Initial experience with stapled hemorrhoidopexy for treatment of hemorrhoids

Abstract

BACKGROUND: Introduction of stapled hemorrhoidopexy by Longo in 1998 represented a radical change in the treatment of hemorrhoids. By avoiding multiple excisions and suture lines in the perianal region, stapled hemorrhoidopexy is intended to offer less postoperative pain than with conventional techniques. OBJECTIVE: To report and analyze the intra and postoperative results gained during initial experience with stapled hemorrhoidopexy. METHODS: One hundred and fifty five patients (67 males) with average age of 39.5 years (21-67 years) underwent stapled hemorrhoidopexy between June 2000 and December 2003 with symptomatic third-degree (n = 74) and fourth-degree (n = 81) hemorrhoids. Mean follow-up period was 20 months (14-60 months). RESULTS: Preoperative symptoms were prolapse (96.7%) and anal bleeding (96.1%). Overall mean operative time was 23 minutes (16-48 minutes). We observed one case of stapler failure and one case of failure to introduce the stapler occurred in a patient with previous anal surgery. Additional sutures for hemostasis were required in 103 patients (66.5%). Resection of skin tags was performed in 45 cases (29%). Postoperatively scheduled analgesia with oral dipyrone and celecoxib was enough for pain control in 131 patients (84.5%). Rescue analgesia was necessary in 24 cases (15.5%). Five patients needed opiates for pain control. Hospital discharge took place on the first postoperative day in 140 patients (90.3%). First defecation without pain was reported by 118 patients (76.1%). Postoperative complications were anal bleeding (10.3%), severe pain (3.2%), urinary retention (3.9%), fever without any signs of perianal infection (1.9%), incontinence for flatus (1.9%), hemorrhoidal thrombosis (1.3%). Two patients presented symptoms of recurrent hemorrhoidal disease and were successfully treated by conventional hemorrhoidectomy. They were no cases of anal stenosis, permanent incontinence, chronic pain or deaths in this series. CONCLUSIONS: Hemorrhoidopexy can be considered a feasible and safe alternative technique to conventional hemorroidectomy for select patients.

Documented Complications of Staple Hemorrhoidopexy: A Systematic Review

“…Complications including anastomotic dehiscence have been reported secondary to the use of a defective stapler, along with incomplete stapling. 8,23,27,46 Routine checking of the staplers prior to the commencement of surgery has been recommended. 8,23 Tenesmus was more commonly reported in stapled hemorrhoidopexy and authors have attributed this to the presence of a low rectal suture.…”

“…23,24 Fecal impaction was also reported. 6,21,25,26,27 Early complications including anastomotic dehiscence and edema of the anastomotic ring were also reported. 3,8,20,28 Late Complications Late complications were those occurring postoperatively after 7 days, listed in Table 2.…”

Dor pós-operatória: combinações analgésicas e eventos adversos

“…The intensity of pain among these patients, usually moderate to intense, was often related to the pattern of bowel functioning, thus requiring important adjuvant measures, as the use of laxatives (3,10) .…”

“…Dipyrone is currently considered one of the main analgesics, whose clinical efficacy in postoperative pain has been reported in several studies, especially as an adjuvant in surgeries such as hemorrhoidectomy (3,(10)(11)(12)(13) . Studies show that high doses of dipyrone are similar to the administration of OA such as tramadol and meperidine (14) .…”

Early Outcomes in Patients Treated with Stapled Hemorrhoidopexy

“…The incidence of urinary retention after spinal anesthesia is reported to be between 0% and 69% (18). The type of anesthesia used in the operation is not always stated in the literature, but spinal anesthesia is the most commonly preferred (19). Because the risk of urinary retention increases with spinal anesthesia, excessive fluid hydration should be avoided.…”