Residual Prolapse in Patients with III-IV Degree Haemorrhoids Undergoing Stapled Haemorrhoidopexy with CPH34 HV: Results of an Italian Multicentric Clinical Study
CPH34 HV, a high volume stapler, was tested in order to assess its safety and efficacy in reducing residual/recurrent haemorrhoids. The clinical charts of 430 patients with third- to fourth-degree haemorrhoids undergoing SH in 2012-2013 were consecutively reviewed, excluding those with obstructed defecation (rectocele >2？cm; Wexner’s score >15). Follow-up was scheduled at six and 12 months. Rectal prolapse exceeding more than half of CAD was reported in 341 patients (79.3%); one technical failure was reported (0.2%) without any serious untoward effect; and 1.3 stitch/patient (SD, 1.7) was required to achieve complete haemostasis. Doughnuts volume was higher (13.8？mL; SD, 1.5) in patients with a large rectal prolapse than with smaller one (8.9？mL; SD, 0.7) ( value <0.05). Residual and recurrent haemorrhoids occurred in 8 of 430 patients (1.8%) and 5 of 254 patients (1.9%), respectively. A high index of patient satisfaction (visual analogue scale = 8.9; SD, 0.9) coupled with a persistent reduction of constipation scores (CSS = 5.0, SD, 2.2) was observed. The wider prolapse resection well correlated with a clear-cut reduction of haemorrhoidal relapse, a high index of patient satisfaction, and clinically relevant reduction of constipations scores coupled with satisfactory haemostatic properties of CPH34 HV. 1. Introduction Haemorrhoids represent one of the most frequent proctologic diseases, ranging in the adult population from 4% to 34% [1]. Bleeding during or soon after evacuation, anal pain and/or discomfort, and haemorrhoidal prolapse are the most common findings. According to the “Unitary Theory of Rectal Prolapse,” haemorrhoids are determined by an internal rectal prolapse that can be limited to the rectal mucosa (mucosal prolapse) or involve the muscle wall (full-thickness rectal prolapse) as well [2]. During defecation, this internal prolapse can descend down to the anal canal, up to or even beyond the anal verge, thus pushing-out anorectal mucosa and haemorrhoids. This dynamic prolapse weakens over time the supporting structures, such as Treitz’s and Parks’ ligaments, with a progressive sliding down of the haemorrhoids which is primarily due to the internal rectoanal prolapse. Stapled haemorrhoidopexy (SH), by correcting the inherent internal rectal prolapse, achieves not only less postoperative pain, superior functional recovery with earlier return to normal activities, and improved patient satisfaction with respect to conventional haemorrhoidectomy (CH), but it can also ameliorate the symptoms of obstructed defecation, frequently reported in
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