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Published in: World Journal of Surgery 2/2010

01-02-2010

Residual Skin Tags Following Procedure for Prolapse and Hemorrhoids: Differentiation from Recurrence

Authors: Xian Hua Gao, Chuan Gang Fu, Paul Fallah-wandalachi Nabieu

Published in: World Journal of Surgery | Issue 2/2010

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Abstract

Purpose

The aim of this study was to compare the incidence of recurrence and residual skin tag after the procedure for prolapse and hemorrhoids (PPH) versus conventional hemorrhoidectomy (CH) in the Chinese- and English-language literature to explore the definition of recurrence after PPH.

Methods

Related Chinese- and English-language literature was collected by several methods. Meta-analysis was used to compare the incidence of recurrence and residual skin tag of PPH versus CH.

Results

In China, 13.94% of hemorrhoids had a skin tag after PPH. The mean recurrence rate after PPH was 3.23% (range 0.40–26.44%). Our meta-analysis of PPH versus CH of the Chinese studies showed that PPH had a significantly lower recurrence rate—13 studies, odds ratio (OR) 0.27, 95% confidence interval (CI) 0.17–0.42, p < 0.00001—and a higher incidence of skin tags with no significance—6 studies, OR 3.42, 95% CI 0.49–24.04, p = 0.22. Our meta-analysis of PPH versus CH among the English-language studies showed that PPH had a significantly higher recurrence rate—17 studies, 636 patients in the PPH group vs. 625 patients in the CH group, OR 2.96, 95% CI 1.57–5.56, p = 0.0008—and a significantly higher incidence of residual skin tags—8 studies, 297 patients in the PPH group vs. 289 patients in the CH group, OR 1.88, 95% CI 1.15–3.05, p = 0.01. However, the recurrence of prolapse was stated to be ascertained by anorectal examination in only six studies; meta-analysis of the six studies showed that PPH was not associated with a higher recurrence—six studies, 230 patients in the PPH group vs. 220 patients in the CH group; OR 1.87, 95% CI 0.70–5.00, p = 0.22.

