Evaluation of rectal sensory and motor function by means of the electronic barostat after stapled hemorrhoidopexy.
OBJECTIVE
Stapled hemorrhoidopexy is designed to replace the hemorrhoids into the anal canal by excising the redundant rectal mucosa above the anorectal ring, thus resulting in an intrarectal suture. Few studies have evaluated rectal function after this procedure. This prospective study was designed to use the electronic barostat to assess whether rectal motor and sensory functions change after stapled hemorrhoidopexy.


METHODS
Ten patients (4 women, mean age, 46 +/- 9 years) with third-degree and fourth-degree hemorrhoids who underwent stapled hemorrhoidopexy were studied. One week before and six months after surgery, they underwent three different rectal distensions (pressure-controlled stepwise, volume-controlled stepwise, and ramp) controlled by an electronic barostat.


RESULTS
Rectal distensibility was significantly lower after surgery during pressure stepwise (P = 0.01), during volume stepwise (P = 0.006), and during ramp distension (P = 0.001). Volume thresholds for desire to defecate, urgency, and discomfort were significantly lower after surgery during all three distensions (P < 0.05). Volume threshold for first perception also was significantly lower after surgery during volume ramp distension (P = 0.01).


CONCLUSIONS
Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. These impairments persist for at least six months after surgery.
De Nardi
Paola
P
Surgical Department, San Raffaele Scientific Institute, Vita-Salute University San Raffaele, Milan, Italy. denardi.paola@hsr.it
Corsetti
Maura
M
Passaretti
Sandro
S
Squillante
Simone
S
Castellaneta
Antonio Gianluca
AG
Staudacher
Carlo
C
Testoni
Pier Alberto
PA
D016009:Chi-Square Distribution; D005260:Female; D006484:Hemorrhoids / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012007:Rectum / Q000503:physiopathology* / Q000601:surgery*; D018709:Statistics, Nonparametric; D017792:Surgical Stapling