Circular mucosal anopexy: Experience and technical considerations

Area of Science:

• Colorectal Surgery
• Surgical Innovation
• Patient Outcomes

Background:

• Circular mucosal anopexy (CMA) is a surgical technique for hemorrhoids and rectal mucosal prolapse (RMP).
• While offering a more comfortable postoperative period than resective techniques, CMA is associated with notable recurrence and complication rates.
• This study evaluates the efficacy of CMA in treating hemorrhoids and RMP.

Purpose of the Study:

• To assess the effectiveness of Circular Mucosal Anopexy (CMA) for hemorrhoids and rectal mucosal prolapse (RMP).
• To compare recurrence rates and postoperative outcomes of CMA.
• To evaluate the safety and efficacy of CMA in major ambulatory surgery (MAS) settings.

Main Methods:

• A retrospective analysis of 613 patients undergoing surgery for hemorrhoids or RMP between 1999 and 2011.
• CMA was performed on 327 patients, with data on hemorrhoidal grades, recurrence, postoperative pain (Visual Analogical Scale - VAS), and early complications collected.
• Comparison between recurrent and non-recurrent groups was conducted, with 79.9% of procedures performed as major ambulatory surgery (MAS).

Main Results:

• 31 patients (9.5%) required reoperation, with higher rates in advanced hemorrhoidal grades.
• No significant differences in recurrence were found based on gender, surgical time, or hemorrhoidal grade, but age was a factor.
• 81.3% of patients reported low postoperative pain (VAS ≤ 2) at one week; early complications included bleeding (5 patients) and pain requiring admission (6 patients).

Conclusions:

• Circular mucosal anopexy (CMA) demonstrates a higher recurrence rate compared to resective techniques for hemorrhoids.
• CMA is a viable and effective treatment option for hemorrhoids within the context of major ambulatory surgery (MAS).
• The technique is associated with low rates of postoperative pain and early complications.