Conclusions

PPH is not associated with a higher recurrence rate but is associated with a higher incidence of skin tags compared with CH. The reported high recurrence rates are probably caused by improper inclusion of residual skin tags into the recurrence data. Surgeons should perform anorectal examinations to differentiate a residual skin tag from a recurrence.
Literature
1.
go back to reference Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50:878–892CrossRefPubMed Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50:878–892CrossRefPubMed
2.
go back to reference Gravie JF, Lehur PA, Huten N et al (2005) Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35CrossRefPubMed Gravie JF, Lehur PA, Huten N et al (2005) Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35CrossRefPubMed
3.
go back to reference Ortiz H, Marzo J, Armendariz P et al (2005) Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 48:809–815CrossRefPubMed Ortiz H, Marzo J, Armendariz P et al (2005) Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 48:809–815CrossRefPubMed
4.
go back to reference Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305CrossRefPubMed Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305CrossRefPubMed
5.
go back to reference Burch J, Epstein D, Baba-Akbari A, et al (2008) Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation. Health Technol Assess 12:iii–iv, ix–x, 1–193 Burch J, Epstein D, Baba-Akbari A, et al (2008) Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: a systematic review and economic evaluation. Health Technol Assess 12:iii–iv, ix–x, 1–193
6.
go back to reference Ascanelli S, Gregorio C, Tonini G et al (2005) Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial. Chir Ital 57:439–447PubMed Ascanelli S, Gregorio C, Tonini G et al (2005) Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial. Chir Ital 57:439–447PubMed
7.
go back to reference Correa-Rovelo JM, Tellez O, Obregon L et al (2002) Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial. Dis Colon Rectum 45:1367–1374 discussion 1374–1365CrossRefPubMed Correa-Rovelo JM, Tellez O, Obregon L et al (2002) Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial. Dis Colon Rectum 45:1367–1374 discussion 1374–1365CrossRefPubMed
8.
go back to reference Nisar PJ, Acheson AG, Neal KR et al (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 47:1837–1845CrossRefPubMed Nisar PJ, Acheson AG, Neal KR et al (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 47:1837–1845CrossRefPubMed
9.
go back to reference Lan P, Wu X, Zhou X et al (2006) The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis 21:172–178CrossRefPubMed Lan P, Wu X, Zhou X et al (2006) The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. Int J Colorectal Dis 21:172–178CrossRefPubMed
10.
go back to reference Fueglistaler P, Guenin MO, Montali I et al (2007) Long-term results after stapled hemorrhoidopexy: high patient satisfaction despite frequent postoperative symptoms. Dis Colon Rectum 50:204–212CrossRefPubMed Fueglistaler P, Guenin MO, Montali I et al (2007) Long-term results after stapled hemorrhoidopexy: high patient satisfaction despite frequent postoperative symptoms. Dis Colon Rectum 50:204–212CrossRefPubMed
11.
go back to reference Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19CrossRefPubMed Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19CrossRefPubMed
12.
go back to reference Boccasanta P, Capretti PG, Venturi M et al (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182:64–68CrossRefPubMed Boccasanta P, Capretti PG, Venturi M et al (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182:64–68CrossRefPubMed
13.
go back to reference Smyth EF, Baker RP, Wilken BJ et al (2003) Stapled versus excision haemorrhoidectomy: long-term follow up of a randomised controlled trial. Lancet 361:1437–1438CrossRefPubMed Smyth EF, Baker RP, Wilken BJ et al (2003) Stapled versus excision haemorrhoidectomy: long-term follow up of a randomised controlled trial. Lancet 361:1437–1438CrossRefPubMed
14.
go back to reference Pavlidis T, Papaziogas B, Souparis A et al (2002) Modern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis 17:50–53CrossRefPubMed Pavlidis T, Papaziogas B, Souparis A et al (2002) Modern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis 17:50–53CrossRefPubMed
15.
go back to reference Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 89:1376–1381CrossRefPubMed Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 89:1376–1381CrossRefPubMed
16.
go back to reference Ganio E, Altomare DF, Milito G et al (2007) Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. Br J Surg 94:1033–1037CrossRefPubMed Ganio E, Altomare DF, Milito G et al (2007) Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. Br J Surg 94:1033–1037CrossRefPubMed
17.
go back to reference Hetzer FH, Demartines N, Handschin AE et al (2002) Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg 137:337–340CrossRefPubMed Hetzer FH, Demartines N, Handschin AE et al (2002) Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg 137:337–340CrossRefPubMed
18.
go back to reference Rowsell M, Bello M, Hemingway DM (2000) Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 355:779–781CrossRefPubMed Rowsell M, Bello M, Hemingway DM (2000) Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 355:779–781CrossRefPubMed
19.
go back to reference Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355:782–785CrossRefPubMed Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355:782–785CrossRefPubMed
20.
go back to reference Cheetham MJ, Cohen CR, Kamm MA et al (2003) A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 46:491–497CrossRefPubMed Cheetham MJ, Cohen CR, Kamm MA et al (2003) A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 46:491–497CrossRefPubMed
21.
go back to reference Racalbuto A, Aliotta I, Corsaro G et al (2004) Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial. Int J Colorectal Dis 19:239–244CrossRefPubMed Racalbuto A, Aliotta I, Corsaro G et al (2004) Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial. Int J Colorectal Dis 19:239–244CrossRefPubMed
