Introduction:Hemorrhoidal disease is a common pathology and its
surgical treatment is based, among other things, on pedicular resection after
failure of medical and instrumental treatment. The aim of this study is to
analyze the epidemiological, clinical, therapeutic and evolving aspects of
hemorrhoidal disease at the stage of surgical treatment at the University
Hospital Center of Brazzaville.Patients and Methods:We conducted a retrospective and descriptive study
carried out from January 2020 to December 2021, a 24 months period, in the
Digestive surgery department of the University Hospital Center of Brazzaville.
It concerned patients who underwent a surgical procedure for hemorrhoidal
disease.Results: 21 cases were collected, representing a hospital frequency of 2.3%, with
a sex ratio of 4.3 in favor of men. The average age of patients was 42.2 ± 11.9
years. The symptoms were mainly proctalgia, mass sensation and rectal bleeding.
We recorded five cases (19.1%) of hemorrhoidal thrombosis and 16 cases (80.9%)
of hemorrhoidal prolapse including 12 cases requiring manual integration
(Goligher grade III) and four irreducible permanent cases (Goligher grade IV).
The Grade III prolapse was associated with a polyp in one patient and with
posterior anal fissure in another patient. Out of the 21 patients, 14 underwent
a tripedicular hemorrhoidectomy according to Milligan and Morgan. Two patients
underwent mono- and bipedicular hemorrhoidectomy with resection of associated
lesions and five patients underwent emergency thrombectomy. The outcome was
favorable for all our patients. The average length of hospital stay was 1.5 ±
2.1 days.Conclusion:In the event of failure of medical and instrumental
treatment, the hemorrhoidal cure according to Milligan and Morgan is the
surgical treatment of reference for hemorrhoidal disease at the University
Hospital Center of Brazzaville.
References
[1]
Agbo, S.P. (2011) Surgical Management of Hemorrhoids. Journal of Surgical Technique and Case Report, 3, 68-75. https://doi.org/10.4103/2006-8808.92797
[2]
Pigot, F. (2011) Pathologie hémorroïdaire: Traitement chirurgical. La Presse Médicale, 40, 941-947. https://doi.org/10.1016/j.lpm.2011.06.014
[3]
Siproudhis, L., Pigot, F., Godeberge, P., Damon, H., Soudan, D. and Bigard, M.A. (2006) Defecation Disorders: A French Population Survey. Diseases of Colon and Rectum, 49, 219-227. https://doi.org/10.1007/s10350-005-0249-8
[4]
Pillant-Le Moult, H., Auber, M. and De Parades, V. (2015) Traitement chirurgical classique des hémorroïdes. Journal de Chirurgie Viscérale, 152, S3-S9. https://doi.org/10.1016/j.jchirv.2014.09.003
[5]
Higuero, T., Abramowitz, L., Castinel, A., et al. (2016) Guidelines for the Treatment of Hemorrhoids (Short Report). Journal of Visceral Surgery, 153, 213-218. https://doi.org/10.1016/j.jviscsurg.2016.03.004
[6]
Milligan, E.T.C., Naunton Morgan., C., et al. (1934) Surgical Anatomy of the Anal Canal and the Operative Treatment of Hæmorrhoids. The Lancet, 230, 1119-1124. https://doi.org/10.1016/S0140-6736(00)88465-2
[7]
Ele, N., Okiémy, G., Chocolat, J.R., Ibamba Ikassi, A., Note Madzele, M. and Massengo, R. (2007) Résultats du traitement chirurgical de la maladie hémorroïdaire selon la technique de Milligan Morgan: A propos de 56 cas. Le Mali Médical, 22, 58-60.
Ajayi, D.O., Banigoi, O.G. and Nnamdi, K. (1974) Anal Fissure, Fistule Abscessee and Haemmorroids in a Tropical Population. Diseases of Colon and Rectum, 17, 55-60. https://doi.org/10.1007/BF02587537
[10]
Diarra, M. and Konat É, A. (2015) La maladie hémorroïdaire interne au centre d’endoscopie digestive du chu Gabriel Toure de Bamako. Le Mali Médical, 30, 38-41.
[11]
Diallo, G. and Sissoko, F. (2003) La maladie hémorroïdaire dans le service de Chirurgie B de l’hôpital du Point G. Le Mali Médical, 18, 9-11.
[12]
Claude, M.J., Ngomirakiza, J.B., Kamatari, D., et al. (2019) Hemorroidectomy in Three Hospitals of Bujumbura, Burundi. Journal of African Clinical Cases and Reviews, 3, 424-430.
[13]
Tournu, G., Abramowitz, L., Couffignal, C., et al. (2017) Prevalence of Anal Symptoms in General Practice: A Prospective Study. BMC Family Practice, 18, Article No. 78. https://doi.org/10.1186/s12875-017-0649-6
[14]
Chew, S.S., Marshall, L., Tham, J., Grieve, D.A., Douglas, P.R. and Newstead, G.L. (2003) Short-Term and Long-Term Results of Combined Sclerotherapy and Rubber Bandligation of Haemorrhoids and Mucosal Prolapsed. Diseases of Colon and Rectum, 46, 1232-1237. https://doi.org/10.1007/s10350-004-6720-0
[15]
Frexinos, J., Buscail, L. and Staumont, G. (2003) Hemorroides. In: Frexinos, J. and Buscail, L., Eds., Hepato Gastro-Enterologie Proctologie, 5th Édition, Masson, Paris, 395-401.
[16]
Goligher, J.C. (1984) Surgery of the Anus, Rectum and Colon. 5th Edition, Billiere Tindall, London, 101.
[17]
De Parades, V., Parisot, C. and Atienza, P. (2005) L’hémorroïdectomie selon la technique de Milligan et Morgan. Journal de Chirurgie Viscérale, 142, 302-305.
[18]
Madoff, R.D. and Fleshman, J.W. (2004) American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Hemorrhoids. Gastroenterology, 126, 1463-1473. https://doi.org/10.1053/j.gastro.2004.03.008
[19]
Konate, A., Niass, M.I., et al. (2015) Le traitement chirurgical de la maladie hémorroïdaire selon la technique de Milligan et Morgan, à propos de 49 cas. African Journal of Gastroenterology and Hepatology, 9, 138-140. https://doi.org/10.1007/s12157-015-0603-y
[20]
Dalibon, P. (2019) La maladie hémorroïdaire. Actualités Pharmaceutiques, 58, 46-50. https://doi.org/10.1016/j.actpha.2019.01.019
[21]
Favreau-Weltzer, C. and Bouchard, D. (2020) L’hémorroïdectomie de Milligan et Morgan: Avantages et inconv ÉNients. Diseases of Colon and Rectum, 14, 24-28.
[22]
Vinson-Bonnet, B. and Juguet, F. (2015) Ambulatory Proctologic Surgery: Recommendations of the French National Coloproctology Society (SNFCP). Journal of Visceral Surgery, 152, 369-372. https://doi.org/10.1016/j.jviscsurg.2015.10.001
