PPH and Biological Glue and Phytonadione infusion in patients with Cirrhosis and Anticoagulation therapy with high risk of bleeding during and after Stapled Hemorrhoidopexy

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Published Aug 29, 2024
DOI: https://doi.org/10.18103/mra.v12i8.5533

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Main Article Content

Eduardo Henrique Pirolla, MD, PhD, PGMA-HMS
Albert Einstein Hospital Chief Surgeon, Former Mentor and Supervisor, Lecturer, Researcher, Spaulding R. N. H./Massachusetts General Hospital Laboratory an Official Teaching Affiliate Hospital at Harvard Medical School.
Gabriel Naman Maccapani, MD
Gastrointestinal and E.R. Surgery, Albert Einstein Hospital Surgeon.

Abstract

Background: Stapled hemorrhoidopexy is a common treatment for grade 3 hemorrhoids. Patients with conditions that increase the risk of bleeding, as cardiac stents usage with clopidogrel bissulfate and liver cirrhosis, should receive an extra care in surgical procedures due to the high risk of bleeding. For this reason and for patients with third degree hemorrhoids we propose the use of stapled hemorrhoidopexy followed by the use of biological glue and the intravenous administration of Phytonadione. Some studies in the literature demonstrate the risks of periprocedural bleeding and post-surgical procedures, generally lasting > 45 minutes and in chemically or pathologically anticoagulated patients as being at high risk of bleeding and death.


Aim: Assess surgical outcomes in patients with hemorrhoids and high risk of bleeding submitted to stapled hemorrhoidopexy followed by biological glue.


Methods: Between 2005 and 2024 172 patients were analyzed, in a retrospective cohort study.


Results: From 86 patients submitted to stapled hemorrhoidopexy followed by the use of biological glue in the local of stapled line, only one (1.16%) presented bleeding in the surgical postoperative (Group 1). Eighty-six patients submitted to PPH procedure and biological glue use, also received 3 days before surgery and 3 days after surgery one dose of 5 mg of Phytonadione (Vitamin K1) per day (Group 2). In this group, no patients presenting rectal bleeding after surgery with the follow up of 3 months. Patients do not have any other complications and pain in the postoperative period.  The median (IQR) operative time was 55 min and the median (IQR) length of hospital stay after surgery was 3 days.


Conclusion: Patients with high risk of bleeding submitted to stapled hemorrhoidopexy followed by the use of biological glue (Group 1) presented very low rates of bleeding in the postoperative period. The adjuvant administration of vitamin K1 (Group2) at a recommended dose is proven to better prevent bleeding.

Keywords: Hemorrhoid. Liver cirrhosis. Stents. Clopidogrel, K Vitamin

Article Details

How to Cite
PIROLLA, Eduardo Henrique; MACCAPANI, Gabriel Naman. PPH and Biological Glue and Phytonadione infusion in patients with Cirrhosis and Anticoagulation therapy with high risk of bleeding during and after Stapled Hemorrhoidopexy. Medical Research Archives, [S.l.], v. 12, n. 8, aug. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5533>. Date accessed: 06 sep. 2024. doi: https://doi.org/10.18103/mra.v12i8.5533.
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Issue
Vol 12 No 8 (2024): Vol 12 No 8 (2024): August ISSUE, Issue 8, VOl.12
Section
Research Articles

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