Clinical Study Of Anastomotic Reinforcement And Suture In PPH For Mixed Hemorrhoids

Objective: Mixed hemorrhoids are common anorectal diseases in clinic,and severe mixed hemorrhoids which are ineffective in conservative treatment usually need surgical treatment.At present,the major complications of PPH are anastomotic bleeding,anastomotic dehiscence,re-prolapse,anastomotic stenosis,anastomotic relaxation of rectal mucosal hernia into anastomotic outlet obstructive constipation,etc.In order to better solve the above problems,we improved the traditional PPH and conducted clinical research to investigate the anastomotic reinforcement and suture for mixed hemorrhoids after PPH.prevention of complications.Methods: From November 2016 to February 2018,patients who were treated with PPH by the same surgeon in the Anorectal Surgery Department of the First Affiliated Hospital of China Medical University were randomly divided into three groups: traditional PPH operation group(group A);anastomotic reinforcement intermittent suture group(group B);anastomotic reinforcement continuous suture group(group C).The clinical data of three groups were collected and analyzed statistically.Results: 180 patients were screened and followed up successfully.There were 76 cases in non-suture group,53 cases in discontinuous suture group and 51 cases in continuous suture group.There were no significant differences in sex ratio,age,BMI index,ASA score,diabetes mellitus and history of abdominal pressure among the three groups.The general analysis of patients’ treatment(Table 2): There was no significant difference in the operation time,hospital stay,pain and medical expenses among the three groups(p = 0.864,0.177,0.174,0.434).Comparisons of defecation before and after operation(Table 3): There was no difficulty in defecation in the three groups before operation.The follow-up results of 1 month after operation showed that there were 5 patients with difficulty in defecation in Group A,1 patient with difficulty in defecation in Group B,and no difficulty in defecation in Group C.There was no statistical difference in defecation difficulty between Group A and Group B(p=0.546).There was no significant difference in defecation difficulty between group B and group C(p=0.150).There was significant difference in defecation difficulty between group A and group C(p=0.044).The defecation difficulty of group C was significantly reduced compared with group A.The follow-up results of 6 months after operation showed that there were 6 patients with dyspepsia in group A,1 patient with dyspepsia in group B,and no dyspepsia in group C.There was no statistical difference in dyspepsia between group A and group B(p=0.446).There was no statistical difference in dyspepsia between group B and group C(p=0.090).There was no statistical difference in dyspepsia between group A and group C after operation(p=0.090).There was a statistical difference in the difficulty of stool(p=0.023).The recurrence and prolapse of group C was significantly less than that of group A.Postoperative massive hemorrhage(Table 4): Follow-up results within 48 hours after operation showed that there were 5 patients with active hemorrhage within 48 hours after operation in Group A,1 patient with active hemorrhage within 48 hours after operation in Group B,no active hemorrhage within 48 hours after operation in Group C,and active hemorrhage within 48 hours in Group A and Group B.There was no statistical difference(p=0.546).There was no statistical difference in the active hemorrhage within 48 hours after operation between group B and group C(p=0.150).There was statistical difference between group A and group C in the active hemorrhage within 48 hours after operation(p=0.044).The active hemorrhage within 48 hours after operation in group C was significantly less than that in group A.Follow-up results of active hemorrhage 48 hours after operation showed that there were 2 patients with active hemorrhage 48 hours after operation in group A,2 patient with active hemorrhage 48 hours after operation in group B,and 3 patients with active hemorrhage 48 hours after operation in group C.There was no statistical difference in the situation of active hemorrhage 48 hours after operation in three groups(p=0.433).Comparisons of recurrence prolapse after operation(Table 5): There were 5 cases of recurrence prolapse in group A,1 case of recurrence prolapse in group B,and no recurrence prolapse in group C.There was no statistical difference in recurrence prolapse between group A and group B(p=0.490).There was no statistical difference in recurrence prolapse between group B and group C(p=0.150),group A and group C(p=0.150).There was significant difference in recurrence and prolapse in group C(p=0.044).The recurrence and prolapse in group C was significantly less than that in group A.Postoperative acute urinary retention,anal swelling and rectovaginal fistula(Table 6): There were 7 patients with acute urinary retention after operation in Group A,5 patients with acute urinary retention after operation in Group B,6 patients with acute urinary retention after operation in Group C.There was no significant difference in recurrence and prolapse among the three groups(P=0.246),and there was no significant difference in recurrence and prolapse after operation in Group A.There were 12 patients with obvious anal bloating sensation,15 patients with obvious anal bloating sensation in group B,14 patients with obvious anal bloating sensation in group C,and there was no significant difference in postoperative anal bloating sensation among the three groups(p=0.318).There was no rectovaginal fistula among the three groups.Conclusions: Anastomotic reinforcement and suture have clinical significance in preventing active hemorrhage,outlet obstructive constipation and recurrent prolapse after PPH for mixed hemorrhoids.