講演情報
[JKS1-2]Pocket Dissection as a Minimally Invasive Surgery for Hemorrhoids
*Katsuhisa Ohashi1 (1. OHASHI Clinic, Japan)
【Background】
Hemorrhoidectomy by ligation and excision (LE) provides excellent long-term control but is associated with postoperative pain and delayed bleeding. Since 2005, aluminum potassium sulfate and tannic acid (ALTA) therapy has been widely adopted as a minimally invasive treatment for internal hemorrhoids. However, recurrence and occasional severe complications remain concerns. To preserve curability while minimizing ALTA use, we perform Pocket Dissection (PD).
【Surgical Technique】
PD is based on three essential steps: division of the lateral connections, division of the ligament of Treitz, and wide posterior dissection under the hemorrhoid while preserving the internal hemorrhoidal mucosa. This permits en bloc ligation and excision without any incision of internal hemorrhoidal mucosa. ALTA is selectively injected only into residual internal hemorrhoids that cannot be adequately treated by PD.
【Results】
Following its introduction in 2019, PD significantly reduced both the frequency of combination therapy with ALTA and the amount of ALTA used, without increasing recurrence or major complications. We evaluated 319 consecutive patients treated over a recent two-year period. The ALTA combination rate was 22.3%. Three patients developed Clavien–Dindo grade III complications, all of which were anal fistulas requiring surgery. No patient required surgical hemostasis for postoperative bleeding. Postoperative pain peaked on postoperative day 1 (median NRS, 2) and improved steadily thereafter. Both the Fecal Incontinence Severity Index (FISI) and Constipation Scoring System (CSS) improved significantly after surgery.
【Conclusions】
Pocket Dissection reduced dependence on ALTA, with acceptable postoperative pain, few major complications, and no clinically significant postoperative bleeding requiring surgical intervention. Pocket Dissection may represent a practical minimally invasive surgical option for a broad spectrum of hemorrhoidal disease.
Hemorrhoidectomy by ligation and excision (LE) provides excellent long-term control but is associated with postoperative pain and delayed bleeding. Since 2005, aluminum potassium sulfate and tannic acid (ALTA) therapy has been widely adopted as a minimally invasive treatment for internal hemorrhoids. However, recurrence and occasional severe complications remain concerns. To preserve curability while minimizing ALTA use, we perform Pocket Dissection (PD).
【Surgical Technique】
PD is based on three essential steps: division of the lateral connections, division of the ligament of Treitz, and wide posterior dissection under the hemorrhoid while preserving the internal hemorrhoidal mucosa. This permits en bloc ligation and excision without any incision of internal hemorrhoidal mucosa. ALTA is selectively injected only into residual internal hemorrhoids that cannot be adequately treated by PD.
【Results】
Following its introduction in 2019, PD significantly reduced both the frequency of combination therapy with ALTA and the amount of ALTA used, without increasing recurrence or major complications. We evaluated 319 consecutive patients treated over a recent two-year period. The ALTA combination rate was 22.3%. Three patients developed Clavien–Dindo grade III complications, all of which were anal fistulas requiring surgery. No patient required surgical hemostasis for postoperative bleeding. Postoperative pain peaked on postoperative day 1 (median NRS, 2) and improved steadily thereafter. Both the Fecal Incontinence Severity Index (FISI) and Constipation Scoring System (CSS) improved significantly after surgery.
【Conclusions】
Pocket Dissection reduced dependence on ALTA, with acceptable postoperative pain, few major complications, and no clinically significant postoperative bleeding requiring surgical intervention. Pocket Dissection may represent a practical minimally invasive surgical option for a broad spectrum of hemorrhoidal disease.