Hemorroidopexia por grampeamento parcial: aspectos clínicos e impacto sob a fisiologia anorretal

Abstract

Hemorrhoidal disease affects millions of people worldwide, representing a medical and socioeconomic problem. Currently, Milligan-Morgan Haemorrhoidectomy (MMH) and circular stapled hemorrhoidectomy (CSH) are the two most frequently used surgical techniques for hemorrhoidal treatment of third or fourth degrees. The first technique is related to the biggest postoperative pain and the longer time to return to labor activities. In the second technique, due to the inferior rectal and anal canal stapled circumferential, fecal urgency cases and postoperative stenosis are described. In order to minimize the above mentioned technical complications, it was planned the stapled partial hemorrhoidopexy (PSH). However, there are a few studies referring this surgical technique in the literature nowadays. This study proposes to assess the results achieved through prospective and descriptive analisys, in consecutive patients with mixed or internal hemorrhoidal disease, with surgical indication, being the internal component of the hemorrhoidal disease classified as grade II, III or IV, submitted to PSH at Colorectal Surgery Department of Rio de Janeiro State University (UERJ). PSH surgery was assessed concerning the method feasibility, postoperative pain and bleeding, impact in anorectal functionality, quality of life and hemorrhoidal disease recurrence. Between December 2013 to August 2014, 17 patients were submitted to PSH and followed-up over a one-year period. Among them, 82% showed internal hemorrhoids grade III and 18% grade IV. The surgical mean time was 09:09 minutes (07:03-12:13 minutes). The mean pain in immediate postoperative (IPO) assessed using a visual analog scale (VAS) for pain was 1 (0-7). The mean postoperative labor return was 9 days (4-19 days). None of the patients showed anal stenosis. Seventy-six percent of the patients were satisfied with the surgery in 90 days postoperative. Comparing the preoperative data to the manometry after 90 days, none of the assessed variables showed statistical difference. There was no hemorrhoidal disease recurrence after a postoperative follow-up period. The stapled partial hemorrhoidopexy shows safe and efficient surgery technique in the hemorrhoidal disease with few impacts in the anorectal physiology, with low rates in fecal urgencies and anal stenosis.