Stapled and Closed Hemorrhoidectomy: A Comparative Retrospective Study with Long-term Follow-up

Authors

  • Chakrapan Euanorasetr Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • Woraporn Sriyodwieng Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Abstract

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.

References

1. Chakrapan Euanorasetr. Complications of surgical hemorrhoidectomy. In: Parinya Thavichaigarn, et al, editor. Advances in surgery/RCST 21, Bangkok: Bangkok Medical Publisher; 2002. p. 394-456.

2. Longo A, Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure, In; Proceedings of the 6th World Congress of Endoscopic Surgery 1998; Rome, Italy.

3. Thompson WHF. The nature of hemorrhoids. Br J Surg 1975;62:542-5.

4. Longo A. Stapled anopexy and stapled hemorrhoidectomy: two opposite concepts and procedures. Dis Colon Rectum 2002; 45: 571-2.

5. Ortiz H, Marzo J, Armendariz P, Randomized clinical trial of stapled hemorrhoidopexy versus conventional diathermy hemorrhoidectomy, Br J Surg 2002; 89: 1376-81.

6. Raculbato A, Aliotta I, Corsaro G, et al. Hemorrhoidal stapler prolapsectomy vs Milligan-Morgan hemorrhoidectomy: a long-term randomized trial, Int J Colorectal Dis 2003; 7ะ (Epub ahead of print).

7. Boccasanta P, Capretti PG, Venturi M, et al. Randomized controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 2001; 182:64-8.

8. Brown SR, Ballan K, Ho E, et al. Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles; a prospective randomized comparison with conventional hemorrhoidectomy, Colorectal Dis 2001; 3:175-7.

9. Cheetham MJ, Cohen CR, Kamm MA, et al. A randomized, controlled trial of diathermy hemorrhoidectomy vs stapled homorrhoidectomy in an intended day-case setting with longer-term follow up. Dis Colon Rectum 2003; 40: 491-7.

10. Ganio E, Altomare DF, Gabrielli F, et al. Prospective randomized multicentre trial comparing stapled with open hemorrhoidectomy, Br J Surg 2001; 88:669-74.

11. Ho YH, Cheong WK, Tsang C, et al. Stapled hemorrhoidectomy-cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months, Dis Colon Rectum 2000; 43:1666-75.

12. Kairaluoma M, Nuorva K, Kellokumpu I. Day-care stapled (circular) vs diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 2003: 46:93-9.

13. Krska Z, Kvasnieka J, Fultyes J, et al. Surgical treatment of hemorrhoids according to Longo and Milligan Morgan: an evaluation of prospective tissue response. Colorectal Dis 2003;5: 573-6.

14. Mehigan BJ, Monson JR, Hastley JE, Stapling procedure for hemorrhoids versus Milligan-Morgan hemorrhoidectomy: randomized controlled trial. Lancet 2000;355:782-5.

15. Ooi BS, Ho YH, Tang CL, et al. Results of stapling and conventional hemorrhoidectomy. Tech Coloproctol 2002;6:59-60.

16. Palimento D, Piechio M, Attanasio U, et al. Stapled and open hemorrhoidectomy: Randomized controlled trial of early results. World J Surg 2003; 27: 203-7.

17. Pavidis T, Papaziogas B, Souparis A, et al. Modern stapled Longo procedure vs conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial. Int J Colorectal Dis 2002; 17: 50-3.

18. Rowsell M, Bellow M, Hemingway DM. Circumferential mucosectomy (stapled hemorrhoidectomy) versus conventional hemorrhoidectomy: randomized controlled trial. Lancet 2000: 355: 779-81.

19. Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan hemorrhoidectomy. Br J Surg 2001; 88:1049-53.

20. Smyth EF, Baker RP, Wilken BJ, et al. Stapled versus excision hemorrhoidectomy: long-term follow up of a randomized controlled trial. Lancet 2003; 361: 1437-8.

21. Wilson MS, Pope V, Doran HE, et al. Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial. Dis Colon Rectum 2002; 45:1437-44.

22. Au-Yong I, Rowsell M, Hemingway DM. Randomized controlled trial of stapled hemorrhoidectomy vs conventional hemorrhoidectomy, a three and half year follow up. Colorectal Dis 2004;6: 37-8.

