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Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model

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Abstract

Background: The procedure for prolapsing hemorrhoids (PPH) is a new surgical method for the treatment of symptomatic hemorrhoids. In cases of recurrent prolapse, the performance of a second PPH may result in a ring of mucosa and submucosa between the two circular staple lines. In this study, we used a porcine model to assess whether PPH can be safely performed twice. Methods: Five adult pigs underwent two PPH procedures in one session, leaving a ring of ~1 cm of mucosa between the two staple lines. One month later, the pigs were examined under anesthesia. The anal canal was assessed using the following four methods: (a) clinical examination, (b) evaluation of mucosal blood perfusion at different levels of the anal canal via a laser Doppler flow detector, (c) measurement of concentrations of hydroxyproline and collagen to check for fibrosis, and (d) histopathological examination. Results: At the completion of the study period, all five pigs showed no clinical evidence of anorectal dysfunction. On examination under anesthesia 1 month after surgery, there was no evidence of anal stenosis in any of the pigs. The mean mucosal blood flow between the two staple lines did not differ significantly from the flow measured proximally and distally (394 vs 363 and 339 flow units, respectively; p = NS). The collagen levels, based on hydroxyproline concentration, were 81 mcg/mg between the staple lines, compared to 82 and 79 proximally and distally, respectively (p = NS). There was no significant difference in degree of fibrosis, as assessed histopathologically, between specimens taken from the ring between the staple lines and specimens taken from the area external to the staple lines. Conclusions: The results of this porcine model suggest that a second synchronous PPH is feasible. A controlled experience involving human subjects is required to determine the safety and usefulness of this technique in cases of metachronous application for recurrent or residual hemorrhoids.

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References

  1. DF Altomare M Rinaldi PL Sallustio P Martino M De Fazio V Memeo (2001) ArticleTitleLong-term effects of stapled haemorrhoidectomy on internal anal function and sensitivity. Br J Surg 88 1487–1491 Occurrence Handle10.1046/j.0007-1323.2001.01898.x Occurrence Handle1:STN:280:DC%2BD3MngvF2nug%3D%3D Occurrence Handle11683746

    Article  CAS  PubMed  Google Scholar 

  2. G Arbman H Krook S Haapaniemi (2000) ArticleTitleClosed vs. open hemorrhoidectomy—is there any difference? Dis Colon Rectum 43 31–34 Occurrence Handle1:STN:280:DC%2BD3c3ntFahug%3D%3D Occurrence Handle10813120

    CAS  PubMed  Google Scholar 

  3. JP Arnaud P Pessaux N Huten et al. (2001) ArticleTitleTreatment of hemorrhoids with circular stapler, a new alternative to conventional methods: a prospective study of 140 patients. J Am Coll Surg 193 161–165 Occurrence Handle10.1016/S1072-7515(01)00973-5 Occurrence Handle1:STN:280:DC%2BD3MvksF2qtA%3D%3D Occurrence Handle11491446

    Article  CAS  PubMed  Google Scholar 

  4. GC Beattie MA Loudon (2001) ArticleTitleFollow-up confirms sustained benefit of circumferential stapled anoplasty in the management of prolapsing haemorrhoids. Br J Surg 88 850–852 Occurrence Handle10.1046/j.0007-1323.2001.01790.x Occurrence Handle1:STN:280:DC%2BD3MzkvFWgsQ%3D%3D Occurrence Handle11412257

    Article  CAS  PubMed  Google Scholar 

  5. DE Beck (1998) Hemorrhoidal disease. DE Beck SD Wexner (Eds) Fundamentals of anorectal surgery. WB Saunders London 237–253

    Google Scholar 

  6. P Boccasanta PG Capretti M Venturi et al. (2001) ArticleTitleRandomized controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182 64–68 Occurrence Handle10.1016/S0002-9610(01)00654-7 Occurrence Handle1:STN:280:DC%2BD3MvovFOnuw%3D%3D Occurrence Handle11532418

    Article  CAS  PubMed  Google Scholar 

  7. MJ Cheetham NJ Mortensen PO Nystrom MA Kamm RK Phillips (2000) ArticleTitlePersistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet 356 730–733 Occurrence Handle10.1016/S0140-6736(00)02632-5 Occurrence Handle1:STN:280:DC%2BD3M%2FjvVKquw%3D%3D Occurrence Handle11085693

    Article  CAS  PubMed  Google Scholar 

  8. E Ganio DF Altomare F Gabrielli G Milito S Canuti (2001) ArticleTitleProspective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg 88 669–674 Occurrence Handle1:STN:280:DC%2BD3M3mslentw%3D%3D Occurrence Handle11350437

    CAS  PubMed  Google Scholar 

  9. YH Ho WK Cheong C Tsang et al. (2000) ArticleTitleStapled hemorrhoidectomy—cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43 1666–1675

    Google Scholar 

  10. S Ibrahim C Tsang YL Lee KW Eu F Seow-Choen (1998) ArticleTitleProspective, randomized trial comparing pain and complications between diathermy and scissors for closed hemorrhoidectomy. Dis Colon Rectum 41 1418–1420 Occurrence Handle1:STN:280:DyaK1M%2FjvFCitw%3D%3D Occurrence Handle9823809

    CAS  PubMed  Google Scholar 

  11. KH Khalil A O’Bichere D Sellu (2000) ArticleTitleRandomized clinical trial of sutured versus stapled closed haemorrhoidectomy. Br J Surg 87 1352–1355 Occurrence Handle10.1046/j.1365-2168.2000.01624.x Occurrence Handle1:STN:280:DC%2BD3crgtVGlug%3D%3D Occurrence Handle11044160