22.
go back to reference Basdanis G, Papadopoulos VN, Michalopoulos A et al (2005) Randomized clinical trial of stapled hemorrhoidectomy vs open with Ligasure for prolapsed piles. Surg Endosc 19:235–239CrossRefPubMed Basdanis G, Papadopoulos VN, Michalopoulos A et al (2005) Randomized clinical trial of stapled hemorrhoidectomy vs open with Ligasure for prolapsed piles. Surg Endosc 19:235–239CrossRefPubMed
23.
go back to reference Bikhchandani J, Agarwal PN, Kant R et al (2005) Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg 189:56–60CrossRefPubMed Bikhchandani J, Agarwal PN, Kant R et al (2005) Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg 189:56–60CrossRefPubMed
24.
go back to reference Chung CC, Cheung HY, Chan ES et al (2005) Stapled hemorrhoidopexy vs. Harmonic Scalpel hemorrhoidectomy: a randomized trial. Dis Colon Rectum 48:1213–1219CrossRefPubMed Chung CC, Cheung HY, Chan ES et al (2005) Stapled hemorrhoidopexy vs. Harmonic Scalpel hemorrhoidectomy: a randomized trial. Dis Colon Rectum 48:1213–1219CrossRefPubMed
25.
go back to reference Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg 88:1049–1053CrossRefPubMed Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy. Br J Surg 88:1049–1053CrossRefPubMed
26.
go back to reference Kairaluoma M, Nuorva K, Kellokumpu I (2003) Day-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 46:93–99CrossRefPubMed Kairaluoma M, Nuorva K, Kellokumpu I (2003) Day-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 46:93–99CrossRefPubMed
27.
go back to reference Leventoglu S, Mentes BB, Akin M et al (2008) Haemorrhoidectomy with electrocautery or ultrashears and stapled haemorrhoidopexy. ANZ J Surg 78:389–393CrossRefPubMed Leventoglu S, Mentes BB, Akin M et al (2008) Haemorrhoidectomy with electrocautery or ultrashears and stapled haemorrhoidopexy. ANZ J Surg 78:389–393CrossRefPubMed
28.
go back to reference Zmora O, Colquhoun P, Abramson S et al (2004) Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model. Surg Endosc 18:757–761CrossRefPubMed Zmora O, Colquhoun P, Abramson S et al (2004) Can the procedure for prolapsing hemorrhoids (PPH) be done twice? Results of a porcine model. Surg Endosc 18:757–761CrossRefPubMed
29.
go back to reference Boccasanta P, Venturi M, Roviaro G (2007) Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse: a randomized controlled trial. Int J Colorectal Dis 22:245–251CrossRefPubMed Boccasanta P, Venturi M, Roviaro G (2007) Stapled transanal rectal resection versus stapled anopexy in the cure of hemorrhoids associated with rectal prolapse: a randomized controlled trial. Int J Colorectal Dis 22:245–251CrossRefPubMed
30.
go back to reference Lau PY, Meng WC, Yip AW (2004) Stapled haemorrhoidectomy in Chinese patients: a prospective randomised control study. Hong Kong Med J 10:373–377PubMed Lau PY, Meng WC, Yip AW (2004) Stapled haemorrhoidectomy in Chinese patients: a prospective randomised control study. Hong Kong Med J 10:373–377PubMed
31.
go back to reference Jongen J, Bock JU, Peleikis HG et al (2006) Complications and reoperations in stapled anopexy: learning by doing. Int J Colorectal Dis 21:166–171CrossRefPubMed Jongen J, Bock JU, Peleikis HG et al (2006) Complications and reoperations in stapled anopexy: learning by doing. Int J Colorectal Dis 21:166–171CrossRefPubMed
32.
go back to reference Wexner SD (2001) The quest for painless surgical treatment of hemorrhoids continues. J Am Coll Surg 193:174–178CrossRefPubMed Wexner SD (2001) The quest for painless surgical treatment of hemorrhoids continues. J Am Coll Surg 193:174–178CrossRefPubMed
33.
go back to reference Gerjy R, Nystrom PO (2007) Excision of residual skin tags during stapled anopexy does not increase postoperative pain. Colorectal Dis 9:754–757CrossRefPubMed Gerjy R, Nystrom PO (2007) Excision of residual skin tags during stapled anopexy does not increase postoperative pain. Colorectal Dis 9:754–757CrossRefPubMed
34.
go back to reference Gerjy R, Derwinger K, Nystrom PO (2006) Perianal local block for stapled anopexy. Dis Colon Rectum 49:1914–1921CrossRefPubMed Gerjy R, Derwinger K, Nystrom PO (2006) Perianal local block for stapled anopexy. Dis Colon Rectum 49:1914–1921CrossRefPubMed
35.
go back to reference Martinsons A, Narbuts Z, Brunenieks I et al (2007) A comparison of quality of life and postoperative results from combined PPH and conventional haemorrhoidectomy in different cases of haemorrhoidal disease. Colorectal Dis 9:423–429CrossRefPubMed Martinsons A, Narbuts Z, Brunenieks I et al (2007) A comparison of quality of life and postoperative results from combined PPH and conventional haemorrhoidectomy in different cases of haemorrhoidal disease. Colorectal Dis 9:423–429CrossRefPubMed
36.
go back to reference Liao XJ, Meng Q, Yang GG et al (2008) Efficacy of the procedure for prolapse and hemorrhoids combined with external hemorrhoids excision in the treatment of III or IV mixed hemorrhoids. Zhonghua Wei Chang Wai Ke Za Zhi 11:525–528PubMed Liao XJ, Meng Q, Yang GG et al (2008) Efficacy of the procedure for prolapse and hemorrhoids combined with external hemorrhoids excision in the treatment of III or IV mixed hemorrhoids. Zhonghua Wei Chang Wai Ke Za Zhi 11:525–528PubMed
37.
go back to reference Koh PK, Seow-Choen F (2005) Mucosal flap excision for treatment of remnant prolapsed hemorrhoids or skin tags after stapled hemorrhoidopexy. Dis Colon Rectum 48:1660–1662CrossRefPubMed Koh PK, Seow-Choen F (2005) Mucosal flap excision for treatment of remnant prolapsed hemorrhoids or skin tags after stapled hemorrhoidopexy. Dis Colon Rectum 48:1660–1662CrossRefPubMed
Metadata
Title
Residual Skin Tags Following Procedure for Prolapse and Hemorrhoids: Differentiation from Recurrence
Authors
Xian Hua Gao
Chuan Gang Fu
Paul Fallah-wandalachi Nabieu
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 2/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0295-9

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