RESUMEN
Objective: To compare the application effects of tissue-selecting therapy stapler (TST), procedure for prolapse and hemorrhoids (PPH), and Ruiyun procedure for hemorrhoids (RPH) in the treatment of mixed hemorrhoids, specifically focusing on primary outcomes such as recovery time, pain levels, and quality of life. Methods: Based on the presence of mixed hemorrhoids,120 patients were admitted to the general surgery department of the hospital from January 2019 to December 2022 were selected and randomly divided into three groups, with 40 cases in each group. The parameters like VAS, ARP, SAP, and HF-QoL scores were chosen to comprehensively assess pain, anal function, and overall quality of life. Group A was treated with TST, group B was treated with PPH, and group C was treated with RPH. The parameters related to surgical treatment and rehabilitation, pain levels [Visual Analog Scale (VAS)] at different times, preoperative and postoperative anal dynamic function [anal rest pressure (ARP), squeeze anal pressure (SAP), and duration of contraction], anal function and quality of life were compared among the three groups. The incidence rates of complications that occurred within 1 month after surgery and postoperative recurrence rate were calculated. Results: There were significant differences in intraoperative blood loss, surgical time, length of hospital stay, and wound healing time among the three groups (TST, PPH, and RPH) (P < .05). There were statistically significant differences in VAS scores among the three groups (TST, PPH, and RPH) on the 1st and 2nd day after surgery (P < .05). The scores increased in sequence from group C, group A to group B. There was no statistically significant difference among the three groups (TST, PPH, and RPH) in terms of ARP, SAP, and duration of contraction before and after treatment, and Wexner scores at different time points after surgery (P > .05). There were statistically significant differences in HF-QoL scores among the three groups (TST, PPH, and RPH) at 1 month and 3 months after surgery (P < .05). One month after surgery, the HF-QoL score of group C was lower than those of groups A and B (P < .05). Three months after surgery, the HF-QoL scores increased in sequence from group C, group A to group B (P < .05). There were statistically significant differences in the incidence rates of urinary retention and anal stenosis among the three groups (TST, PPH, and RPH) (P < .05). The incidence rates of urinary retention and anal stenosis in group B were much higher than those in group B, group A and group C (P < .05). Conclusion: RPH not only shows superiority in treating mixed hemorrhoids in terms of intraoperative blood loss, surgical time, postoperative pain, and quality of life, but also holds promise for enhancing clinical practices with potentially shorter hospital stays and improved patient outcomes.
RESUMEN
Background. The Mirizzi syndrome (MS) is a rare complication of cholecystolithiasis that is often accompanied by severe inflammation and fibrosis around Calot's triangle. It is difficult to treat Type 2 MS surgically, and the treatment for this condition has not yet been standardized. The data on operative management are limited. The study aimed to review our institutional clinical experience regarding surgery and provide recommendations for treating Type 2 MS. Methods: We conducted a retrospective study on 6 patients with MS who were surgically treated at our institution between January 2010 and December 2019. The classification of MS by McSherry CK, Ferstenberg H, Virshup M. The Mirizzi syndrome: Suggested classification and surgical therapy. Surg Gastroenterol. 1982;1:219-225 was used. Mucosal approach was used to treat Type 2 MS. The parameters for comparison included patient demographics, operative procedures, operation time, blood loss, length of hospital stay, complications, and follow-up. Results: There were 23 patients with MS among 10 386 cholecystectomies in our area. Six patients with Type 2 MS had successful surgery, and the mucosal approach was used. The average operative time was 253.3 ± 32.5 minutes. The average blood loss was 70.0 ± 14.1 mL. The mean postoperative hospital stay was 9.5 ± 3.9 days. There was no postoperative mortality. The most frequent postoperative complications were bile leakage (16.7%), and postoperative intra-abdominal collection (16.7%). The mean postoperative follow-up was 10 months, and all patients are asymptomatic. The mucosal approach may decrease the risk of bile duct injury, biliary tract infection, and blood loss more than other surgical approaches. Conclusion: This study demonstrates that the mucosal approach is an effective surgical procedure for Type 2 MS.