Stapled versus excision haemorrhoidectomy: long-term follow up of a randomised controlled trial

Smyth, Edward F.; Baker, Richard P.; Wilken, Bert J.; Hartley, John E.; White, T. J.; Monson, J. R. T.

doi:10.1016/s0140-6736(03)13106-6

Cited by 84 publications

(128 citation statements)

References 3 publications

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“…However, in the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported. In studies evaluating stapl ed hem orrhoid opexy and conventional hemorrhoidectomy for Grade III and IV hemorrhoids with an adequate and systematic follow-up (>1 year), the incidence of recurrence was 0 to 26 % and 0 to 10.8 %, respectively; reoperation rate was up to 16.7 % after stapled hemorrhoidopexy [43,46,61,[63][64][65][70][71][72]. After conventional Ferguson's hemorrhoidectomy, a redo surgery for recurrent hemorrhoids was necessary in 0.8 % of cases in a large series [73].…”

Section: Resultsmentioning

confidence: 99%

“…In most patients, incontinence is transitory, due to excessive anal stretching secondary to circular anal dilator insertion [62]. At long-term follow-up, persistent continence problems were reported in a minority of patients with no significant difference with respect to conventional hemorrhoidectomy [61,[63][64][65]. Similarly, fecal urgency is a common complication especially soon after stapled hemorrhoidopexy.…”

Section: Complicationsmentioning

confidence: 99%

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Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

Picchio¹,

Greco²,

Filippo

et al. 2014

Indian J Surg

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Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with conservative therapies, especially for Grade III and IV hemorrhoids. In this review, we present and discuss the results of the most diffuse surgical techniques for hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorrhoids, with closure (Fergusson's technique) or without closure (Milligan-Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes a significant postoperative pain because of wide external wounds in the innervated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postoperative pain and faster return to normal activities. In the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conventional hemorrhoidectomy. Double stapler hemorrhoidopexy may be an alternative to simple stapled hemorrhoidopexy to reduce the recurrence in advanced hemorrhoidal prolapse. Transanal hemorrhoidal deartertialization was showed to be as effective as stapled hemorrhoidopexy in terms of treatment success, complications, and incidence recurrence. However, further high-quality trials are recommended to assess the efficacy and safety of this technique.

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Section: Resultsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

Picchio¹,

Greco²,

Filippo

et al. 2014

Indian J Surg

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“…[23] 50 staplerli hastanın 10' unda ilk yıl nüks saptamıştır. Yine Ortiz ve arkadaşları da [24] 27 hastanın 7' sinde rekürrens olduğunu saptamıştır [24] Smyth ve arkadaşlarının bir çalışmasında % 2 vakada nüks saptanmıştır [15]. Bizim 1 vakamızda 1 yıl sonra nüks gözlendi ve konvansiyonel hemoroidektomi ile başarılı bir şekilde tedavi edildi.…”

Section: Discussionunclassified

“…Desoky ve Shalaby [27], stapler ile hemoroidopeksi yapılan vakaların %2 ' sinde, konvansiyonel yöntemle yapılan vakaların % 5 ' inde anal stenoz vakasına rastlamışlardır. Smyth ve arkadaşlarının bir çalışmasında yaklaşık 3 yıl izlemlerde, yaşam kalitesi yönüyle konvansiyonel yöntemlerden bir farkı olmadığı tespit edilmiştir [15]. Hastalarımızda tenezm, anal kaşıntı, parsiyel inkontinans gibi yaşam kalitesini düşüren postoperatif problemler görülmedi.…”

Section: Discussionunclassified

“…[9][10][11][12]. Birçok çalışmada, Konvansiyonel Hemoroidektomi (KH) uygulanan hastalarda post operatif ağrıyı azaltma yöntemleri araştırılmış fakat genel kabul edilen bir kanaate varılamamıştır [13][14][15][16]. Longo 1998 de, distal anal kanalda, çoklu eksizyon ve sütür işleminin ağrıya sebep olduğunu açıklamış, tarif ettiği cerrahi müdahale ile operasyon sonrası ağrıyı azaltmış, işe dönüş zamanı ve hastanede kalış süresini kısaltmıştır.…”

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The Clinical Outcome of Stapled Hemorrhoidopexy

Duman¹,

Özdemi̇r²,

Yücel³

et al. 2013

Ann Clin Anal Med

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ÖzetAmaç: Stapler Hemoroidopeksi (SH-Longo yöntemi) yöntemi ile tedavi edilen hastaların post operatif morbidite, rekürrenslerin, analjezik gereksinimlerinin ve hastanede kalış süreleri ile vakalarımızdaki tecrübelerimizi aktarmayı amaçladık. Gereç ve Yöntem: Semptomatik 3, 4. derece hemoroidleri olan hastaların SH ile yapılan tedavileri retrospektif olarak incelendi. Post operatif 1., 4., 7. günlerde rutin olarak anal muayene yapıldı. Post operatif 1., 3., 6., 12. aylarda da kontrol muayeneleri yapıldı. Hastaların demografik verileri, postoperatif analjezik gereksinimleri, operasyon zamanları, hastanede kalış süreleri, komplikasyon verileri, anestezi tipi, tekrarlama sıklığı incelendi. Bulgular: Bu çalışma 6' sı kadın, 50' si erkek toplam 56 hasta üzerinde yapıl-mıştır. Yaş ortalaması 31 olarak bulundu. Ortalama operasyon süresi 38 dk., hastanede kalış süresi ise ortalama 1,8 gün olarak bulundu. 1 yıl süre ile takip edilen hastalardan, 4 kişide üriner retansiyon, 2'sinde mukozal prolapsus, 2'sinde trombüs, 2 vakada anal kanama, 1 kişide nüks gözlenmiştir. Tartışma:Hemoroidal hastalıklarda stapler yöntemi sonuç ve komplikasyonlar yönüyle konvansiyonel yöntemlere göre, iyi bir alternatif yöntemdir. Minimal analjezik kullanımı, kısa süre hastanede yatış ve normal aktiviteye dönüş gibi avantajları olan bu yöntemin dezavantajlarının tespiti için daha çok birikim ve daha uzun süre takibe ihtiyaç vardır. Anahtar KelimelerStapler Hemoroidopeksi; Longo; Hemoroid Abstract Aim: This study was carried out to present our experiences with the patients undergoing stapled hemorrhoidopexy, their postoperative morbidity, the rate of recurrence, analgesic requirements and in-patient hospital stay. Material and Method: Patients with symptomatic third and fourth degree hemorrhoids and having received stapled hemorrhoidopexy were retrospectively analyzed. Fourth and seventh postoperative days, first, third, sixth and twelfth postoperative months, follow-up examinations were performed. The demographic data of patients, the postoperative analgesic requirements, the date of the operation, the duration of hospital stay, the data of complications, frequency of recurrence and type of anesthesia were investigated. Result: This study included totally 56 patients; of these patients, there were 6 women and 50 men. The average age was 31. The average operating time was 38 minutes. Besides, the average length of hospital stay was recorded as 1.8 day. Of the patients who were followed up for one year, four of them was observed to have urinary retention. Also, a mucosal prolapsed was seen in two patients, a thrombus was observed in two patients, anal bleeding was again seen in two patients and one patient had a recurrence. Discussion: Compared with the conventional techniques, stapled hemorrhoidopexy is a good alternative method in treatment of hemorrhoids. This method has the advantages of a minimal analgesic use, shorter hospital stay, a speedier return to normal activities; on the other hand, to be able to determine the disadvantages of staple...

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