Hemoroidal Hastalık ve Longo Prosedürü
Özet
Hemoroidal hastalık (HH), anal yastıkların patolojik olarak genişleyip kanla dolması sonucu ortaya çıkar ve hastalarda belirgin rahatsızlıklara yol açar. Hemoroidler; iç, dış ve karma tip olmak üzere sınıflandırılır. İleri yaş, kronik kabızlık, gebelik, yetersiz lif tüketimi ve yanlış dışkılama alışkanlıkları hemoroidal hastalığın etiyolojisinde önemli rol oynar. Klinik olarak en yaygın belirtiler arasında ağrısız rektal kanama, perianal kaşıntı ve şişlik yer alırken, ileri vakalarda prolapsus ve defekasyon sırasında rahatsızlık görülebilir.
Tanı sürecinde, fiziksel muayene, anoskopi ve kolonoskopi gibi yöntemler kullanılarak benzer belirtilere sahip maligniteler ve inflamatuar bağırsak hastalıkları gibi diğer anorektal patolojiler ekarte edilir. Tedavi, hastalığın ciddiyetine göre şekillenir ve diyet değişiklikleri, farmakolojik ajanlar ile cerrahi girişimler arasında değişir. Cerrahi yöntemler arasında 1997’de geliştirilen Longo prosedürü dikkat çeker. Bu yöntem, prolabe dokuyu sirküler stapler aracılığıyla anatomik pozisyonuna döndürür ve dış yara oluşumunu önler. Longo prosedürünün avantajları arasında daha az postoperatif ağrı, hızlı iyileşme ve düşük kanama riski bulunur. Ancak, geleneksel hemoroidektomi yöntemlerine kıyasla nüks oranı ve pelvik sepsis gibi komplikasyon riskleri daha yüksektir.
Tüm dezavantajlarına rağmen Longo prosedürü, ileri düzey hemoroidal hastalık vakalarının tedavisinde etkili ve minimal invaziv bir seçenek sunar. Kısa iyileşme süresi ve ameliyat sonrası konforu artırması, bu yöntemi geleneksel cerrahi tekniklere kıyasla tercih edilir hâle getirmektedir.
Hemorrhoidal disease (HD) arises from the pathological enlargement and engorgement of anal cushions with blood, leading to significant discomfort. It is categorized into internal, external, and mixed types. Contributing factors include advanced age, chronic constipation, pregnancy, poor dietary habits, and inadequate defecation practices. The primary clinical manifestations involve painless rectal bleeding, pruritus, and perianal swelling, with severe cases presenting with prolapse and discomfort during defecation.
The diagnostic process encompasses a thorough physical examination, anoscopy, and colonoscopy to exclude differential diagnoses such as malignancies and inflammatory bowel diseases. Treatment modalities vary according to the severity of the condition, ranging from lifestyle and dietary modifications to pharmacological interventions and surgical techniques. Among surgical interventions, the Longo procedure, introduced in 1997, has gained prominence. This technique utilizes a circular stapler to reposition prolapsed tissue and restore anatomical continuity without external incisions. The Longo method is associated with several advantages, including reduced postoperative pain, expedited recovery, and minimal bleeding. However, it also carries a higher recurrence rate and the potential for complications, such as pelvic sepsis, compared to conventional hemorrhoidectomy.
Despite these limitations, the Longo procedure remains a valuable, minimally invasive option for the management of advanced cases. It offers improved patient outcomes by minimizing recovery time and enhancing postoperative comfort, thereby establishing itself as a favorable alternative to traditional surgical approaches.
Referanslar
Gallo G, Sturiale JMA, Milito GCG, Cocorullo FMG. Consensus statement of the Italian society of colorectal surgery ( SICCR ): management and treatment of hemorrhoidal disease. 2020;145–64.
Lohsiriwat V. Hemorrhoids : From basic pathophysiology to clinical management. 2017;18(17):2009–17.
Kaidar-person O, Person B, Wexner SD, Ed F. Hemorrhoidal Disease : A Comprehensive Review. 2007;102–17. .
Chong PS. Hemorrhoids a nd Fissure in Ano. 2008;37:627–44.
Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, et al. The prevalence of hemorrhoids in adults. 2012;215–20.
Corman ML. Hemorrhoids. In-Corman ML (Ed). Colon and rectal surgery. 8 th edition. Lipincott Raven Co.Philadelphia-New York, 2013;272-45. .
Margetis, Nikolaos. "Pathophysiology of internal hemorrhoids." Annals of gastroenterology 32.3 (2019): 264.
Mott T, Pensacola NH. Hemorrhoids : Diagnosis and Treatment Options. 2018;(February). .
Jacobs D. Hemorrhoids. 2014;944–51. .
Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009-2017 [PMID: 22563187 DOI: 10.3748/wjg.v18.i17.2009].
Goligher JC, Duthie HL, Nixon HH Surg anus, rectum colon, 5th edn Baillière Tindall, London, pp 98–149. .
Mott, T., Latimer, K., & Edwards, C. (2018). Hemorrhoids: Diagnosis and Treatment Options. American family physician, 97(3), 172–179.
Guttenplan M. (2017). The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist. Current gastroenterology reports, 19(7), 30. https://doi.org/10.1007/s11894-017-0574-9.
Jacobs D. (2014). Clinical practice. Hemorrhoids. The New England journal of medicine, 371(10), 944–951. https://doi.org/10.1056/NEJMcp1204188.
Herold A. (2020). Differenzialdiagnose des Hämorrhoidalleidens [Differential diagnosis of hemorrhoidal disease]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 71(4), 269–274. https://doi.org/10.1007/s00105-020-04553-y.
Percalli, L., Passalia, L., Pricolo, R., & Riccò, M. (2019). Pre-operative assessment of internal mucosal rectal prolapse in internal hemorrhoids: technical details and results from a single institution. Acta bio-medica : Atenei Parmensis, 90(2), 308–315.
Panarese A, Pironi D, Vendettuoli M, Pontone S, Arcieri S, Conversi A, et al. Stapled and conventional Milligan-Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis 2011; 27(4): 483-487.
Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM. Haemorrhoidectomy with Ligasure™ vsconventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 2010; 12(2): 85-93. .
Allegra, G., Particular experience with mechanical sutures: Circular stapler for hemorrhoidectomy, GIORN Chir. 1990; 11(3): 95-97.
Puia, I. C., Puia, A., Florea, M. L., Cristea, P. G., Stanca, M., Fetti, A., & Moiş, E. (2021). Stapled Hemorrhoidopexy: Technique and Long Term Results. Chirurgia (Bucharest, Romania : 1990), 116(1), 102–108. https://doi.org/10.21614/chirurgia.116.1.102.
Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Sixth World Congress of Endoscopic Surgery, Rome, Italy. Bologna: Monduzzi Publishing Co., 1998; 777-84.
Chen, J. S., & You, J. F. (2010). Current status of surgical treatment for hemorrhoids--systematic review and meta-analysis. Chang Gung medical journal, 33(5), 488–500.
Ascanelli S, Gregorio C, Tonini G, Baccarini M, Azzena G. Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial]. Chir Ital. 2005 Jul-Aug;57(4):439-47.).
Taviloğlu, Prof. Dr. Korhan. Kolorektal Hastalıklar ve Proktoloji: Güncel tanı ve tedavi . İstanbul : cinius yayınları, 2016. sayfa 349.
Lumb KJ, Colquhoun PH, Malthaner RA, Jayaraman S. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006 Oct 18;2006(4):CD005393.
Gravié JF, Lehur PA, et all. Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg. 2005 Jul;242(1):29-35.
Guttenplan M. (2017). The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist. Current gastroenterology reports, 19(7), 30. https://doi.org/10.1007/s11894-017-0574-9.
Referanslar
Gallo G, Sturiale JMA, Milito GCG, Cocorullo FMG. Consensus statement of the Italian society of colorectal surgery ( SICCR ): management and treatment of hemorrhoidal disease. 2020;145–64.
Lohsiriwat V. Hemorrhoids : From basic pathophysiology to clinical management. 2017;18(17):2009–17.
Kaidar-person O, Person B, Wexner SD, Ed F. Hemorrhoidal Disease : A Comprehensive Review. 2007;102–17. .
