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

Abstract

Background: Stapled haemorrhoidopexy is a non-excisional approach for haemorrhoids as opposed to conventional open Milligan-Morgan and Ferguson closed haemorrhoidectomy techniques. It repositions the prolapsed haemorrhoid tissue and also causes vascular interruption to the haemorrhoids. This causes faster recovery and lesser post-operative pain.Methods: In authors institute, stapled haemorrhoidopexy was being carried out using two rows proximate PPH circular haemorrhoidal stapler. In February 2018, MIRUS three rows circular stapler was introduced. This is a retrospective observational study carried out at Artemis Hospital, Gurgaon, India. Authors studied records and operative notes of all patients who underwent stapled haemorrhoidopexy between February 2018 and September 2019 and compared key parameters.Results: A total of 224 patients underwent stapled haemorrhoidopexy between February 2018 and September 2019. 116 using MIRUS three rows circular stapler and 108 using two rows proximate PPH circular haemorrhoidal stapler. Most of the studied parameters were comparable with only significant statistical difference seen in higher use of haemostatic sutures in two rows stapler group compared to three rows stapler group. Haemostatic sutures were needed in three row stapler group for 27 patients and in two rows stapler group for 39 patients.Conclusions: Author’s initial experience shows slightly better haemostasis with three rows stapled haemorrhoidopexy with no significant difference in other parameters.

Clinical outcomes of stapled hemorrhoidopexy using a novel three-row stapler for grade III/IV hemorrhoids: A single-center experience with literature review

“…For the qualitative literature review, 8 papers were analyzed that included systematic reviews, observational studies, randomized clinical trials, and retrospective case series studies [5,6,8,9,[10][11][12][13][14]. A network meta-analysis performed by Zhang pler (TST) technique.…”

“…In our first-hand experience, grade IV haemorrhoids were more incident than grade III hemorrhoids, and the mid-term postoperative outcomes with a three-row stapler were acceptable. The short-term outcomes of this device had been investigated in a previous high-volume single-center study by Gupta et al [8]. Moreover, given that prolonged hospitalization could be a consequence of severe postoperative pain or adverse events, the incidence of urine retention and the length of stay were independently assessed as secondary endpoints.…”

“…This investigation highlights the clinical utility of this procedure for standard office-based treatment. An earlier study that compared the use of a two-row device (Proximate® PPH) with the three-row (MIRUS™) hemorrhoids stapler found that the PPH group had a higher rate of hemostatic suturing (n=39 of 108 patients, 36.11%) than MIRUS™ group (n=27 of 116 patients, 23.3%) [8].…”

“…Recent studies suggest that three-row staplers may offer improved postoperative outcomes than two-row staplers [8,9]. Further, when using the PPH approaches on patients with grade III/IV hemorrhoids who essentially require surgical treatment, the incidence of recurrence, severe postoperative bleeding, and pain/discomfort is reduced [9].…”