Stapled Hemorrhoidectomy: 6-Year Experience in Thai Patients
Background: Hemorrhoidal disease is one of the most common anorectal disorders worldwide. Stapled hemorrhoidectomy (SHD) is a relatively new technique introduced in 1998. Nowadays, there are sufficient evidences of its benefits. There are 25 randomized clinical trials comparing SHD with open hemorrhoidectomy and 6 randomized clinical trials comparing SHD with closed hemorrhoidectomy (CHD). There are also 5 systematic reviews of randomized trials comparing SHD and conventional hemorrhoidectomy. We have previously studied and retrospectively compared hemorrhoidectomy by stapled technique (n = 88) and closed hemorrhoidectomy (n =88).
Objective: The aim of this study was to analyze the results of our 6-year experience of SHD in Thai patients and to compare with our previous study.
Patients and Methods: From January 2004 to December 2006, 116 patients underwent SHD using PPH.03. We compared these data including 88 SHD using PPH-01 performed between October 2000 and December 2003 with 88 CHD from our previous study. All procedures were performed under spinal anesthesia and in jackknife position.
Results: In SHD group (N= 204), 96 were male (47%) and 108 were female (53%) with median age of 51 years (20-80 years). In CHD group (N= 88), 36 were male (41%) and 52 were female (59%) with median age of 47 years (22-79 years). SHD group required less analgesic consumption than CHD group (58.3% vs 100%; p<0.05). Mean operative time was shorter in SHD than CHD group (17 vs 35 minutes; p <0.05). Postoperative hospitalization for one day was more common in SHD than CHD group (81.9% vs 20.4%;p <0.05). Postoperative complication rates especially urinary retention were lower in SHD than CHD group (36.8% vs. 62.5% and 32.8% vs. 55.7%; p <0.05; respectively). Overall recurrent hemorrhoidal symptoms were similar between the two groups after median follow-up period of 34 months (3-77 months). SHD group developed less recurrent bleeding than CHD group (1.5% vs 9.1%; p <0.05). No serious complications after SHD were found.
Conclusions: Our results confirm that SHD is simple (shorter operative time), safe (less postoperative pain and less complications) and effective (low recurrent symptoms). Stapling technique also reduces the length of hospital stay. There are no serious complications. This study demonstrates that the previously published favorable results of SHD can be reproduced in Thai patients. The keys of success are proper patient selection and good surgical technique. Because of the rather high urinary retention rate, SHD should not be performed under spinal anesthesia as a day-case surgery.
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