Analysis of the effect and postoperative recurrence of grade <b>Ⅳ</b> mixed hemorrhoids treated by C<b>-</b>shaped mucosal resection and anastomosis above the dentate line_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Tiegang ¹ ,  DUAN Chuanyou ¹ , WU Guokui ² , HAN Jianbo ² , TONG Fei ² , ZHANG Bo ³ , CAO Hongyong ⁴

1. Department of General Surgery, Nanjing Liuhe District People’s Hospital (Liuhe Hospital Affiliated to Yangzhou University Medical College), Nanjing 210000, P. R. China;
2. Department of General Surgery, Nanjing Red Cross Hospital, Nanjing 210001, P. R. China;
3. Department of Proctology, Zhongda Hospital Southeast University, Nanjing 210009, P. R. China;
4. Department of General Surgery, Nanjing Hospital of Nanjing Medical University (Nanjing First Hospital), Nanjing 210006, P. R. China;

Corresponding?author：

DUAN Chuanyou, Email: yangza98445@163.com

Keywords：

degree Ⅳ mixed hemorrhoids; C-shaped mucosal resection and anastomosis above the dentate line; curative effect; anal function

DOI：

10.7507/1007-9424.202307032

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Objective To 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. Methods A 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. Results The 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)]. Conclusion Compared 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.

Citation： WANG Tiegang, DUAN Chuanyou, WU Guokui, HAN Jianbo, TONG Fei, ZHANG Bo, CAO Hongyong. Analysis of the effect and postoperative recurrence of grade Ⅳ mixed hemorrhoids treated by C-shaped mucosal resection and anastomosis above the dentate line. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 726-732. doi: 10.7507/1007-9424.202307032 Copy

