Operative Verfahrenswahl beim fortgeschrittenen Hämorrhoidalleiden – worauf kommt es an?

Zusammenfassung

Das Hämorrhoidalleiden betrifft ca. 2 – 3 Mio. Patienten pro Jahr in Deutschland. Als fortgeschrittenes Hämorrhoidalleiden werden die Hämorrhoiden angenommen, die operiert werden sollten. In Deutschland erfolgen ca.50 000 Operationen/Jahr aufgrund von Hämorrhoiden. Die passgenaue Operation für den einzelnen Patienten erfolgt nach eingehender proktologischer Untersuchung, hierfür stehen einige z. T. sehr unterschiedliche Techniken zur Verfügung. Es werden die verschiedenen Verfahren dargestellt und wo sinnvoll schematisch erläutert, um diese anschließend kritisch zu diskutieren. Auch sollen die individuellen Gegebenheiten des einzelnen Patienten wie z. B. eine Antikoagulation beleuchtet werden und in Zeiten der aufkommenden Nachwuchssorgen auch ein Blick auf die Ausbildung dieser Eingriffe geworfen werden.

Abstract

About 2 – 3 million patients suffer from haemorrhoid disease in Germany each year. Advanced haemorrhoid disease is assumed if an operation is planned. In Germany, approximately 50,000 operations per year are performed for haemorrhoids. Individual therapy and surgery are implemented after proctological examination. A wide variety of surgical procedures are available. These techniques will be described and illustrated. Individual comorbidities such as anticoagulation and will be discussed, together with options for teaching these surgical skills – in times of difficult recruitment.

