Less postoperative pain and more frequent recurrence: Can this dilemma caused by the stapled haemorrhoidopexy procedure be avoided?

Abstract

Although early studies highlighted the advantages of stapled haemorrhoidopexy (SH) (minimal pain and a rapid return to work), long-term follow-up revealed that residual skin tags, external prolapsed haemorrhoids and recurrence were frequent. The aim of our study was to investigate whether the above-mentioned problems could be prevented by performing additional interventions (AIs) during SH. We compared SH with and without AIs in terms of pain, wound-healing time, patient satisfaction and recurrence. A total of 106 patients with Grade III-IV haemorrhoids diagnosed between 2016 and 2018 were included. There were four subgroups: Grade III-IV patients undergoing SH alone or SH+AI. Subgroup 1 (Grade III; SH alone) showed significant decreases in the visual analogue scale pain scores on days 1 and 15 (P=.004), but no significant decreases were found in subgroups 2-4 (P=.839, P=.092, and P=.781, respectively). Satisfaction was highest in subgroup 1 (4.22±1.01), but there was no significant difference in satisfaction among the subgroups (P=.323). The overall recurrence rate was 13.2% and the difference among subgroups was significant (P=.023). Depending on the haemorrhoid characteristics, the use of more than one repair method provides the best results. Although AIs increase pain and wound-healing time, patient counselling enhances long-term satisfaction and success.