title: Circular mucosal anopexy: Experience and technical considerations.
abstract: BACKGROUND
  Circular mucosal anopexy (CMA) achieves a more comfortable postoperative period than resective techniques. But complications and recurrences are not infrequent. This study aims to evaluate of the efficacy of CMA in the treatment of hemorrhoids and rectal mucosal prolapse (RMP).
  
  
  METHODS
  From 1999 to 2011, 613 patients underwent surgery for either hemorrhoids or RMP in our hospital. CMA was performed in 327 patients. Gender distribution was 196 male and 131 female. Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade. Major ambulatory surgery (MAS) was performed in 79.9%. Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared. Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications.
  
  
  RESULTS
  A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade). No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age. In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week. Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain.
  
  
  CONCLUSIONS
  Recurrence rate is higher in CMA than in resective techniques. CMA is a useful technique for the treatment of hemorrhoids in MAS. Pain and the rate of complications are both low.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
authors.forename: Luis Antonio
authors.initials: LA
authors.lastname: Hidalgo Grau
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España. Electronic address: neus.ruiz.edo@gmail.com.
authors.forename: Neus
authors.initials: N
authors.lastname: Ruiz Edo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
authors.forename: Sara
authors.initials: S
authors.lastname: Llorca Cardeñosa
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Heredia Budó
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Estrada Ferrer
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
authors.forename: Marta
authors.initials: M
authors.lastname: Del Bas Rubia
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
authors.forename: Eva María
authors.initials: EM
authors.lastname: García Torralbo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital de Mataró, Mataró (Barcelona), España.
authors.forename: Xavier
authors.initials: X
authors.lastname: Suñol Sala
mesh_terms: D000328:Adult; D005260:Female; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012005:Rectal Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*
keywords: Anopexia mucosa circular; Circular mucosal anopexy; Hemorrhoids; Hemorroides; Prolapso mucoso rectal; Rectal mucosal prolapse