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2007 Program and Abstracts | 2007 Posters
Long Term Outcome of Circular Stapled Mucosectomy in the Treatment of Hemorrhoids - a Prospective Trial Results
Igor Lebski1, Jaroslaw Leszczyszyn*2,1
1Surgery, EMC Instytut Medyczny S.A., Wroclaw, Poland; 2Faculty of Physiotherapy, University School of Physical Education, Wroclaw, Poland

Circular stapled mucosectomy (CSM) is an alternative option for surgical treatment of symptomatic hemorrhoids. Results, showed in recent papers, are good; however incidents of fecal urgency, a well as other complications were also reported.Our study is a prospective analysis of CSM results in treatment of hemorrhoids in 5 years follow-up.
Method: 50 patients, who underwent CSM between 07.2000 and 06.2001 were included into the trial. 5 (10%) patients had preoperatively II° hemorrhoids, 34 (68%) III° and 11 (22%) IV°. All patients complained of frequent proctorrhagia. 15 (30%) had anal soiling, 14 (28%) had pruritus of the anus and 1 patient (with IV° hemorrhoids) reported incidents of occasional liquid feces incontinence.Patients with concomitant hemorrhoidal thrombosis, anal fissure and with history of proctologic procedures were excluded.22 (44%) procedures were performed in spinal, 28 (56%) in short intravenous anaesthesia. All procedures were done by trained colorectal surgeons (over 20 CSM done before trial).
Results: Mean procedure time was 30,4 (14,1- 63,3) minutes.Mean postoperative hospital stay time was 2,1 (1-5) days. During surgery, in 5 (10%) cases, submucosal haematoma was noted; in 25(50%) cases additional hemostasis due to stapling line bleeding was required.In post-op period 1 patient required surgery (haemostatic suture on stapling line) due to prolonged rectal bleeding. No other complications were noted in post-op period.Postoperative pain was measured with VAS scale (0-no pain; 10 - worst possible pain).Mean VAS pain score at 1 post-op day was 1,83 (0,0 - 7,2, SD=1,79).3 months after surgery 47 (94%) patients had no symptoms of hemorrhoids (bleeding, prolapse).3 (6%) had infrequent anal bleeding, 1 (2%) patient reported frequent anal bleeding. Patient was qualified for surgery (Milligan-Morgan procedure).No fecal incontinence incidents were noted. 1 (2%) patient had transient fecal urgency.Patient satisfaction was measured with VAS scale (0- not satisfied at all, 10 - fully satisfied). Mean score was 9,6 (6,4 - 10,0, SD=0,82).Consecutive follow-up visits were performed annually.Five years after surgery 43 (87,7%) patients were symptoms-free, 6 (12,3%) patients had infrequent anal bleedings, of which 3 (50%) required symptomatic, topical treatment. No other hemorrhoids symptoms or fecal incontinence were noted. All patients were free of fecal urgency. VAS satisfaction score was 9,3 (6,3-10,0, SD=0,72)
Conclusions: Long term results of CSM are good. In our series no serious complications in short and long term period were noted. Patients were overall satisfied with treatment results.


2007 Program and Abstracts | 2007 Posters
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