The influencet of different sequences of PPH on patients with mixed hemorrhoids and anal fissures
YANG Bo,XIA Xu
Department of Gastrointestinal Hernia and Anorectal Surgery, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 Hospital,Chengdu610051, China
Abstract:
Objective To explore the influence of different sequences of procedure for prolapse and hemorrhoids (PPH) on patients with mixed hemorrhoids and anal fissures. Methods 120 patients with annular mixed hemorrhoids and anal fissure admitted from November 2020 to April 2024 were retrospectively analyzed. According to the different surgical operation method, they were divided into pre-PPH group (PPH first, then anal fissure resection suture) and post-PPH group (anal fissure resection suture first, then PPH), and 60 cases were included in each group. The perioperative indicators (surgical time, first defecation time, number of cases with first defecation within 24-48 h, hospitalization time), incidence rates of surgical complications, pain status (VAS) at 1, 3 and 7 days after surgery, defecation status (PAC-SYM) and anal status (anal resting pressure, rectal resting pressure, positive rate of anorectal reflex) before surgery and at 7 days after surgery were compared between groups. Results The surgical time, first defecation time and hospitalization time in pre-PPH group were significantly shorter than those in post-PPH group (P <0.05), and the number of cases with first defecation within 24-48 h was significantly more than that in post-PPH group (P <0.05). The total incidence rate of surgical complications in pre-PPH group (11.67%) was significantly lower than that in post-PPH group (26.67%) (P <0.05). Within 7 days after surgery, VAS in both groups was decreased gradually, and the score at each time period was significantly lower in pre-PPH group than that in post-PPH group (P <0.05). The PAC-SYM scores in both groups were declined significantly at 7 days after surgery, and the scores in pre-PPH group were significantly lower than those in post-PPH group (P <0.05). The anal canal resting pressure and rectal resting pressure in the two groups at 7 days after surgery were significantly increased, and the anal canal resting pressure in pre-PPH group was significantly higher than that in post-PPH group (P <0.05). The positive rate of anorectal reflex at 7 days after surgery was significantly higher in pre-PPH group (P <0.05). Conclusion Compared with first anal fissure resection suture, first PPH can treat annular mixed hemorrhoids with anal fissure, and the latter one has more obvious advantages in reducing postoperative pain and improving defecation status and anal function.
