Ligation and mucopexy for prolapsing hemorrhoids--a ten year experience

Pravin J Gupta, Surekha Kalaskar, Pravin J Gupta, Surekha Kalaskar

Abstract

Objective: The aim of this study is to clinically test the efficacy of author's approach of suture ligation and mucopexy for patients having symptomatic and prolapsing hemorrhoids.

Materials and methods: 616 patients (255 females) complaining of symptoms of hemorrhoids were included in the study. The hemorrhoids were suture ligated with an absorbable suture material under vision. Operating time, postoperative complications, time to return to work, and outcome of the procedure were analyzed. Follow-up was planned following discharge after 1 month, 6 months and after at least 1 year. Patient satisfaction was also assessed.

Results: The mean procedure time was 8 +/- 0 minutes (range, 6-15 minutes), and the total admission period was 12 +/- 4 Hours. Perianal thrombosis and skin tags were the commonest post-operative complications. The mean total analgesic dose and duration of pain control using analgesics was 19 +/- 4 tablets, and 9 +/- 3 days respectively.The postoperative follow up after 4 weeks revealed therapeutic success in 589 patients (95.6%), who presented with hemorrhoidal bleeding. Prolapse was no longer observed in 98% of patients and 96% patients experienced no pain after defecation. 93% patients completed the one-year follow-up and 89 percent of them were asymptomatic. The patient satisfaction scoring was 8.2% on visual analogue scale.

Conclusion: Suture ligation and mucopexy of hemorrhoids is an easy-to-perform technique that is well accepted by patients and has good results for prolapsing hemorrhoids.

Figures

Figure 1
Figure 1
Hemorrhoids at multiple positions.
Figure 2
Figure 2
Hemorrhoids after ligation and mucopexy.

References

    1. Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R, Bonatti H. The vascular nature of hemorrhoids. J Gastrointest Surg. 2006;10:1044–50. doi: 10.1016/j.gassur.2005.12.004.
    1. Farag AE. Pile suture: a new technique for the treatment of haemorrhoids. Br J Surg. 1978;65:293–5. doi: 10.1002/bjs.1800650422.
    1. Block IR. Obliterative suture technique for internal hemorrhoidectomy. Dis Colon Rectum. 1985;28:679–80. doi: 10.1007/BF02553454.
    1. Hussein AM. Ligation-anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum. 2001;44:1887–90. doi: 10.1007/BF02234474.
    1. Serdev N. The surgical treatment of hemorrhoids. Their suturing ligation without excision. Khirurgiia (Sofiia) 1990;43:65–8.
    1. Awojobi OA. Modified pile suture in the outpatient treatment of hemorrhoids. A preliminary report. Dis Colon Rectum. 1983;26:95–97. doi: 10.1007/BF02562582.
    1. Bruch HP, Roblick UJ. Pathophysiology of hemorrhoids. Chirurg. 2001;72:656–9. doi: 10.1007/s001040170120.
    1. Haas PA, Fox TA, Jr, Haas GP. The pathogenesis of hemorrhoids. Dis Colon Rectum. 1984;27:442–450. doi: 10.1007/BF02555533.
    1. Pernice LM, Bartalucci B, Bencini L, Borri A, Catarzi S, Kroning K. Early and late (ten years) experience with circular stapler hemorrhoidectomy. Dis Colon Rectum. 2001;44:836–841. doi: 10.1007/BF02234704.
    1. Kolbert GW, Raulf F. Evaluation of Longo's technique for haemorrhoidectomy by doppler ultrasound measurement of the superior rectal artery. Zentralbl Chir. 2002;127:19–21. doi: 10.1055/s-2002-21566.
    1. Galkin E. X-ray endovascular embolization of the superior rectal artery: New potentialities in the surgical management of chronic hemorrhoids. Vestn Rentgenol Radiol. 2001;6:44–9.
    1. Gaj F, Trecca A, Crispino P. Transfixed stitches technique versus open haemorrhoidectomy. Results of a randomised trial. Chir Ital. 2007;59:231–5.
    1. Kim JC. Analysis of surgical treatments for circumferentially protruding haemorrhoids: complete excision with repair using flaps versus primary excision with secondary suture-ligation. Asian J Surg. 2006;29:128–34.
    1. Gaj F, Trecca A, Crispino P. Transfixed stitches technique versus open haemorrhoidectomy. Results of a randomised trial. Chir Ital. 2007;59:231–5.
    1. Wang ZJ, Tang XY, Wang D, Zhao B, Han W, Yang XQ, Huang YT. The pathological characters and its clinical significance of internal hemorrhoids. Zhonghua Wai Ke Za Zhi. 2006;44:177–80.

Source: PubMed

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