    Article  CAS  PubMed  Google Scholar 

  12. J Konsten CG Baeten (2000) ArticleTitleHemorrhoidectomy vs. Lord’s method: 17-year follow-up of a prospective, randomized trial. Dis Colon Rectum 43 503–506 Occurrence Handle1:STN:280:DC%2BD3c3kvVKjug%3D%3D Occurrence Handle10789746

    CAS  PubMed  Google Scholar 

  13. Longo A (1998) Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with circular suture device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery, Rome, Italy, 3–6, June

    Google Scholar 

  14. BJ Mehigan JR Monson JE Hartley (2000) ArticleTitleStapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355 782–785 Occurrence Handle10.1016/S0140-6736(99)08362-2 Occurrence Handle1:STN:280:DC%2BD3c7nsFSruw%3D%3D Occurrence Handle10711925

    Article  CAS  PubMed  Google Scholar 

  15. Millito G, Correse F, Casciani CU (1998) Surgical treatment of mucosal prolapse and hemorrhoids by stapler. Proceedings of the 6th World Congress of Endoscopic Surgery, Rome, Italy, 3–6 June

  16. PE Mortensen J Olsen IK Pedersen J Christiansen (1987) ArticleTitleA randomized study on hemorrhoidectomy combined with anal dilatation. Dis Colon Rectum 30 755–757 Occurrence Handle1:STN:280:BieD3czpt1Y%3D Occurrence Handle3308368

    CAS  PubMed  Google Scholar 

  17. LM Pernice B Bartalucci L Bencini A Borri S Catarzi K Kroning (2001) ArticleTitleEarly and late (ten years) experience with circular stapler hemorrhoidectomy. Dis Colon Rectum 44 836–841 Occurrence Handle1:STN:280:DC%2BD3MzhvFOqtA%3D%3D Occurrence Handle11391144

    CAS  PubMed  Google Scholar 

  18. M Rowsell M Bello DM Hemingway (2000) ArticleTitleCircumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 355 779–781 Occurrence Handle10.1016/S0140-6736(99)06122-X Occurrence Handle1:STN:280:DC%2BD3c7nsFSrug%3D%3D Occurrence Handle10711924

    Article  CAS  PubMed  Google Scholar 

  19. D Savioz B Roche T Glauser A Dobrinov C Ludwig MC Marti (1998) ArticleTitleRubber band ligation of hemorrhoids: relapse as a function of time. Int J Colorectal Dis 13 154–156 Occurrence Handle10.1007/s003840050156 Occurrence Handle1:STN:280:DyaK1M%2FivVaisA%3D%3D Occurrence Handle9810517

    Article  CAS  PubMed  Google Scholar 

  20. R Shalaby A Desoky (2001) ArticleTitleRandomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg 88 1049–1053 Occurrence Handle10.1046/j.0007-1323.2001.01830.x Occurrence Handle1:STN:280:DC%2BD3MvktlWhsQ%3D%3D Occurrence Handle11488788

    Article  CAS  PubMed  Google Scholar 

  21. HI Sharif L Lee J Alexander-Williams (1991) ArticleTitleDiathermy haemorrhoidectomy. Int J Colorectal Dis 6 217–219 Occurrence Handle1:STN:280:By2C387ntlI%3D Occurrence Handle1770291

    CAS  PubMed  Google Scholar 

  22. M Singer V Chaudhry J Cintron et al. (2001) ArticleTitleEarly experience with stapled hemorrhoidectomy in the United States. Dis Colon Rectum 44 A7

    Google Scholar 

  23. H Stegemann K Stadler (1967) ArticleTitleDetermination of hydroxyproline. Clin Chim Acta 18 267–273 Occurrence Handle1:CAS:528:DyaF2sXltFCht70%3D Occurrence Handle4864804

    CAS  PubMed  Google Scholar 

  24. SD Wexner K Baig (2001) ArticleTitleThe evaluation and physiologic assessment of hemorrhoidal disease: a review. Tech Coloproc 5 165–168 Occurrence Handle10.1007/s101510100020 Occurrence Handle1:STN:280:DC%2BD387jvVCrtA%3D%3D

    Article  CAS  Google Scholar 

  25. SD Wexner (2001) ArticleTitleThe quest for painless surgical treatment of hemorrhoids continues. J Am Coll Surg 193 174–178 Occurrence Handle10.1016/S1072-7515(01)00997-8 Occurrence Handle1:STN:280:DC%2BD3MvksF2qug%3D%3D Occurrence Handle11491448

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Ethicon Endo-Surgery (Cincinnati, OH, USA).

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Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA

    O. Zmora, P. Colquhoun, E. G. Weiss, J. Efron, A. M. Vernava III, J. J. Nogueras & S. D. Wexner

  2. Basic Research Laboratory, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA

    S. Abramson

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  1. O. Zmora
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  2. P. Colquhoun
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  3. S. Abramson
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  4. E. G. Weiss
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  5. J. Efron
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  6. A. M. Vernava III
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  7. J. J. Nogueras
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  8. S. D. Wexner
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Correspondence to S. D. Wexner.

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Zmora, O., Colquhoun, P., Abramson, S. et al. Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model . Surg Endosc 18, 757–761 (2004). https://doi.org/10.1007/s00464-003-8141-x

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  • DOI: https://doi.org/10.1007/s00464-003-8141-x

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