Schlüsselwörter

Hämorrhoiden - Longo - Milligan-Morgan - Fansler-Arnold - HAL - RAR

Key words

hemorrhoids - hemorrhoidopexie - Ferguson

• Literatur

• 1 Joos A, Arnold R, Borschitz T. et al. S3-Leitlinie – Hämorrhoidalleiden. Abschluss-Version vom 01.04.2019. Im Internet: http://www.awmf.org/uploads/tx_szleitlinien/081-007l_S3_Haemorrhoidalleiden_2019-04_1.pdf Stand: 24.06.2019
• 2 Davis BR, Lee-Kong SA, Migaly J. et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum 2018; 61: 284-292 doi:10.1097/DCR.0000000000001030
• 3 Milligan ETC, Morgan CN, Jones LE. et al. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. Lancet 1937; 233: 1119-1124 doi:10.1016/S0140-6736(00)88465-2
• 4 Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum 1959; 2: 176-179 doi:10.1007/BF02616713
• 5 Milone M, Maietta P, Leongito M. et al. Ferguson hemorrhoidectomy: is still the gold standard treatment?. Updates Surg 2012; 64: 191-194 doi:10.1007/s13304-012-0155-2
• 6 Khalil KH, OʼBichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy. Br J Surg 2000; 87: 1352-1355 doi:10.1046/j.1365-2168.2000.01624.x
• 7 Xu L, Chen H, Lin G, Ge Q. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech 2015; 25: 106-110 doi:10.1097/SLE.0000000000000136
• 8 Koblandin SN, Schalkow JL. Eine neue Methode zur Behandlung von Hämorrhoiden mit Hilfe eines Zirkularstaplers. Zelinograd (Kasachstan): Wissenschaftliches Archiv des Zelinograder Medizinischen Institutes; 1981: 27-28
• 9 Longo A. Treatment of Hemorrhoid Disease by Reduction in Mucosal and Haemorrhoidal Products with a Circular Stapling Device – New Procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery. Rome, Italy: Manduzzi; 1998: 777-784
• 10 Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 1995; 90: 610-613
• 11 Liu H, Yang C, Chen B. et al. Clinical outcomes of Doppler-guided haemorrhoidal artery ligation: a meta-analysis. Int J Clin Exp Med 2015; 8: 4932-4939
• 12 Hussein AM. Ligation-anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum 2001; 44: 1887-1890 doi:10.1007/BF02234474
• 13 Fansler WA, Anderson JK. A plastic operation for certain types of hemorrhoids. JAMA 1933; 101: 1064-1065
• 14 Raulf F, Arnold K. Stellenwert der geschlossenen Hämorrhoidektomie. Chir Gastroenterol 1986; 2: 27-32
• 15 Whitehead W. The surgical treatment of haemorrhoids. Br Med J 1882; 1: 148-150 doi:10.1136/bmj.1.1101.148
• 16 Parks AG. Submucous haemorrhoidectomy. Proc R Soc Med 1959; 52 (Suppl.) S89-S91
• 17 Schäfer H, Tolksdorf S, Vivaldi C. Radiofrequenzablation (Rafaelo^®-Prozedur) zur Therapie von prolabierenden Hämorrhoiden III°. coloproctology 2018; 40: 204-210 doi:10.1007/s00053-018-0250-z
• 18 Duben J, Ponížil P, Dudešek B. et al. Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a 10-year experience. Rozhl Chir 2018; 97: 419-422
• 19 Simillis C, Thoukididou SN, Slesser AA. et al. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 2015; 102: 1603-1618 doi:10.1002/bjs.9913
• 20 Maloku H, Gashi Z, Lazovic R. et al. Laser hemorrhoidoplasty procedure vs. open surgical hemorrhoidectomy: a trial comparing 2 treatments for hemorrhoids of third and fourth degree. Acta Inform Med 2014; 22: 365-367 doi:10.5455/aim.2014.22.365-367
• 21 Faes S, Pratsinis M, Hasler-Gehrer S. et al. Short‐ and long‐term outcomes of laser haemorrhoidoplasty for grade II–III haemorrhoidal disease. Colorectal Dis 2019; 21: 689-696 doi:10.1111/codi.14572
• 22 McCloud JM, Jameson JS, Scott AN. Life-threatening sepsis following treatment for haemorrhoids: a systematic review. Colorectal Dis 2006; 8: 748-755 doi:10.1111/j.1463-1318.2006.01028.x
• 23 Asfar S. Anoplasty for post-hemorrhoidectomy low anal stenosis: a new technique. World J Surg 2018; 42: 3015-3020 doi:10.1007/s00268-018-4561-6
• 24 Faucheron JL, Arvin-Berod A, Riboud R. et al. Rectal perforation and peritonitis complicating stapled haemorrhoidopexy. Colorectal Dis 2010; 12: 831-832 doi:10.1111/j.1463-1318.2009.02086.x
• 25 Jongen J, Kahlke V. Response to: rectal perforation and peritonitis complicating haemorrhoidopexy, Faucheron et al. Colorectal Dis 2010; 12: 1272 doi:10.1111/j.1463-1318.2010.02426.x
• 26 Porrett LJ, Porrett JK, Ho YH. Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg 2015; 100: 44-57 doi:10.9738/INTSURG-D-13-00173.1
• 27 Raymond TM, Raman SR, Basnyat PS. First case of rectal inclusion cyst after stapled haemorrhoidopexy (PPH). Colorectal Dis 2008; 10: 733-734 doi:10.1111/j.1463-1318.2008.01504.x
• 28 Jongen J, Pfister K. Response to ‘First case of rectal inclusion cyst after stapled haemorrhoidopexy (PPH)’ (Raymond et al., Colorectal Disease 2008; 10: 733–734). Colorectal Dis 2009; 11: 102-103 doi:10.1111/j.1463-1318.2008.01740.x
• 29 Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 2008; 12: 7-19 doi:10.1007/s10151-008-0391-0
• 30 Petersen S, Jongen J, Schwenk W. Agraffectomy after low rectal stapling procedures for hemorrhoids and rectocele. Tech Coloproctol 2011; 15: 259-264 doi:10.1007/s10151-011-0704-6
• 31 Gallo G, Podzemny V, Pescatori M. Intestinal obstruction requiring fecal diversion due to rectal hematoma following a hemorrhoid laser procedure (HeLP). Tech Coloproctol 2016; 20: 507-508 doi:10.1007/s10151-016-1485-8
• 32 Celentano V, Banerjee A, Luvisetto F. et al. Retained needle following transanal hemorrhoidal dearterialization. Dis Colon Rectum 2017; 60: 1225-1227 doi:10.1097/DCR.0000000000000899
• 33 Greensmith S, Ip B, Vujovic Z. Rectal perforation secondary to transanal haemorrhoidal dearterialisation. Ann R Coll Surg Engl 2017; 99: e154-e155 doi:10.1308/rcsann.2017.0059
• 34 Brown SR, Tiernan JP, Watson AJM. et al. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 2016; 388: 356-364 doi:10.1016/S0140-6736(16)30584-0
• 35 Watson AJ, Hudson J, Wood J. et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet 2016; 388: 2375-2385 doi:10.1016/S0140-6736(16)31803-7
• 36 Du T, Quan S, Dong T. et al. Comparison of surgical procedures implemented in recent years for patients with grade III and IV hemorrhoids: a network meta-analysis. Int J Colorectal Dis 2019; 34: 1001-1012 doi:10.1007/s00384-019-03288-0
• 37 Song Y, Chen H, Yang F. et al. Transanal hemorrhoidal dearterialization versus stapled hemorrhoidectomy in the treatment of hemorrhoids: a PRISMA-compliant updated meta-analysis of randomized control trials. Medicine (Baltimore) 2018; 97: e11502 doi:10.1097/MD.0000000000011502
• 38 Emile SH, Elfeki H, Sakr A. et al. Transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) in treatment of internal hemorrhoids: a systematic review and meta-analysis of randomized clinical trials. Int J Colorectal Dis 2019; 34: 1-11 doi:10.1007/s00384-018-3187-3
• 39 Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (open) versus Ferguson haemorrhoidectomy (closed): a systematic review and meta-analysis of published randomized, controlled trials. World J Surg 2016; 40: 1509-1519 doi:10.1007/s00268-016-3419-z
• 40 Milito G, Cadeddu F, Muzi MG. et al. Haemorrhoidectomy with Ligasure vs. conventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 2010; 12: 85-93 doi:10.1111/j.1463-1318.2009.01807.x
• 41 Xu L, Chen H, Lin G. et al. Ligasure versus Ferguson hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech 2015; 25: 106-110 doi:10.1097/SLE.0000000000000136
• 42 Chen HL, Woo XB, Cui J. et al. Ligasure versus stapled hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Surg Laparosc Endosc Percutan Tech 2014; 24: 285-289 doi:10.1097/SLE.0000000000000009
• 43 Lee KC, Liu CC, Hu WH. et al. Risk of delayed bleeding after hemorrhoidectomy. Int J Colorectal Dis 2019; 34: 247-253 doi:10.1007/s00384-018-3176-6