Comparative Efficacy of Procedure for Prolapse and Hemorrhoids vs Traditional Surgery for Outlet Obstructive Constipation

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Introduction

There are multiple surgical procedures available for the treatment of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids, with traditional ligation of prolapsed rectal mucosa and hemorrhoids and procedure for prolapse and hemorrhoids (PPH) being the most commonly used.

Aim

To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.

Patient Profile

  • Patients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential haemorrhoids
  • Grade Ⅲ or Ⅳ hemorrhoids
  • Age 45-65 years
  • Grade Ⅱ or Ⅲ internal rectal prolapse diagnosed by defecography
  • Clinical manifestations including difficulty in defecation, sensation of anorectal obstruction, anal tenesmus or discomfort, prolonged defecation, and the frequent need of manual maneuvers to facilitate defecations

Methods

  • Short-term (operative time, postoperative hospital stay, postoperative urinary retention, postoperative perianal edema, and postoperative pain) and long-term (postoperative anal stenosis, postoperative sensory anal incontinence, postoperative recurrence, and postoperative difficulty in defecation) clinical effects were compared between the two groups.

Results

  • In PPH group, short-term clinical effects, operative time and postoperative hospital stay were significantly shorter than in the control group (P < 0.01)
  • The visual analogue scale scores at 24 h after surgery, first defecation, and one week after surgery were significantly lower in the PPH group
 Table 1 Outcome measures for short-term efficacy and safety

Outcome measure

PPH group (n = 54)

Control group (n = 54)

χ 2 or t value

P value

Operative time, min

24.36 ± 5.16

44.27 ± 6.57

17.514

< 0.001

Postoperative hospital stay, d

2.1 ± 1.4

3.6 ± 2.3

4.094

0.001

Postoperative VAS score

 

 

 

 

At 24 h

2.9 ± 0.9

8.3 ± 1.1

27.923

< 0.001

At first defecation

2.0 ± 0.5

6.5±0.8

35.055

< 0.001

At one week

1.7 ± 0.5

5.0 ± 0.7

28.205

< 0.001
  • The incidence of postoperative urinary retention was higher in the PPH group than in the control group, but the difference was not statistically significant
  • The incidence of perianal edema was significantly lower in the PPH group (P < 0.05)
  • The incidences of postoperative anal stenosis, sensory anal incontinence, and recurrence were significantly lower in PPH-treated patients. (Figure 1)
Figure 1: Outcome measures for short and long-term efficacy and safety (at one year after surgery)

Conclusion

  • PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids
  • The study demonstrated that PPH is a better choice for treatment of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids

 Reference

World J Gastroenterol 2015; 21;26: 8178-8183

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