Clinical Experience with a Circular Stapled Hemorrhoidopexy without Circular Anal Dilator (CAD)

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Purpose: The circular stapled hemorrhoidopexy (SH) reduces mucosal prolapse and interrupts the end branches of the upper hemorrhoidal artery through a suitable instrument, Procedure for Prolapse and Hemorrhoids (PPH). However, there are some technical difficulties in routine use of the circular anal dilator (CAD). The goal of this study was to evaluate the efficacy and the safety of a CSH without use of a CAD. Methods: Between April 2005 and November 2006, 250 patients with Grade III and IV prolapsed hemorrhoids who had undergone CSH with PPH without using a CAD were retrospectively analyzed. The sex and age, the operation time, the type of anesthesia, the number of excised hemorrhoid piles, the degree of hemorrhoids and postoperative pain (consumed analgesics), the hospital stay, the postoperative complications, and the number of follow-up examinations at the outpatient clinic were analyzed. Results: The operation time was 17.76 minutes (10∼35 minutes). Most patients (89%) experienced spinal anesthesia. The degrees of hemorrhoids were Grade III (45%) and Grade IV (55%). The numbers of excised piles were 3 (44%), 4 (43%), and more than 5 (13%). The number of consumed postoperative analgesics was 0.97 times (mean). The mean hospital stay was 2.83 days. The postoperative complications were pain, bleeding, and urinary retention. Conclusions: A CSH without use of a CAD was an effective and safe surgical modality compared with other procedures for treating hemorrhoids. This procedure is feasible and convenient. The procedure is a new alternative in the treatment of severe hemorrhoids.