Long-term Outcome of Stapled Hemorrhoidopexy for Grade III and Grade IV Hemorrhoids

Abstract

Stapled hemorrhoidopexy is a safe and effective treatment for Grade III and Grade IV hemorrhoids. Recurrence requiring reoperation was higher in Grade IV hemorrhoids than in Grade III hemorrhoids.

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

“…After conventional Ferguson's hemorrhoidectomy, a redo surgery for recurrent hemorrhoids was necessary in 0.8 % of cases in a large series [73]. In a study with a minimum follow-up of 5 years, recurrence occurred in 18.2 % of patients, and reoperation was performed in 7.2 % of cases after stapled hemorrhoidopexy [49]. However, when long-term control of hemorrhoid-related symptoms was considered, no signi fica nt differ en ce was fo un d b etwe en sta ple d hemorrhoidopexy and conventional hemorrhoidectomy with exception of the presence of prolapse [49].…”

“…In a study with a minimum follow-up of 5 years, recurrence occurred in 18.2 % of patients, and reoperation was performed in 7.2 % of cases after stapled hemorrhoidopexy [49]. However, when long-term control of hemorrhoid-related symptoms was considered, no signi fica nt differ en ce was fo un d b etwe en sta ple d hemorrhoidopexy and conventional hemorrhoidectomy with exception of the presence of prolapse [49]. In a large p a r t o f p a t i e n t s w i t h r e c u r r e n c e a f t e r s t a p l e d hemorrhoidopexy symptoms related to hemorrhoids are absent or moderate [49].…”

“…However, when long-term control of hemorrhoid-related symptoms was considered, no signi fica nt differ en ce was fo un d b etwe en sta ple d hemorrhoidopexy and conventional hemorrhoidectomy with exception of the presence of prolapse [49]. In a large p a r t o f p a t i e n t s w i t h r e c u r r e n c e a f t e r s t a p l e d hemorrhoidopexy symptoms related to hemorrhoids are absent or moderate [49]. These data may explain why the h i g h e r i n c i d e n c e o f r e c u r r e n c e a f t e r s t a p l e d hemorrhoidopexy does not affect the long-term results in terms of patient satisfaction.…”

“…In the existing literature, this complication occurs in 4 to 25 % of cases [41][42][43][44][45][46][47][48]. Bleeding predominantly affects patients with fourth-degree hemorrhoids [49,50]. Most bleeding complications occur during operation at the staple line and should be managed with suture of the bleeding points, after a careful inspection of the stapled suture line [49,50].…”

“…Bleeding predominantly affects patients with fourth-degree hemorrhoids [49,50]. Most bleeding complications occur during operation at the staple line and should be managed with suture of the bleeding points, after a careful inspection of the stapled suture line [49,50]. After the introduction of the newer circular stapler (PPH03, Ethicon EndoSurgery, Cincinnati, OH), which has a closed staple height of 0.75 mm, bleeding after stapled hemorrhoidopexy may be reduced because of an increase in compression on the rectal tissue and blood vessels.…”