1.	Perivoliotis K, Spyridakis M, Zintzaras E, et al. Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial. Int J Colorectal Dis, 2021, 36(2): 353-363.
2.	Giamundo P, De Angelis M, Mereu A. Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease. Tech Coloproctol, 2020, 24(2): 199-205.
3.	Acar T, Acar N, Tosun F, et al. House advancement flap anoplasty for severe post-hemorrhoidectomy anal stenosis. Tech Coloproctol, 2020, 24(3): 261-262.
4.	魏欣, 黃丹, 胡發涌, 等. PPH結合內痔縫扎術治療重度內痔的臨床療效. 腹部外科, 2020, 33(2): 156-158.
5.	譚玉成, 陸航. 吻合器經肛門直腸黏膜選擇性切除釘合術治療低位直腸良性腫瘤臨床療效研究. 陜西醫學雜志, 2021, 50(5): 572-574, 578.
6.	徐林生, 胡炳德, 梁丁保, 等. 內鏡下負壓套扎術和痔上黏膜環切術治療Ⅱ/Ⅲ度內痔的療效對比. 現代消化及介入診療, 2020, 25(4): 527-528, 532.
7.	中華醫學會外科學分會結直腸肛門外科學組, 中華中醫藥學會肛腸病專業委員會, 中國中西醫結合學會結直腸肛門病專業委員會. 痔臨床診治指南 (2006版). 中華胃腸外科雜志, 2006, 9(5): 461-463.
8.	Luedi MM, Schober P, Hammoud B, et al. Preoperative pressure pain threshold is associated with postoperative pain in short-stay anorectal surgery: a prospective observational study. Anesth Analg, 2021, 132(3): 656-662.
9.	Jang? H, Langhoff-Roos J, Rosth?j S, et al. Wexner score and quality of life in women with obstetric anal sphincter injury. Int Urogynecol J, 2020, 31(6): 1115-1121.
10.	Tuan NA, Duc NM, Van Hiep P, et al. The efficacy of transanal total mesorectal excision: a preliminary vietnamese report. Med Arch, 2020, 74(3): 216-223.
11.	Liang Y, An T, Xin W. Exploring the value of rectal anal canal pressure measurement in the diagnosis of Hirschsprung’s disease. Heliyon, 2022, 8(6): e09619.
12.	趙學堯, 劉孟宇, 韓學杰, 等. 《中醫肛腸科常見病診療指南》臨床應用評價研究. 中國中藥雜志, 2017, 42(17): 3252-3256.
13.	Eberspacher C, Mascagni P, Di Nardo D, et al. Caiman versus LigaSure hemorrhoidectomy: postoperative pain, early complications, long-term follow-up, and costs. Surg Innov, 2020, 27(3): 272-278.
14.	Wang X, Yin X, Guo XT, et al. Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: a randomized controlled trial. J Integr Med, 2020, 18(6): 492-498.
15.	Rho M, Guida AM, Materazzo M, et al. Ligasure hemorrhoidectomy: updates on complications after an 18-year experience. Rev Recent Clin Trials, 2021, 16(1): 101-108.
16.	Yu K, Li H, Xue P, et al. Modified ultrasound scalpel haemorr-hoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial. Trials, 2023, 24(1): e140. doi: 10.1186/s13063-023-07175-6.
17.	Du B, Xu Z, Zhong X. Electroacupuncture for postoperative pain in mixed hemorrhoids: a meta-analysis. Medicine (Baltimore), 2022, 101(50): e32247. doi: 10.1097/MD.0000000000032247.
18.	梁鳳, 喬曉, 韓成艷, 等. 內鏡下橡皮圈套扎術與經典外科手術吻合器痔上黏膜環切釘合術治療痔瘡的臨床療效. 中國內鏡雜志, 2023, 29(2): 13-19.
19.	Huang H, Wen K, Ding X, et al. The efficiency and safety of modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation in circumferential mixed hemorrhoids: a randomized controlled trial. Langenbecks Arch Surg, 2023, 408(1): e332. doi: 10.1007/s00423-023-03081-2.
20.	Pei X, Song S, Li H, et al. Efficacy and safety of acupoint catgut embedding in treating postoperative pain of mixed hemorrhoids: a randomized controlled trial protocol. Medicine (Baltimore), 2021, 100(19): e25948. doi: 10.1097/MD.0000000000025948.
21.	Feng J, Cheng J, Xiang F. Management of intractable pain in patients treated with hemorrhoidectomy for mixed hemorrhoids. Ann Palliat Med, 2021, 10(1): 479-483.
22.	呂兵兵, 魏東, 張遠耀, 等. 腹腔鏡盆底修復直腸懸吊聯合痔上黏膜環切吻合術治療完全性直腸脫垂的療效分析. 中華普通外科雜志, 2020, 35(9): 713-715.
23.	范雷濤, 孫源, 李春雨. 比較兩種聯合術式治療混合痔的臨床療效和肛腸動力學變化. 中國普外基礎與臨床雜志, 2021, 28(1): 79-84.
24.	Shen J, Zhou X, Zhao J, et al. Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial. Int J Colorectal Dis, 2023, 38(1): e104. doi: 10.1007/s00384-023-04403-y.
25.	張慧嫦, 熊秋華, 羅秀瓊. PPH聯合部分肛門內括約肌切斷術應用于重度混合痔并直腸肛管靜息壓高壓患者的療效觀察. 中國普外基礎與臨床雜志, 2020, 27(4): 454-459.

