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. 2022 May 1;65(5):742-749.
doi: 10.1097/DCR.0000000000002191.

Transanal Suture Mucopexy for Hemorrhoids

Shantikumar D Chivate  1 , Madhura M Killedar  2 , Laxmikant D Ladukar  3 , G Shanthi Vardhani  4 , Sunil K Kavathe  3 , Sripad R Kanekar  5
Affiliations

Transanal Suture Mucopexy for Hemorrhoids

Shantikumar D Chivate et al. Dis Colon Rectum. .

Abstract

Background: Core factors involved in the treatment of hemorrhoids include the engorgement of hemorrhoids, prolapse, recurrence, and pain.

Objective: The goal of this study was to assess the safety, pain, and efficacy of the transanal suture mucopexy for the treatment of hemorrhoids.

Design: This was a retrospective study over a 13-year period.

Setting: This procedure was performed, and data collected, from medical records at six centers in India.

Patients: This study includes 5634 patients who had grade II to IV symptomatic hemorrhoids. Patients suffering from thrombosed hemorrhoids, inflammatory bowel disease, anal strictures, and anorectal carcinoma were excluded.

Interventions: Hemorrhoidal swelling was reduced by manual massage and a steep Trendelenburg position under saddle block. The reduced hemorrhoids were fixed to the muscles of the rectal wall using sutures. Each suture measured 0.5 to 1.0 cm in length; double-locking continuous sutures were used, along the complete circumference of the rectum, at 2 and 4 cm proximal to the dentate line.

Main outcome measures: Pain assessed using the visual analog scale and hemorrhoid recurrence served as outcome measures.

Results: The transanal suture mucopexy procedure was performed for 5634 patients with symptomatic hemorrhoids. A dull pain compatible with a visual analog score of 2 to 3 was reported in 126 (2.2%) patients; in the remaining 5508 (97.8%) patients, the visual analog score was 1 to 2. Effective treatment without complications occurred for 5541 patients (98.65%). A recurrence rate of 1.3% was recorded in 5634 cases with a mean follow-up of 7 ± 6 years.

Limitations: Utilization of a self-illuminating proctoscope or Brinckerhoff or anal speculum is essential.

Conclusion: Transanal suture mucopexy, designed with 2 suture rows, is a safe procedure with a short learning curve. It is associated with minimal pain, low recurrence rate, and fewer complications. See Video Abstract at http://links.lww.com/DCR/B841.

Mucopexia transanal con sutura para enfermedad hemorroidal: ANTECEDENTES:Los factores centrales involucrados en el tratamiento de la enfermedad hemorroidal incluyen congestión de hemorroides, prolapso, recurrencia y dolor.OBJETIVO:Evaluar la seguridad, el dolor y la eficacia de la mucopexia transanal con sutura para el tratamiento de la enfermedad hemorroidal.DISEÑO:Estudio retrospectivo durante un período de 13 años.ESCENARIO:Este procedimiento se realizó y se recopilaron datos de expedientes médicos en seis centros en India.PACIENTES:Este estudio incluye 5634 pacientes con enfermedad hemorroidal sintomática grado II a IV. Se excluyeron pacientes que padecían hemorroides trombosadas, enfermedad inflamatoria intestinal, estenosis anales y carcinoma anorrectal.INTERVENCIONES:La inflamación hemorroidal se redujo mediante masaje manual y posición Trendelenburg profundo bajo bloqueo caudal. Las hemorroides reducidas se fijaron a los músculos de la pared rectal mediante suturas. Cada sutura midió 0.5 a 1.0 cm de longitud, se utilizaron suturas en surgete continuo de doble anclado, a lo largo de la circunferencia completa del recto, a dos y cuatro cm proximales a la línea dentada.PRINCIPALES MEDIDAS DE RESULTADO:El dolor se evaluó mediante la escala de puntuación analógica visual y se evaluó la presencia de recurrencia.RESULTADOS:El procedimiento de mucopexia transanal con sutura se realizó en 5634 pacientes con hemorroides sintomáticas. Se informó un dolor sordo compatible con una puntuación analógica visual de 2-3 en 126 (2.2%) pacientes; en los 5508 (97.8%) pacientes restantes, la puntuación analógica visual fue de 1-2. La mayoría (5541 pacientes [98.65%]) tuvo un tratamiento eficaz sin complicaciones. Se registró una tasa de recurrencia del 1.3% en 5634 casos con un seguimiento medio de 7 ± 6 años.LIMITACIONES:La utilización de un proctoscopio autoiluminado o de Brinckerhoff o espéculo anal es esencial.CONCLUSIÓN:La mucopexia transanal con sutura es un procedimiento seguro diseñado con dos filas de suturas asociadas con dolor mínimo y baja tasa de recurrencia con menos complicaciones. Tiene una curva de aprendizaje corta. Consulte Video Resumen en http://links.lww.com/DCR/B841. (Traducción-Dr. Jorge Silva Velazco).

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Figures

FIGURE 1.
FIGURE 1.
Proctoscope and inside view in situ.
FIGURE 2.
FIGURE 2.
Reduction of hemorrhoid enlargement after Trendelenburg position and massage. Right, hemorrhoid engorgement. Left, reduced hemorrhoid.
FIGURE 3.
FIGURE 3.
Pictoral presentation of transanal suture mucopexy.
FIGURE 4.
FIGURE 4.
Two suture lines 2 and 4 cm proximal to dentate line.
FIGURE 5.
FIGURE 5.
Hemorrhoid engorgement before and after transanal suture mucopexy.
FIGURE 6.
FIGURE 6.
Testing vascularity by injection of indocyanine green. Blue arrows show proximal suture line.
See this image and copyright information in PMC

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