Magdey Mohamed Elsebae* and Ahmed Mohamed Abdelaziz Hassan
Department of General Surgery, Theodor Bilharz Research Institute, EgyptFulltext PDF
Introduction: symptomatic internal hemorrhoids in liver cirrhosis patients in Egypt, with its associated bleeding diathesis, would favour a transanal-stapled hemorrhoidopexy precluding the need to excise either anoderm or perianal skin in those patients with potential advantages of reduction of operating time, postoperative pain, hospital stay and time to return to work. The aim of this work was to assess the efficacy, safety, pitfalls and the surgical outcome of stapled hemorrhoidopexy in liver cirrhosis patients in Egypt.Patients and
Methods: Thirty patients with symptomatic prolapsed hemorrhoids comorbid with liver cirrhosis who had intractable response to other non-surgical interventions underwent stapled hemorrhoidopexy. The efficacy outcomes measures were operative time, post-operative pain, analgesia requirement, and length of hospital stay, patient satisfaction and return to normal activities. The safety outcomes measures were post-operative bleeding, urinary retention, anal stenosis and sphincter damage.
Results: The average operative time was 27 min (range 20-45 min). Bleeding from the staple line after removal of the hemostatic gauze occurred in seven patients. VAS sore was ≤ 3 in 80% and 93.3% of patients at 1st and 2nd postoperative days respectively 73.3% of patients required two doses of parenteral analgesia (Ketolac®) in first postoperative day, which reduced to a single dose in 60% of patients in second postoperative day. Post-operative hospital stay was 2-4 days. Postoperative complications were urinary retention (10%), Minor delayed postoperative stapleline bleeding per rectum, which did not require any intervention, (46.7%) of patients. All patients received the procedure without symptom relapse except six of patients complained of prolapse of mass per rectum during defecation at 1 week -1st month (20%) both however, recovered and became symptom free at 3 months of follow-up. No patient reported incontinence to flatus or stool and none developed anal stenosis.Conclusion: Stapled hemorrhoidopexy is a feasible and safe approach for prolapsed hemorrhoids concurrent with liver cirrhosis however; a larger scale controlled trials needed to support our results.
Stapled hemorrhoidopexy; Liver cirrhosis; hemorrhoids
Elsebae MM, Hassan AMA. Stapled Hemorrhoidopexy in Egyptian Patients with Liver Cirrhosis: Initial Single Institution Experience. Clin Surg. 2017; 2: 1392.