Initial experience and long-term results with stapled hemorrhoidectomy.

Abstract

Background : Radical change in the treatment of prolapsed internal hemorrhoids occurred after the initiation of stapled hemorrhoidectomy (SH) by Longo in 1998. By avoiding multiple excisions and suture lines in the perianal region and preserving of the anal cushions, stapled hemorrhoidectomy is intended to offer less postoperative pain, less discomfort and less flatus incontinence than conventional techniques.

Objective : To report and analyze the intra-operative technique, early and late postoperative complications and long-term results of initial experience in stapled hemorrhoidectomy

Methods : Retrospective study of medical records of the 3rd and 4th degree internal hemorrhoid patients underwent stapled hemorrhoidectomy at Prapokklao Hospital from October 2005 to February 2008. Follow-up programs were 2 and 4 weeks postoperatively in all patients. Long-term follow up was obtained by phone in March 2008.

Results : Thirty-six patients were included, 26 males and 10 females (2.6:1) with average age of 51.8 years (27-86 yrs). Among 9 cases of having underlying diseases, there were 2 cases of previous conventional hemorrhoidectomy (CH) with recurrent symptoms, 4 cases receiving anticoagulants or anti-platelets. Leading symptoms were mostly both prolapse and anal bleeding (29 cases). About 1/5 of cases suffered only prolapse without bleeding(7 cases). Overall mean operating time was 42.6 minutes (the first eighteen cases was 66.4 minutes, the last eighteen cases was 35.5 minutes). Additional sutures for hemostasis were required in 16 cases(44.4 percent). Average postoperative simple pain score was 3.08.Postoperative parenteral opioid analgesia was needed in 14 cases(38.9 percent),and oral analgesia in 22 cases(61.1 percent). Mean hospital stay was 2.4 days(1-9 days). First defecation without pain was reported by 33 patients(91.7 percent).Early postoperative complications (<24 hours) were 1 case of anal bleeding needed surgical control (2.8 percent), 7 case of urinary retention (19.4 percent) of which were 6 males and 1 female. Late complications(24 hours-2 weeks) were 1 case of secondary bleeding controlled by anal packing (2.8 percent), and
another 1 case of mild rectal stenosis corrected by anal dilatation(2.8 percent).Mean follow-up period was 13.4 months(1-28 months). Long-term results can be obtained in 30 cases(83.3 percent). Negative long term results were reported in 6 cases(20 percent), of which were 2 cases of small amount of bleeding, 2 cases of mild protrusion, 1 case of severe protrusion(as before SH) and 1 case of flatus incontinence. There were no cases of long-term stenosis, permanent incontinence or chronic pain. Patientsû overall satisfaction rate to SH was 86.7 percent(26 cases), and non-satisfaction rate was 13.3 percent (4 cases).

Conclusions : Stapled hemorrhoidectomy(SH) can be considered a feasible, less pain, less invasive and safe alternative technique to conventional hemorrhoidectomy(CH).The results strongly depend on experiences of patient selection, familiarity to the instruments and technical capabilities of the surgeon.

Key words : Stapled Hemorrhoidectomy, Stapled Hemorrhoidopexy, Conventional Hemorrhoidectomy