Abstract
Purpose
To investigate the efficacy and safety of stapled hemorrhoidopexy in treating prolapsed hemorrhoids in patients with liver cirrhosis.
Patients and Methods
Eight consecutive cases of patients with prolapsed hemorrhoids comorbid with liver cirrhosis, who had intractable response to other interventions, were enrolled in this retrospective study between January 2002 and June 2006 at our institute. Six patients (75%) had Child–Pugh class A liver cirrhosis, whereas only two patients (25%) had class B disease. Rectal varices were identified in three patients (37.5%), and esophageal varices were identified in six patients (75%). Concurrent rectal and esophageal varices existed in three patients (37.5%). The patients underwent stapled hemorrhoidopexy with Proximate® PPH-03 in a lithotomy position under spinal/intravenous general anesthesia.
Results
There was no procedure-related mortality or major complications except hemorrhage. Two patients (25%) were complicated with postoperative staple-line bleeding, which was managed with conservative treatment without reoperation. There were no leading symptoms of relapsing during a follow-up period of at least 6 months.
Conclusions
This study may prove that stapled hemorrhoidopexy is a feasible and safe approach for prolapsed hemorrhoids concurrent with liver cirrhosis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Corman ML (2005) Hemorrhoids. In: Corman ML (ed) Colon & rectal surgery, 5th edn. Williams & Wilkins, Philadelphia, pp 177–253
Sarfeh IJ, Tarnawaski A (1987) Gastric mucosal vasculopathy in portal hypertension. Gastroenterology 93:1129–1131
Hosking SW, Smart HL, Johnson AG, Triger DR (1989) Anorectal varices, haemorrhoids, and portal hypertension. Lancet 18:349–352
Misra SP, Dwivedi M, Misra V (1996) Prevalence and factors influencing hemorrhoids, anorectal varices and colopathy in patients with portal hypertension. Endoscopy 29:340–345
Bresci G, Gambardella L, Parisi G, Federici G, Bertini M, Rindi G, Metrangolo S, Tumino E, Bertoni M, Cagno MC, Capria A (1998) Colonic disease in cirrhotic patients with portal hypertension: an endoscopic and clinical evaluation. J Clin Gastroenterol 26:222–227
Yamakado S, Kanazawa H, Kobayashi M (1995) Portal hypertensive colopathy: endoscopic findings and the relation to portal pressure. Int Med 34:153–157
Wang TF, Lee FY, Tsai YT, Lee SD, Wang SS, Hsia HC, Lin WJ, Lin HC, Lai KH, Chan CY (1992) Relationship of portal pressure, anorectal varices and hemorrhoids in cirrhotic patients. J Hepatol 15:170–173
Rabinovitz M, Schade RR, Dindzans VJ, Belle SH, Van Thiel DH, Gavaler JS (1990) Colonic disease in cirrhosis. An endoscopic evaluation in 412 patients. Gastroenterology 99:195–199
Longo A (1998) Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th world congress of endoscopic surgery, Rome, Italy, June 3–6
Hegedus L, Ladocsi B, Wellner I, Olah A (2001) New surgical method in the treatment of severe hemorrhoidal bleeding caused by decompressed liver cirrhosis. Magy Seb 54:52–53 (Hungarian)
Biswas S, George ML, Leather AJ (2003) Stapled anopexy in the treatment of anal varices: report of a case. Dis Colon Rectum 46:1284–1285
Singer MA, Cintron JR, Fleshman JW, Chaudry V, Birnbaum EH, Read TE, Spitz JS, Abcarian H (2002) Early experience with stapled hemorrhoidectomy in the United States. Dis Colon Rectum 45:260–267
Cheetham MJ, Cohen CR, Kamm MA, Phillips RK (2003) A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer term follow-up. Dis Colon Rectum 46:491–497
Senagore AJ, Singer M, Abcarian H, Fleshman J, Corman M, Wexner S, Nivatvongs S (2004) A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results. Dis Colon Rectum 47:1824–1836
Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan–Morgan haemorrhoidectomy: randomized controlled trial. Lancet 355:782–785
Pavlidis T, Papaziogas B, Souparis A, Patsas A, Koutelidakis I, Papaziogas T (2002) Modern stapled Longo procedure vs. conventional Milligan–Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis 17:50–53
Lan P, Wu X, Zhou X, Wang J, Zhang L (2006) The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systemic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis 21:172–178
Picchio M, Palimento D, Attanasio U, Renda A (2006) Stapled vs open hemorrhoidectomy: long-term outcome of a randomized controlled trial. Int J Colorectal Dis 19:239–244
Huang WS, Wang JY, Chin CC (2003) Stapled hemorrhoidectomy with PPH-33 versus conventional Ferguson hemorrhoidectomy: preliminary analysis in Chang Gung Memorial Hospital. J Soc Colorectal Surg ROC 14:33–38
Jongen J, Bock JU, Peleikis HG, Eberstein A (2006) Complications and reoperations in stapled anopexy: learning by doing. Int J Colorectal Dis 21:166–171
Bravo AA, Sheth SG, Chopra S (2001) Liver biopsy. New Engl J Med 15:495–500
Chen HH, Wang JY, Changchien CR, Yeh CY, Tsai WS, Tang R (2002) Effective management of posthemorrhoidectomy secondary hemorrhage using rectal irrigation. Dis Colon Rectum 45:234–238
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Huang, WS., Lin, P.Y., Chin, CC. et al. Stapled hemorrhoidopexy for prolapsed hemorrhoids in patients with liver cirrhosis; a preliminary outcome for 8-case experience. Int J Colorectal Dis 22, 1083–1089 (2007). https://doi.org/10.1007/s00384-007-0271-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-007-0271-5