23. Correa-Ravelo JM, Tellez O, Obregon L, et al. Stapled rectal mucosectomy vs closed hemorrhoidectomy: a randomized clinical trial. Dis Colon Rectum 2002; 45:1367-74.

24. Khalil KH, O'Bichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed hemorrhoidectomy. Br J Surg 2000;87:1352-5.

25. Hetzer FH, Demartines N, Handschin AE, et al. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg 2002; 137: 337-40.

26. Peng BC, Tayne DG, Ho YH. Randomized trial of rubber band ligation vs stapled hemorrhoidectomy for prolapsed piles. Dis Colon Rectum 2003; 46:291-7.

27. Sutherland LM, Burchard AK, Matsuda K, et al. A systematic review of stapled hemorrhoidectomy. Arch Surg 2002;137:1345-406.

28. Habr-Gama A, Sousa AHS, Rovelo MC, et al. Stapled hemorrhoidectomy: initial experience of a Latin American group. J Gastrointes Surg 2003; 7: 809-13.

29. Orrom W, Hayashi A, Rusnak C, et al. Initial experience with stapled anoplasty in the operative management of prolapsing hemorrhoids and mucosal rectal prolapse. Am J Surg 2002; 183: 519-24.

30. Pernice LM, Bartalucci B, Bencini L, et al. Early and late (ten years) experience with circular stapler hemorrhoidectomy. Dis Colon Rectum 2001: 44: 836-41.

31. Arnaud JP, Pessaux P, Huten N, et al. Treatment of hemorrhoids with circular stapler, a new alternative of conventional methods: a prospective study of 140 patients. J Am Coll Surg 2001; 193: 161-5.

32. Bassadanis G, Harlaftis N, Michalapoulos A, et al. Surgical treatment of hemorrhoids with the use of the circular stapler and open hemorrhoidectomy: a comparative study. Tech Coloprotol 2000; 4: 137-40.

33. Beattie GC, Loudon MA. Hemorrhoid surgery revised (letter). Lancet 2000; 355:1648.

34. Cheetam MJ, Mortensen NJM, Nystrom PO, et al. Persistent pain and fecal urgency after stapled hemorrhoidectomy. Lancet 2000; 356:730-3.

35. Wong LY, Jiang JK, Chang SC, et al. Rectal perforation: a life threatening complication of stapled hemorrhoidectomy: report of a case. Dis Colon Rectum 2003; 46: 116-7.

36. Chakrapan Euanorasetr. Stapled hemorrhoidectomy. In: Chakrapan Euanorasetr, et al, editor, Advances in surgery RCST 26. Bangkok: Bangkok Medical Publisher; 2547, p. 68-87.

37. Molloy RG, Kingsmore D, Life threatening sepsis after stapled hemorrhoidectomy. Lancet 2000; 355: 816.

38. Roos P. Hemorrhoid surgery revised (letter), Lancet 2000355:1648.

39. Maw A, Eu KW, Seow-Choen F. Retroperitoneal sepsis complicating stapled hemorrhoidectomy; report of a case and review of the literature. Dis Colon Rectum 2002;45:826

40. Ripetti Y, Caricato M, Arullani A. Rectal perforations retropneumoperitoneum and pneumomediastinum after stapled hemorrhoidectomy. Dis Colon Rectum 2002; 45268-70.

41. MaDonald PS, Bona R, Cohen CRG, Rectovaginal fistula after stapled hemorrhoidopexy. Colorectal Dis 2004; 6: 64-5.

42. Cispriani S, Pescatori M. Acute rectal obstruction following PPH hemorrhoidectomy. Colorectal Dis 2002; 4: 367-70.

Downloads

Published

2005-03-31

How to Cite

1.
Euanorasetr C, Sriyodwieng W. Stapled and Closed Hemorrhoidectomy: A Comparative Retrospective Study with Long-term Follow-up. Thai J Surg [Internet]. 2005 Mar. 31 [cited 2024 Apr. 20];26(1):9-16. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/242185

Issue

Section

Original Articles