Primary anoplasty with implantation of vascular pedicles after emergent hemorrhoidectomy

Catedra Chirurgie Generală, USMF „N.Testemițanu”, Chișinău, Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Introducere. Tromboza hemoroidală acută (THA) posedă un risc neprognozabil de evoluție spre ulcerație și/sau gangrenă, necesitind tratament de urgență. Tratamentul chirurgical al THA a fost tradițional limitat din frică eventualelor complicații postoperatorii. Scopul studiului: analiza eficacitații clinice precoce și a siguranței hemoroidectomiei urgente închise la bolnavii cu THA. Metode. Lotul cercetat a cuprins 71 pacienți; virsta medie – 42,48 ani; barbați – 53,52%. Durata de la debutul THA pîna la spitalizare – 85,48 ore (18-172). Necroza mucoasei a fost observată în 42,25% cazuri. La toți bolnavii s-a efectuat hemoroidectomia urgentă (≤24 ore de la internare) cu implantarea pediculilor vasculari și anoplastie primară. Metoda de anestezie: generală i/v – 73,23% cazuri; locală infiltrativă – 21,12% și spinală – 5,63% cazuri. Regimul de analgezie postoperatorie s-a selectat în raport cu solicitarea bolnavului. Evaluarea rezultatelor clinice s-a efectuat pe durata unei luni. Rezultate. Toate intervențiile s-au efectuat într-o sedința; numărul de hemoroizi excizați – 2,83±0,04/pacient. Durata medie a operației – 20 min (15-35). În 2,81% cazuri a fost notaăa hemoragia din locurile de punctie ale pielii perianale. La 11,26% pacienți s-a observat retenția acută tranzitorie de urină. Administrarea opioidelor (1-3 zile) a fost necesară în 60,56% cazuri. Complicații nespecifice au fost notate în 2 cazuri. Perioada de spitalizare a durat în mediu – 5,21 zile (3-11). Pe perioada de evaluare nu au fost înregistrate cazuri de deces și nici un pacient nu a necesitat reinternare. Dehiscența plagii (>1 mm) a fost observata la 8,45% bolnavi, iar strictura anală – la 7,04%, simptomatologia cedînd după dilatare. Concluzii. Hemoroidectomia urgentă cu implantarea pediculilor vasculari și anoplastie primară este eficientă și sigură, și poate fi utilizată pe larg în managementul THA, asociindu-se cu o durată scurtă de spitalizare și frecvența cumulativă redusă a complicațiilor.Introduction. Acute hemorrhoidal thrombosis (AHT) possess an unpredictable risk of progression to ulceration and/or mucosal gangrene, requiring emergency treatment. Surgical intervention for AHT has been traditionally limited by fear of possible postoperative complications. The aim of study: analysis of early clinical efficacy and safety of closed emergent hemorrhoidectomy in patients with AHT. Methods. There were 71 patients included in study; average age – 42,48 years; male – 53,52%. Duration from onset of AHT till hospitalization – 85,48 hours (18-172). Mucosal necrosis was observed in 42,25% cases. In all patients was performed emergency hemorrhoidectomy (≤24 hours from admission) with the implantation of vascular pedicles and primary anoplasty. The method of anesthesia: general i/v – 73,23% cases, local tumescent – 21,12% and spinal – 5,63% cases. Postoperative analgesia regimen was selected in relation to the patient’s request. Evaluation of clinical outcomes was made during one month. Results. All interventions were performed in one session; the number of excised piles – 2,83±0,04 per patient. The average duration of operation was 20 min (15-35). In 2,81% cases was noted hemorrhage from the perianal skin puncture sites. In 11,26% patients was observed transient acute urinary retention. The administration of opioids (1-3 days) was required in 60,56% cases. Nonspecific complications were noted in 2 cases. The hospitalization period lasted on average – 5,21 days (3-11). During the follow-up there were no deaths and no patient required readmission. Wound dehiscence (>1 mm) was observed in 8,45% patients, but anal stricture – in 7,04%, the symptoms diminished after dilation. Conclusion. Emergency hemorrhoidectomy with the implantation of vascular pedicles and primary anoplasty is effective and safe and can be widely used in the management of AHT, being associated with a shorter duration of hospitalization and reduced cumulative frequency of complications

Ранние результаты срочной геморроидэктомии с анопластикой при остром тромбозе геморроидальных узлов

The aim of the current study was to analyze the clinical efficacy and safety of emergent closed hemorrhoidectomy with implantation of vascular pedicles and primary plasty of anal mucosa and anoderm in patients with prolapsed thrombosed hemorrhoids. Seventy-one patients who underwent surgical intervention within 24 hours of admission were enrolled in the study. Clinical evolution and postoperative complications were assessed during one month after hemorrhoidectomy. Mean age of the patients was 42.48 ± 0.89 years. The mean time between onset of thrombosis and hospital admission was 85.48 ± 5.18 hours. Duration of hospitalization was 5.21 ± 0.18 days. Urinary retention (11.26%) was the most common postoperative complication. Primary bleeding after surgery occurred in 2 (2.81%) cases, both of which were controlled conservatively. Two patients experienced non-specific transient complications. Symptomatic anal stenosis developped in 5 (7.04%) patients, but no one needed further surgical intervention. We conclude that emergent closed hemorrhoidectomy is efficient and safe, and in absence of contraindications can be widely used in the treatment of patients with an acute thrombosis of hemorrhoids. Implantation of vascular pedicles after hemorrhoidectomy allows for decreaseding of mucosal injury and bleeding rates in early postoperative period.Целью настоящего исследования являлся анализ клинической эффективности и безопасности закрытой геморроидэктомии с первичной пластикой анальной слизистой и имплантацией сосудистых ножек у больных с острым тромбозом выпавших геморроидальных узлов. В исследование было включено 71 пациент, перенесшие хирургическое вмешательство в первые 24 часа после госпитализации. Динамика клинических проявлений и послеоперационные осложнения были оценены в течение одного месяца после геморроидэктомии. Средний возраст пациентов был 42,48 ± 0,89 года. Продолжительность периода между появлением первых симптомов тромбоза и госпитализацией составила в среднем 85,48 ± 5,18 часа, а длительность госпитализации – 21 ± 0,18 дней. Наиболее частым послеоперационным осложнением явилась острая задержка мочи – 11,26%. Первичное кровотечение после операции зарегистрировали в 2 (2,81%) случаях, в обоих гемостаз был достигнут консервативными средствами. У двух пациентов наблюдались неспецифические осложнения временного характера. Симптоматическая анальная стриктура развилась у 5 (7,04%) пациентов, ни в одном случае не потребовавшая хирургической коррекции. Таким образом, срочная закрытая геморроидэктомия является эффективной и безопасной, и в отсутствии противопоказаний к оперативному лечению может широко использоваться в лечении больных с острым тромбозом геморроидальных узлов. Имплантация сосудистых ножек после геморроидэктомии способствует снижению частоты микротравматизаций слизистой и кровотечений в раннем послеоперационном периоде