Our Summary

This research paper is about comparing different surgical methods used to treat severe cases of hemorrhoids. Hemorrhoids are a very common health problem and severe cases (known as grade III and IV) are usually treated with surgery. There are many types of surgeries for this condition, but this study focused on three: procedure for prolapse and hemorrhoids (PPH), Milligan-Morgan hemorrhoidectomy (MMH), and tissue-selecting therapy stapler (TST).

The researchers looked at a large number of previous studies and analyzed the data collected from them. They focused especially on the negative outcomes (adverse events) of these surgeries. For example, they looked at issues like urinary retention (difficulty peeing), fecal incontinence (lack of control over bowel movements), anal stenosis (narrowing of the anus), and recurrence rates of hemorrhoids.

From their analysis, they found that the TST method had the least negative outcomes. It had lower rates of urinary retention and fecal incontinence, and fewer instances of anal stenosis than the other two methods. The PPH method was found to be the least effective in preventing hemorrhoids from coming back.

In conclusion, the researchers suggest that TST might be the best surgical method for treating severe hemorrhoids. However, they also point out that more research with larger sample sizes is needed.

FAQs

  1. What are the three surgical methods for treating severe hemorrhoids that were compared in this study?
  2. Which surgical method was found to be the most effective and had the least negative outcomes?
  3. What were some of the adverse events or negative outcomes that the researchers focused on in the study?

Doctor’s Tip

A doctor might advise a patient undergoing a hemorrhoidectomy to follow post-operative care instructions carefully, including proper wound care, pain management, and dietary modifications to prevent constipation. They may also recommend gentle exercise and staying hydrated to aid in the healing process. It is important for patients to communicate any concerns or symptoms to their healthcare provider promptly for proper management.

Suitable For

Patients who are typically recommended for hemorrhoidectomy are those with severe cases of hemorrhoids, specifically grade III and IV. These patients often experience significant pain, bleeding, and discomfort due to their hemorrhoids. Conservative treatments such as dietary changes, topical creams, and sitz baths may not provide adequate relief for these individuals, leading their healthcare providers to recommend surgical intervention.

Patients with severe hemorrhoids may also have tried other treatments without success, leading them to consider surgery as a more permanent solution to their symptoms. Additionally, patients who have recurrent hemorrhoids despite conservative measures may be good candidates for hemorrhoidectomy.

Overall, patients who are experiencing significant symptoms that impact their quality of life and have not responded well to conservative treatments are typically recommended for hemorrhoidectomy. It is important for patients to discuss their symptoms and treatment options with their healthcare provider to determine the best course of action for their individual case.

Timeline

Before hemorrhoidectomy:

  1. Patient experiences symptoms of hemorrhoids such as pain, itching, bleeding, and swelling in the anal area.
  2. Patient may try conservative treatments such as dietary changes, topical creams, and sitz baths to alleviate symptoms.
  3. If symptoms persist or worsen, patient consults with a doctor who may recommend surgical intervention for severe cases.

After hemorrhoidectomy:

  1. Patient undergoes pre-operative preparation which may include fasting, bowel preparation, and medication adjustments.
  2. Patient undergoes hemorrhoidectomy surgery which involves removal of the hemorrhoidal tissue.
  3. Patient experiences post-operative pain, discomfort, and potential complications such as bleeding, infection, and urinary retention.
  4. Patient follows post-operative care instructions including pain management, wound care, and dietary modifications.
  5. Patient gradually recovers over the following weeks, with symptoms improving and healing progressing.
  6. Patient attends follow-up appointments with the doctor to monitor healing and address any concerns.
  7. Patient may experience long-term outcomes such as recurrence of hemorrhoids, anal stenosis, or other complications depending on the surgical method used.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hemorrhoidectomy include:

  1. What are the potential risks and complications associated with the different surgical methods for treating severe hemorrhoids?
  2. How long is the recovery time for each surgical method and what can I expect during the recovery process?
  3. What is the success rate of each surgical method in terms of preventing recurrence of hemorrhoids?
  4. How experienced are you in performing the specific surgical method recommended for my case?
  5. Are there any alternative treatments or non-surgical options available for treating severe hemorrhoids?
  6. How will my daily activities and lifestyle be affected after undergoing a hemorrhoidectomy?
  7. Are there any specific post-operative care instructions or dietary changes I should follow to promote healing and prevent complications?
  8. Will I need any follow-up appointments or tests after the surgery to monitor my recovery and ensure the success of the treatment?
  9. How soon can I expect to see improvement in my symptoms after the surgery?
  10. Are there any specific warning signs or symptoms that I should watch out for after the surgery that may indicate a complication or the need for further medical attention?

Reference

Authors: Zhang G, Liang R, Wang J, Ke M, Chen Z, Huang J, Shi R. Journal: Int J Surg. 2020 Feb;74:53-60. doi: 10.1016/j.ijsu.2019.12.027. Epub 2019 Dec 27. PMID: 31887419