Short- and long-term results of harmonic scalpel hemorrhoidectomy versus stapler hemorrhoidopexy in treatment of hemorrhoidal disease

Bilgin, Yusuf; Hot, Semih; Barlas, İlhami Soykan; Akan, Arzu; Eryavuz, Yavuz

doi:10.1016/j.asjsur.2014.09.004

Cited by 27 publications

(18 citation statements)

References 44 publications

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“…Twenty-nine and 9 articles [36][37][38][39][40][41][42][43][44] were selected for the chronological categories of 1998-2008 and 2009-2019, respectively. The mean number of patients per study was 197 ± 80 (range 22-3000 patients).…”

Section: Resultsmentioning

confidence: 99%

“…SH was introduced in 1998 as a conceptually attractive surgical technique as it mobilizes the prolapsed rectal mucosa above the dentate line, back to its original anatomical position [48]. Since stapling is meant to be performed above the dentate line on insensate rectal mucosa, postoperative pain and discomfort ought to be minimized, thereby positively influencing length of stay [42]. Resection of a circumferential ring of rectal mucosa eliminates all distal feeding vessels from the superior rectal artery, theoretically attaining a higher degree of surgical completeness and an expected lower risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy

et al. 2020

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Background Symptomatic haemorrhoids affect a large number of patients throughout the world. The aim of this systematic review was to compare the surgical outcomes of stapled haemorrhoidopexy (SH) versus open haemorrhoidectomy (OH) over a 20-year period. Methods Randomized controlled trials published between January 1998 and January 2019 were extracted from Pubmed using defined search criteria. Study characteristics and outcomes in the form of short-term and long-term complications of the two techniques were analyzed. Any changes in trend of outcomes over time were assessed by comparing article groups 1998–2008 and 2009–2019. Results Twenty-nine and 9 relevant articles were extracted for the 1998–2008 (period 1) and 2009–2019 (period 2) cohorts, respectively. Over the two time periods, SH was found to be a safe procedure, associated with statistically reduced operative time (in 13/21 studies during period 1 and in 3/8 studies during period 2), statistically less intraoperative bleeding (3/7 studies in period 1 and 1/1 study in period 2) and consistently less early postoperative pain on the visual analogue scale (12/15 studies in period 1 and 4/5 studies in period 2) resulting in shorter hospital stay (12/20 studies in period 1 and 2/2 studies in period 2) at the expense of a higher cost. In the longer term, although chronic pain in SH and OH patents is comparable, patient satisfaction with SH may decline with time and at 2-year follow-up OH appeared to be associated with greater patient satisfaction. Conclusions SH appears to be safe with potential advantages, at least in the short term, but the evidence is lacking at the moment to suggest its routine use in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy

et al. 2020

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“…The operative time, duration of hospital stay, VAS scores, and analgesic doses showed no statistically significant differences between the two groups. Postoperative hemorrhage is a relatively common complication in SH, occurring in 1.5-15.6% of the patients [18][19][20][21] , and the maximum bleeding occurs immediately after surgery due to inadequate hemostasis. In SH, the closed staple height that determines the compression is 0.75 mm in PPH stapler and 1.5 mm in DST stapler.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Kiu

Yen

et al. 2020

Sci Rep

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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.

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“…However, none has proven to be clearly superior to the others. [ 20 – 24 ] SH and THD were described as more effective and less painful alternatives to CH. [ 25 , 26 ] A retrospective study indicated that both SH and THD are safe procedures and have similar effectiveness for treating grade III hemorrhoids.…”

Section: Discussionmentioning

confidence: 99%

Transanal hemorrhoidal dearterialization versus stapled hemorrhoidectomy in the treatment of hemorrhoids

Song

Chen

Yang³

et al. 2018

Medicine

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Background and Objective:The aim of this study was to compare the outcomes of transanal hemorrhoidal dearterialization (THD) and stapled hemorrhoidectomy (SH) in the treatment of hemorrhoids by a meta-analysis.Methods:Randomized control trials (RCTs) comparing SH with THD were searched for in databases, including MEDLINE, PubMed, Web of science, Embase, and the Cochrane Library database. Data were independently extracted from each study, and a meta-analysis was performed using RevMan5.2 software.Results:Eight RCTs, including 977 patients, were included in this meta-analysis. No statistically significant differences were noted between THD and SH in terms of total complications (OR, 0.93; 95% CI, 0.69, 1.25), but a significant differences were noted in terms of bleeding (OR, 1.85; 95% CI, 1.10, 3.10). The total recurrence rate was higher in THD than in SH on short-term follow-up; however, the recurrence rate was equal in both the THD and SH groups on long-term follow-up. The present study showed that no significant difference between SH and THD in terms of postoperative pain (OR, 0.43; 95% CI, −0.43, 1.29), operative time (OR, −3.12; 95% CI, −7.01, 0.77), hospital time (OR, −0.00; 95% CI, −0.21, 0.20), time before returning to work (OR,-0.50; 95%CI, −4.42,3.43), and reoperation rate (OR, 1.81; 95% CI, 0.93, 3.54).Conclusion:Our meta-analysis indicated that THD and SH are equally effective techniques for the treatment of hemorrhoids. However, future studies addressing cost-effectiveness, satisfaction rate, and recurrence rate over a long follow-up period are needed to validate these results.

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Short- and long-term results of harmonic scalpel hemorrhoidectomy versus stapler hemorrhoidopexy in treatment of hemorrhoidal disease

Abstract: HSH and SH are both safe and effective methods for surgical treatment of Grade III and Grade IV hemorrhoidal disease. In our study, the HSH method was determined to be safer, easier, and faster to perform, and associated with fewer long-term recurrences than the SH method.

Cited by 27 publications

References 44 publications

A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy

A systematic review of the literature assessing the outcomes of stapled haemorrhoidopexy versus open haemorrhoidectomy

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

Transanal hemorrhoidal dearterialization versus stapled hemorrhoidectomy in the treatment of hemorrhoids

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