Implementation of a New High-Volume Circular Stapler in Stapled Anopexy for Hemorrhoidal Disease: Is Patient’s Short-Term Outcome Affected by a Higher Volume of Resected Tissue?

Abstract

Background: Stapled anopexy is a safe technique for the treatment of hemorrhoids but carries a higher risk of recurrence, which might be caused due to the limited volume of resected tissue. In this study, we investigated the introduction of a high-volume circular stapling device; in particular whether an increased amount of resected tissue could affect patients’ short-term postoperative outcome. Methods: Between 2011 and 2015, stapled anopexy was performed for hemorrhoids and/or anal prolapse in 141 patients (n = 25 conventional PPH-3^©-stapler versus n = 116 high-volume CHEX^©-stapler). In this prospectively collected dataset, operation details and short-term postoperative outcome were compared. Results: With the high-volume stapler, a significantly higher amount of tissue was resected: 9.8 g (range 6.2–11.4) vs. 6.4 g (range 4.9–8.8) with the conventional stapler, p < 0.01. Postoperative short-term outcome did not differ in terms of readmission and complication rates. In all 5 patients who underwent a redo operation for residual hemorrhoids or prolapse, the high-volume stapler was used in the primary operation. Conclusion: A high-volume stapling device for stapled anopexy was introduced safely with a significantly higher amount of resected tissue without a worse short-term outcome. However, it remains unclear whether higher stapling volumes may lead to improved long-term outcome with less reinterventions.