Stapled and Closed Hemorrhoidectomy: A Comparative Retrospective Study with Long-term Follow-up
Background: Recently the new surgical treatment of hemorrhoids using a circular stapler device has gained increasing approval. Stapled hemorrhoidectomy, by using a circular stapler to resect circumferentially a mucosal-submucosal rectal strip in order to restore the correct anatomical relationships of the anal canal structures, reduces the rectal mucosal and hemorrhoidal prolapse.
Objective: To evaluate the long-term results of stapled hemorrhoidectomy and to compare with closed hemorrhoidectomy.
Patients and Methods: A comparative retrospective study was conducted in two groups of patients treated surgically for circumferential third degree hemorrhoids and combined external and internal hemorrhoids. From October 2000 to December 2003, eighty-eight patients underwent stapled hemorrhoidectomy by a single surgeon using the instrument kit (PPHO1). In another group of 88 patients, the closed hemorrhoidectomy was carried out by other surgeons during the same period.
Results: Stapled hemorrhoidectomy, compared with closed hemorrhoidectomy, was found to be less time consuming with less analgesics requirement. The mean duration of postoperative hospitalization was shorter and the complication rate was lower in the stapled hemorrhoidectomy group. Although the urinary retention rate was lower in the stapled group (39.7% vs 55.7%), it was still rather high. During the period of follow-up from 10 months to 4 years, stapled hemorrhoidectomy developed less recurrent symptoms and no readmission.
Conclusion: Our results confirm that surgical treatment of hemorrhoids with stapled hemorrhoidectomy is simple, safe and effective. This technique has significantly lower post operative pain and complications than closed hemorrhoidectomy. Because of the rather high urinary retention rate, stapled hemorrhoidectomy should not be performed as a day-case surgery.
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