Chong PS. Hemorrhoids a nd Fissure in Ano. 2008;37:627–44.
Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, et al. The prevalence of hemorrhoids in adults. 2012;215–20.
Corman ML. Hemorrhoids. In-Corman ML (Ed). Colon and rectal surgery. 8 th edition. Lipincott Raven Co.Philadelphia-New York, 2013;272-45. .
Margetis, Nikolaos. "Pathophysiology of internal hemorrhoids." Annals of gastroenterology 32.3 (2019): 264.
Mott T, Pensacola NH. Hemorrhoids : Diagnosis and Treatment Options. 2018;(February). .
Jacobs D. Hemorrhoids. 2014;944–51. .
Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18(17): 2009-2017 [PMID: 22563187 DOI: 10.3748/wjg.v18.i17.2009].
Goligher JC, Duthie HL, Nixon HH Surg anus, rectum colon, 5th edn Baillière Tindall, London, pp 98–149. .
Mott, T., Latimer, K., & Edwards, C. (2018). Hemorrhoids: Diagnosis and Treatment Options. American family physician, 97(3), 172–179.
Guttenplan M. (2017). The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist. Current gastroenterology reports, 19(7), 30. https://doi.org/10.1007/s11894-017-0574-9.
Jacobs D. (2014). Clinical practice. Hemorrhoids. The New England journal of medicine, 371(10), 944–951. https://doi.org/10.1056/NEJMcp1204188.
Herold A. (2020). Differenzialdiagnose des Hämorrhoidalleidens [Differential diagnosis of hemorrhoidal disease]. Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete, 71(4), 269–274. https://doi.org/10.1007/s00105-020-04553-y.
Percalli, L., Passalia, L., Pricolo, R., & Riccò, M. (2019). Pre-operative assessment of internal mucosal rectal prolapse in internal hemorrhoids: technical details and results from a single institution. Acta bio-medica : Atenei Parmensis, 90(2), 308–315.
Panarese A, Pironi D, Vendettuoli M, Pontone S, Arcieri S, Conversi A, et al. Stapled and conventional Milligan-Morgan haemorrhoidectomy: different solutions for different targets. Int J Colorectal Dis 2011; 27(4): 483-487.
Milito G, Cadeddu F, Muzi MG, Nigro C, Farinon AM. Haemorrhoidectomy with Ligasure™ vsconventional excisional techniques: meta-analysis of randomized controlled trials. Colorectal Dis 2010; 12(2): 85-93. .
Allegra, G., Particular experience with mechanical sutures: Circular stapler for hemorrhoidectomy, GIORN Chir. 1990; 11(3): 95-97.
Puia, I. C., Puia, A., Florea, M. L., Cristea, P. G., Stanca, M., Fetti, A., & Moiş, E. (2021). Stapled Hemorrhoidopexy: Technique and Long Term Results. Chirurgia (Bucharest, Romania : 1990), 116(1), 102–108. https://doi.org/10.21614/chirurgia.116.1.102.
Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Sixth World Congress of Endoscopic Surgery, Rome, Italy. Bologna: Monduzzi Publishing Co., 1998; 777-84.
Chen, J. S., & You, J. F. (2010). Current status of surgical treatment for hemorrhoids--systematic review and meta-analysis. Chang Gung medical journal, 33(5), 488–500.
Ascanelli S, Gregorio C, Tonini G, Baccarini M, Azzena G. Long stapled haemorrhoidectomy versus Milligan-Morgan procedure: short- and long-term results of a randomised, controlled, prospective trial]. Chir Ital. 2005 Jul-Aug;57(4):439-47.).
Taviloğlu, Prof. Dr. Korhan. Kolorektal Hastalıklar ve Proktoloji: Güncel tanı ve tedavi . İstanbul : cinius yayınları, 2016. sayfa 349.
Lumb KJ, Colquhoun PH, Malthaner RA, Jayaraman S. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006 Oct 18;2006(4):CD005393.
Gravié JF, Lehur PA, et all. Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg. 2005 Jul;242(1):29-35.
Guttenplan M. (2017). The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist. Current gastroenterology reports, 19(7), 30. https://doi.org/10.1007/s11894-017-0574-9.
