Comparison of the short-term outcomes of using DST and PPH staplers in the treatment of grade III and IV hemorrhoids

Abstract

Stapled hemorrhoidopexy has a few advantages such as less postoperative pain and faster recovery compared with conventional hemorrhoidectomy. there are two major devices used for stapled hemorrhoidopexy, ppH stapler (ethicon endoSurgery) and DSt stapler (covidien). this study was conducted to investigate the postoperative outcomes among patients with grade iii and iV hemorrhoids who underwent hemorrhoidopexy with either of these two devices. A total of 242 consecutive patients underwent stapled hemorrhoidopexy with either PPH stapler (110 patients) or DST stapler (132 patients) at a single center in 2017. We performed a retrospective case-control study to compare the short-term postoperative outcomes and the complications between these two groups. After matching the cases in terms of age, gender, and the grade of hemorrhoids, there were 100 patients in each group (PPH versus DST). There were no significant differences in the postoperative visual analog scale (VAS) score and analgesic usage. Among complications, the incidence of anorectal stricture was significantly higher in the DSt group (p = 0.02). Evaluation of the mucosal specimen showed that the total surface area, the muscle/mucosa ratio and the surface area of the muscle were also significantly higher in the DSt group (p = 0.03). Further analysis of the DST group demonstrated that patients with anorectal stricture after surgery are younger than patients without anorectal stricture, and higher muscle/mucosa ratio (p = 0.03) and a higher surface area of the muscle (p = 0.03) also measured in the surgical specimen. the two devices provide similar outcomes of postoperative recovery. patients who underwent DSt stapled hemorrhoidopexy had a higher incidence rate of stricture, larger area of muscle excision, and higher muscle/mucosa ratio in the surgical specimen. further investigation is warranted for a better understanding of the correlation between muscle excision and anorectal stricture.

Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR—A Proposal for a Decision-Making Algorithm

“…For the remaining studies, the full texts were obtained and reviewed. Seven studies were excluded based on reasons listed in Table 1 [12][13][14][15][16][17][18]. Cumulatively, 17 articles (15 case reports and two case series) were considered relevant, and 38 patients were included ( Figure 1, Seven papers reported perirectal hematoma [3,17,18,[20][21][22][23][24][25][26][27].…”

“…For the remaining studies, the full texts were obtained and reviewed. Seven studies were excluded based on reasons listed in Table 1 [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Cumulatively, 17 articles (15 case reports and two case series) were considered relevant, and 38 patients were included ( Figure 1 , Table 2 ) [ 3 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

“…The data about hemodynamic status were reported in all case reports and the case series [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]: a hemodynamic instability was reported in a few cases (18.9%, 7/37) and a hemodynamic stabilization and resuscitation were needed.…”

Stapled Hemorrhoidectomy: A Safe Procedure for Third and Fourth Grade Hemorrhoids

“…It has good overall results with very few side effects. [1][2][3][4] Studies suggested that, this model of treatment has various advantages over other conventional treatment methods. Few side effects which are most associated with this technique is postoperative pain but incidence rate of it is also very negligible.…”

The Use of PILA-Pack: Differences in Length of Stay of Hemorrhoidal Patients

“…Hemorrhoids are often referred to as hemorrhoidal disease (HD), are one of the most common anorectal diseases (1). The hemorrhoidal disease affects approximately 4.4-36 per cent of the general population, aged >50 years old (2,3). Hemorrhoids are clumps of tissue made up of muscle and elastic fibers and swollen, bulging blood vessels and supporting tissues that form in the anal canal of an individual.…”