title: Stapled hemorrhoidopexy for prolapsed hemorrhoids in patients with liver cirrhosis; a preliminary outcome for 8-case experience.
abstract: OBJECTIVE
  To investigate the efficacy and safety of stapled hemorrhoidopexy in treating prolapsed hemorrhoids in patients with liver cirrhosis.
  
  
  METHODS
  Eight consecutive cases of patients with prolapsed hemorrhoids comorbid with liver cirrhosis, who had intractable response to other interventions, were enrolled in this retrospective study between January 2002 and June 2006 at our institute. Six patients (75%) had Child-Pugh class A liver cirrhosis, whereas only two patients (25%) had class B disease. Rectal varices were identified in three patients (37.5%), and esophageal varices were identified in six patients (75%). Concurrent rectal and esophageal varices existed in three patients (37.5%). The patients underwent stapled hemorrhoidopexy with Proximate PPH-03 in a lithotomy position under spinal/intravenous general anesthesia.
  
  
  RESULTS
  There was no procedure-related mortality or major complications except hemorrhage. Two patients (25%) were complicated with postoperative staple-line bleeding, which was managed with conservative treatment without reoperation. There were no leading symptoms of relapsing during a follow-up period of at least 6 months.
  
  
  CONCLUSIONS
  This study may prove that stapled hemorrhoidopexy is a feasible and safe approach for prolapsed hemorrhoids concurrent with liver cirrhosis.
authors.affiliation: Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, 6, Sec. West, Chia-Pu Road, Putz, Chiayi 613, Taiwan.
authors.forename: Wen-Shih
authors.initials: WS
authors.lastname: Huang
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Lin
authors.forename: Chih-Chien
authors.initials: CC
authors.lastname: Chin
authors.forename: Chung-Hung
authors.initials: CH
authors.lastname: Yeh
authors.forename: Ching-Chuan
authors.initials: CC
authors.lastname: Hsieh
authors.forename: Te-Sheng
authors.initials: TS
authors.lastname: Chang
authors.forename: Jeng-Yi
authors.initials: JY
authors.lastname: Wang
mesh_terms: D005260:Female; D005401:Fissure in Ano / Q000209:etiology / Q000601:surgery; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects* / Q000379:methods; D013537:Sutures; D016896:Treatment Outcome