1. Perivoliotis K, Spyridakis M, Zintzaras E, et al. Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial. Int J Colorectal Dis, 2021, 36(2): 353-363.
2. Giamundo P, De Angelis M, Mereu A. Hemorrhoid laser procedure with suture-pexy (HeLPexx): a novel effective procedure to treat hemorrhoidal disease. Tech Coloproctol, 2020, 24(2): 199-205.
3. Acar T, Acar N, Tosun F, et al. House advancement flap anoplasty for severe post-hemorrhoidectomy anal stenosis. Tech Coloproctol, 2020, 24(3): 261-262.
4. 魏欣, 黃丹, 胡發涌, 等. PPH結合內痔縫扎術治療重度內痔的臨床療效. 腹部外科, 2020, 33(2): 156-158.
5. 譚玉成, 陸航. 吻合器經肛門直腸黏膜選擇性切除釘合術治療低位直腸良性腫瘤臨床療效研究. 陜西醫學雜志, 2021, 50(5): 572-574, 578.
6. 徐林生, 胡炳德, 梁丁保, 等. 內鏡下負壓套扎術和痔上黏膜環切術治療Ⅱ/Ⅲ度內痔的療效對比. 現代消化及介入診療, 2020, 25(4): 527-528, 532.
7. 中華醫學會外科學分會結直腸肛門外科學組, 中華中醫藥學會肛腸病專業委員會, 中國中西醫結合學會結直腸肛門病專業委員會. 痔臨床診治指南 (2006版). 中華胃腸外科雜志, 2006, 9(5): 461-463.
8. Luedi MM, Schober P, Hammoud B, et al. Preoperative pressure pain threshold is associated with postoperative pain in short-stay anorectal surgery: a prospective observational study. Anesth Analg, 2021, 132(3): 656-662.
9. Jang? H, Langhoff-Roos J, Rosth?j S, et al. Wexner score and quality of life in women with obstetric anal sphincter injury. Int Urogynecol J, 2020, 31(6): 1115-1121.
10. Tuan NA, Duc NM, Van Hiep P, et al. The efficacy of transanal total mesorectal excision: a preliminary vietnamese report. Med Arch, 2020, 74(3): 216-223.
11. Liang Y, An T, Xin W. Exploring the value of rectal anal canal pressure measurement in the diagnosis of Hirschsprung’s disease. Heliyon, 2022, 8(6): e09619.
12. 趙學堯, 劉孟宇, 韓學杰, 等. 《中醫肛腸科常見病診療指南》臨床應用評價研究. 中國中藥雜志, 2017, 42(17): 3252-3256.
13. Eberspacher C, Mascagni P, Di Nardo D, et al. Caiman versus LigaSure hemorrhoidectomy: postoperative pain, early complications, long-term follow-up, and costs. Surg Innov, 2020, 27(3): 272-278.
14. Wang X, Yin X, Guo XT, et al. Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: a randomized controlled trial. J Integr Med, 2020, 18(6): 492-498.
15. Rho M, Guida AM, Materazzo M, et al. Ligasure hemorrhoidectomy: updates on complications after an 18-year experience. Rev Recent Clin Trials, 2021, 16(1): 101-108.
16. Yu K, Li H, Xue P, et al. Modified ultrasound scalpel haemorr-hoidectomy versus conventional haemorrhoidectomy for mixed haemorrhoids: a study protocol for a single-blind randomised controlled trial. Trials, 2023, 24(1): e140. doi: 10.1186/s13063-023-07175-6.
17. Du B, Xu Z, Zhong X. Electroacupuncture for postoperative pain in mixed hemorrhoids: a meta-analysis. Medicine (Baltimore), 2022, 101(50): e32247. doi: 10.1097/MD.0000000000032247.
18. 梁鳳, 喬曉, 韓成艷, 等. 內鏡下橡皮圈套扎術與經典外科手術吻合器痔上黏膜環切釘合術治療痔瘡的臨床療效. 中國內鏡雜志, 2023, 29(2): 13-19.
19. Huang H, Wen K, Ding X, et al. The efficiency and safety of modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation in circumferential mixed hemorrhoids: a randomized controlled trial. Langenbecks Arch Surg, 2023, 408(1): e332. doi: 10.1007/s00423-023-03081-2.
20. Pei X, Song S, Li H, et al. Efficacy and safety of acupoint catgut embedding in treating postoperative pain of mixed hemorrhoids: a randomized controlled trial protocol. Medicine (Baltimore), 2021, 100(19): e25948. doi: 10.1097/MD.0000000000025948.
21. Feng J, Cheng J, Xiang F. Management of intractable pain in patients treated with hemorrhoidectomy for mixed hemorrhoids. Ann Palliat Med, 2021, 10(1): 479-483.
22. 呂兵兵, 魏東, 張遠耀, 等. 腹腔鏡盆底修復直腸懸吊聯合痔上黏膜環切吻合術治療完全性直腸脫垂的療效分析. 中華普通外科雜志, 2020, 35(9): 713-715.
23. 范雷濤, 孫源, 李春雨. 比較兩種聯合術式治療混合痔的臨床療效和肛腸動力學變化. 中國普外基礎與臨床雜志, 2021, 28(1): 79-84.
24. Shen J, Zhou X, Zhao J, et al. Electroacupuncture at Baliao point alleviates post-operative pain and anal distension after procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy): a prospective randomized clinical trial. Int J Colorectal Dis, 2023, 38(1): e104. doi: 10.1007/s00384-023-04403-y.
25. 張慧嫦, 熊秋華, 羅秀瓊. PPH聯合部分肛門內括約肌切斷術應用于重度混合痔并直腸肛管靜息壓高壓患者的療效觀察. 中國普外基礎與臨床雜志, 2020, 27(4): 454-459.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of the effect and postoperative recurrence of grade Ⅳ mixed hemorrhoids treated by C-shaped mucosal resection and anastomosis above the dentate line

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