellikledaha rahat anal eksplorasyon sağlayarak dentad line’ı korunmasına ve böylece post operatif şiddetliağrının ve analjezik ihtiyacının azalmasına ve hastanede kalış süresinin kısalmasına olanak sağladığıdüşüncesindeyiz.

Is there any Advantage of 4 Quadrant Traction of the Anocutaneous Line in Stapler Hemorrhoidopexy?

Objective: In this study, we aimed to investigate the effects of 4 quadrant traction in the anocutaneous line in patients who underwent stapler hemorrhoidopexy (Longo operation) in 3rd and 4th degree hemorrhoids. Material and Methods: Between 2011-2017 stapler hemorrhoidopexy (SH) was performed in a total of 68 patients with symptomatic 3rd and 4th degree hemorrhoids. Retrospectively, standard stapler hemorrhoidopexy (S-SH) procedures were performed on 28 patients and 40 patients with 4 quadrant traction in the ano-cutaneous line performed traction stapler hemorrhoidopexy (TSH). Demographic data, type of anesthesia, duration of operation and hospital stay, early and late complications, distances to the dentad line of the anastomosis line, analgesic requirements were retrospectively analyzed and compared between these two groups of patients. Results: 50 of the 68 patients were male. The mean age of the patients was 36,4 years. Spinal anesthesia was performed in 49 (72%) patients. The mean follow-up period of the patients was 34 (6-70) months. Severe pain was seen in 5 of the 28 S-SH patients despite analgesics, and 3 patients had urinary retention. The average hospital stay of these patients is 4.1 days. One patient was sutured to the anastomosis line in the early period due to hemorrhage and hemostasis was achieved. Patients who underwent T-SH analgesia requirements much less and in this group complications include severe pain in 1 patient, bleeding in 1 patient without intervention, and urinal retention in 2 patients. The mean hospital stay of patients on T-SH was 2,2 days. Conclusion: We believes that traction of the anocutaneous line 4 quadrant in Stapler hemorrhoidopexy allows for more comfortable anal exploration, thus preserving the dentad line, reducing postoperative severe pain and analgesic requirement and also shortening the length of stay in the hospital.

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Longo A. Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoid prolapse with a circularsuturing device: A new procedure. Proc 6th World Cong Endosc Surg 1998; 7:777-84.
Senagore AJ, Singer M, Abcarian H, Fleshman J, Corman M, Wexner S, Nivatvongs S. Procedure for prolapse and hemorrhoids (PPH) multicenter study group. A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: Perioperative and one-year results. Dis Colon Rectum 2004; 47:1824-36.
Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G. Stapled haemorrhoidopexy compared to MilliganMorgan and Ferguson haemorrhoidectomy: A systematic review. Int J Colorectal Dis 2009; 24:335-44.
Jongen J, Eberstein A, Bock J-U, Peleikis H-G, Kahlke V. Complications, recurrences, early and late reoperations after stapled haemorrhoidopexy: Lessons learned from 1,233 cases. Langenbecks Arch Surg 2010; 395:1049-54.
Nisar PJ, Acheson AG, Neal KR. Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systemic review of randomized, controlled trials. Dis Colon Rectum 2004; 47:1837-45.
Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 2007; 50(9):1297-305.
Faucheron JL, Voirin D, Abba J. Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Br J Surg 2012; 99:746-53.
Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 2008; 12:7-19.
Ng KH, Ho KS, Ooi BS, Tang CL, Eu KW. Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg 2006; 93:226-30.
Correa-Rovelo JM, Tellez O, Obrego´n L, Duque-López X, Miranda-Gómez A, Pichardo-Bahena R, Mendez M, Moran S. Prospective study of factors affecting postoperative pain and symptom persistence after stapled rectal mucosectomy for hemorrhoids: A need for preservation of squamous epithelium. Dis Colon Rectum 2003; 6:955-62.
Plocek MD, Kondylis LA, Duhan-Floyd N, Reilly JC, Geisler DP, Kondylis PD. Hemorrhoidopexy staple line height predicts return to work. Dis Colon Rectum 2006; 49:1905-9.
Williams R, Kondylis L, Geisler D, Kondylis P. Stapled hemorrhoidopexy height as outcome indicator. Am J Surg 2007; 193:336-9.