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A Training and Testing System for Performing Vascular Reconstruction In Vitro
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Vascular considerations for stapled haemorrhoidopexy.

F Aigner1, H Bonatti, S Peer

  • 1Department of Visceral, Transplant and Thoracic Surgery, Center for Operative Medicine, Innsbruck Medical University, Austria. felix.aigner@i-med.ac.at

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PubMed
Summary

Stapled haemorrhoidopexy does not alter arterial inflow to hemorrhoids. Preoperative ultrasound can assess vascularization, guiding treatment choices for hemorrhoidal disease.

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Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Medical Imaging

Background:

  • Hemorrhoidectomy techniques aim to reduce arterial supply to enlarged hemorrhoidal tissue.
  • Stapled hemorrhoidopexy (SH) is a common procedure for hemorrhoidal disease.

Purpose of the Study:

  • To investigate morphological and physiological changes in the superior rectal artery (SRA) branches after SH.
  • To assess the effectiveness of SH in reducing arterial inflow to hemorrhoidal vascular plexuses.

Main Methods:

  • Transperineal color Doppler ultrasound was used to measure calibre and arterial flow velocity (AFV) of SRA branches.
  • 37 patients with grade III hemorrhoids undergoing SH and 17 healthy controls were studied.
  • Measurements were taken preoperatively, and at 4 weeks and 3 months postoperatively.

Main Results:

  • Patients with hemorrhoidal disease showed significantly larger SRA branch calibre and higher AFV compared to controls.
  • SH did not lead to significant postoperative alterations in SRA branch calibre or AFV.
  • Higher baseline AFV in patients correlated with a greater recurrence rate of hemorrhoidal disease.

Conclusions:

  • SH does not reduce arterial inflow in the feeding vessels of the anorectal vascular plexus.
  • Preoperative ultrasound assessment of vascularization may help in selecting the optimal treatment for hemorrhoidal disease.
  • High preoperative AFV might indicate that conventional hemorrhoidectomy could be a more suitable option than SH.