title: Predictors of recurrence of prolapse after procedure for prolapse and haemorrhoids.
abstract: OBJECTIVE
  The procedure for prolapse and haemorrhoids (PPH) is an effective surgical therapy for symptomatic haemorrhoids. Compared with haemorrhoidectomy, meta-analysis has shown PPH to be less painful, with higher patient satisfaction and a quicker return to work, but at the cost of higher prolapse recurrence rates. This is the first report describing predictors of prolapse recurrence after PPH.
  
  
  METHODS
  A cohort of patients with symptomatic haemorrhoids, treated with PPH in our hospital between 2002 and 2009, was retrospectively analysed. Multivariate analysis was performed to identify patient-related and perioperative predictors associated with persisting prolapse and prolapse recurrence.
  
  
  RESULTS
  In total, 159 consecutively enrolled patients were analysed. Persistence and recurrence of prolapse was observed in 16% of the patients. Increased surgical experience showed a trend towards lower recurrence rates. Multivariate analysis identified female gender, long duration of PPH surgery and the absence of muscle tissue in the resected specimen as independent predictors of postoperative persistence of prolapse of haemorrhoids. The absence of prior treatment with rubber band ligation (RBL) as well as increased PPH experience at the hospital showed a trend towards a higher rate of prolapse recurrence.
  
  
  CONCLUSIONS
  In order to reduce recurrence of prolapse, PPH should be performed by a surgeon with adequate PPH experience, patients should be treated with RBL prior to PPH and a resection of mucosa with underlying muscle fibres should be strived for.
authors.affiliation: Department of Surgery, Reinier de Graaf Groep, Delft Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. s.festen@rdgg.nl
authors.forename: S
authors.initials: S
authors.lastname: Festen
authors.forename: H
authors.initials: H
authors.lastname: Molthof
authors.forename: A A W
authors.initials: AA
authors.lastname: van Geloven
authors.forename: S
authors.initials: S
authors.lastname: Luchters
authors.forename: M F
authors.initials: MF
authors.lastname: Gerhards
mesh_terms: D005260:Female; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D012005:Rectal Prolapse / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome