Long Term Results After Stapled Hemorrhoidopexy Alone and Complemented by Excisional Hemorrhoidectomy: A Retrospective Cohort Study

Abstract

Background: Stapled hemorrhoidopexy is associated with less postoperative pain and faster recovery. However, it may be associated with a greater risk of symptomatic recurrence. We hypothesized that undertaking a limited surgical excision of hemorrhoid disease after stapling may be a valid approach for selected patients. Aim: To compare long-term results after stapled hemorrhoidopexy with and without complementation with closed excisional technique. Method: In a retrospective uni-institutional cohort study, sixty-five (29 men) patients underwent stapled hemorrhoidopexy and 21 (13 men) underwent stapled hemorrhoidopexy with excision. The same surgeons operated on all cases. Patients underwent stapled hemorrhoidectomy associated with excisional surgery if symptoms attributable to external hemorrhoid piles were observed preoperatively, or if residual prolapse or bulky external disease was observed after the firing of the stapler. A closed excisional diathermy hemorrhoidectomy without vascular ligation was utilized in all complemented cases. All clinical variables were obtained from a questionnaire evaluation obtained through e-mail, telephone interview, or office follow-up. Results: The median duration of postoperative follow-up was 48.5 (6-40) months. Patients with grades 3 and 4 hemorrhoid disease were operated on more frequently using stapled hemorrhoidopexy complemented with excisional technique (95.2% vs. 55.4%, p=0.001). Regarding respectively stapled hemorrhoidopexy and stapled hemorrhoidopexy complemented with excision, there was no difference between the techniques in relation to symptom recurrence (43% and 33%, p=0.45) and median interval between surgery and symptom recurrence (30 (8-84) and 38.8 (8-65) months, p=0.80). Eight (12.3%) patients were re-operated after stapled hemorrhoidopexy and 2 (9.6%), after hemorrhoidopexy with excision (p=0.78). Patient distribution in both groups according to the degree of postoperative satisfaction was similar (p=0.97). Conclusion: Stapled hemorrhoidopexy combined with an excisional technique was effective for more advanced hemorrhoid disease. The combination may have prevented symptomatic recurrence associated to stapled hemorrhoidopexy alone.

Worldwide Disease — Haemorrhoids. How Much Do We Know?

“…Interestingly, very low rates of bleeding were demonstrated in the postoperative period after stapled haemorrhoidopexy followed by the use of biological glue in patients with cardiac stents and risk of bleeding (Pirolla et al, 2017). Simultaneously, stapled haemorrhoidopexy has been recognised as a technique providing higher rates of recurrence (Araujo et al, 2016;Lin et al, 2019).…”

Our initial experience of three versus two rows circular stapler devices for stapled hemorrhoidopexy: a single institution review of 224 cases

“…3 It repositions the prolapsed haemorrhoids tissue and also causes an interruption of the vascular supply to the haemorrhoids cushions by circular resection of the inner layers of rectum above the dentate line. 4 It has shown faster recovery, lesser post-operative pain and an early return to normal activities. 5, 6 Over years it has gained popularity over traditional open procedures due to its minimally invasive nature with no external scars and lesser short-term pain.…”

Analysis of stapled hemorrhoidopexy outcomes: A single-institution based study

“…Conventional excisional hemorrhoidectomy has been the most effective technique for patients with hemorrhoids. However, the efficacy of the technique is masked by the complication of significant postoperative pain, thereby leading to the deferral of treatment [3] . To overcome this complication, Dr. Antonio Longo introduced stapled hemorrhoidopexy (SH) in 1998 and this procedure involves repositioning of the prolapsed hemorrhoidal tissue through a circular resection of the inner layers unlike the complete removal of the tissue followed in conventional methods [4] .…”

“…To overcome this complication, Dr. Antonio Longo introduced stapled hemorrhoidopexy (SH) in 1998 and this procedure involves repositioning of the prolapsed hemorrhoidal tissue through a circular resection of the inner layers unlike the complete removal of the tissue followed in conventional methods [4] . Further the mechanical anopexy interrupts the vascular supply to the hemorrhoid cushions thereby reducing the hemorrhoid tissue [3] . SH is commonly indicated in circumferential grade II, hemorrhoidal prolapse, grade III and IV hemorrhoids [4] .…”