Stapled Hemorrhoidopexy Research Articles

Stapled Hemorrhoidopexy: Technique and Long Term Results.

Background: Stapled hemorrhoidopexy (Longo operation) is a infrequent technique in our area. A different concept from hemorrhoidectomy, a proportionally important raise in cost and a special training may have contributed to it. We report our long-term results with the standard technique. Methods: The data of 35 patients with symptomatic second- and third-degree hemorrhoids who had stapled hemorrhoidopexy using a PPH03 stapler, from 01 January 2012 to 04 December 2020, were retrospectively collected. The sex ratio male: female was 3:4 and the mean age 45 (range 28-60) years. The follow-up consisted in a rectal exam and evaluated anatomical recurrence or prolapse. Results: The mean operative time was 42 (30-70) min. The mean parenteral analgesic doses during the first 24 h were 1,52. The mean postoperative hospital stay was 1.55 (1-2) days. A single patient needed reoperation for a staple line bleeding, two patients had a thrombosis of internal hemorrhoids and in one patient a small prolapse was diagnosed at 3 months follow-up. No hematoma, anastomotic stenosis, persistent anal pain, tenesmus, or impaired anal continence was recorded. One patient mentioned discomfort related to the presence of staples. Patients were followed-up for 6 (1-9) years. Global satisfaction rate was 94%. Conclusion: Stapled hemorrhoidopexy procedure is a safe and feasible procedure, which necessitates few analgesics and allows an early discharge. A rigorous selection of cases and a correct surgical technique allow to obtain good long-term results and offer a high level of patients satisfaction.

Treatment Options for Chronic Hemorrhoids

The paper provides an overview of various treatment options for chronic hemorrhoids based on current national and international recommendations. The publication describes the basic principles of effective conservative therapy of the disease. Methods of minimally invasive treatment options for chronic hemorrhoids are given in details: sclerotherapy, infrared coagulation, latex ligation; advantages and disadvantages of each of these methods are highlighted. Literature data indicate that surgical removal of hemorrhoids remains an effective method of treatment for patients with hemorrhoids stage III IV, who underwent unsuccessful minimally invasive procedures. The characteristics of possible complications after hemorrhoidectomy and the frequency of their occurrence are also given. The authors analyze results of using stapler hemorrhoidopexy and the technique of Doppler-controlled ligation of hemorrhoidal arteries. Despite the variety of techniques, it remains relevant to search for further treatment options for chronic hemorrhoids in order to choose an effective individual treatment tactics for each patient, taking into account various manifestations of hemorrhoidal disease.

AN OBSERVATIONAL COMPARATIVE STUDY OF STAPLER HEMORRHOIDOPEXY AND THE MILLIGAN MORGAN OPEN HEMORRHOIDECTOMY IN TERTIARY CARE CENTER OF CENTRAL INDIA

Introduction: Hemorrhoids also called piles. It is vascular structures in the analcanal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed. the unqualified term "hemorrhoid" is often used to refer to the disease. Material and method: The present study was conducted in the Department of Surgery, Sri Aurobindo Medical College & PG Institute Indore M.P over a duration of one and half years (November 2017 to May 2019). The study was a cross-sectional prospective study and it compares results between Milligan Morgan haemorrhoidectomy and Stapler haemorrhoidopexy for the management of grade 2, 3, and 4 hemorrhoids. Results: In this study, most of the cases were between age group 30-50 [50%] years with the mean age being 43 years. Hemorrhoids more common in males 30 [65%], male: female ratio being 3:1. The most common presentation in hemorrhoids was bleeding per rectum in 47% followed by something coming out per rectum in 43 % & painful defecation in 10 % cases respectively. The duration of surgery was significantly low in the stapler group with meantime being 44.25 compared to open group 63 with the mean difference being 19 mins (P < 0.001). In 17of 21 [85%] whereas in grade IV all 09 [100%] patients had open surgery grade III had mixed options 03/07 [30/70 %] stapler & open respectively. Postoperatively the mean duration of hospital stay in stapler group was 4.15± 1.03 as compared to the open group 6.05 ± 1.84 with the mean difference being 2 days (P<0.001). The duration of recovery was significantly faster in stapler group with the mean hospital stay being 7.55 as compared to the open group 12.45 with mean difference being 5 days(P<0.001). Postoperative bleeding was found in both the groups which eventually subsided completely in stapler group on POD - 7 and only 3[7.5%]. Patients had bleeding on POD – 7 in the open group. (P < 0.001). The findings were statistically significant as suggested by P-Value. Urinary Retention was found in both groups i.e. 5% and 7.5% in stapler and open group respectively. (P= 0.632). Conclusion: The results of this study concluded that Stapler hemorrhoidopexy had lesser operating time, lower duration of hospital stays, and quicker recovery with less postoperative pain & bleeding as compared to Open hemorrhoidectomy. Hence it was concluded that stapler hemorrhoidopexy is a better option as compared to open hemorrhoidectomyfor grade II. grade III, & a few selected cases of grade IV hemorrhoids. patients stapler procedure was choice in grade II haemorrhoids.

Severe Postoperative Bleeding After Stapled Hemorrhoidopexy: Incidence and Causes

Severe postoperative bleeding (SPB) represents a major issue of stapled hemorrhoidopexy (SH). The aim of the study is to assess SPB events over last 6 years. This essay is a retrospective study of clinical records on SH patients over a 6-year period 2012–2018 in the First Affiliated Hospital of a university. SPB events and other serious complications are assessed. A total of 41 of 3350 SH patients experienced SPB events and 49 SPB episodes (98%, 49/50) occurred within 14 postoperative days. Of the 41 SPB patients, 37 were discharged, 28 were identified as anastomotic bleeding, and 34 had an average Hb decrease of 33.9 g/l (range, 5–90 g/l). Univariate and multivariate analyses show the statistical significance between the SPB events and variables of surgeon group (p = 0.017 < 0.05), constipation (p = 0.030 < 0.05) and incarcerated hemorrhoid (p = 0.015 < 0.05). No postoperative mortality, rectal perforation, extrarectal/abdominal hemorrhage, and severe pelvic infection have been reported. SPB’s incidence is 1.25% and usually occurs within 2 weeks after SH. Patients with incarcerated hemorrhoid or constipation are more prone to SPB events, and extensive surgical experience can significantly reduce SPB events.

The comparative study of conventional vs stapled haemorrhoidectomy

Background: Several comparative studies are reported in Literature to define a standard for ideal treatment of hemorrhoidal disease. Radical surgery is the only therapeutic option in case of III and IV stage haemorrhoids. Hemorrhoids surgical techniques are classified as Open, Closed and Stapled ones. This study was done to compare the postoperative recovery and complications of PPH and conventional MMH. Materials & Methods: 30 patients with haemorrhoids were managed with surgical ligation and excision of haemorrhoids i.e. by the Milligan-Morgan technique (Group I) and the remaining 30 were managed with stapled haemorrhoidectomy, which was performed by Longo’s technique (Group II). Postoperatively, the patients were properly assessed for the degree of pain according to VAS pain scale, number of analgesics consumed, any urinary retention, first bowel action postoperatively, any haemorrhage or urinary or faecal incontinence. Results: The maximum number of patients were seen in the age group 30-40 years i.e. 18 (30%), of which 14 (23.33%) were male and 4 (6.66%) were female. Analgesics required during hospitalization was 12.33 in group I and 4 in group II, acute urine retention was seen in 8 in group I and 4 in group II, pain (vas) on day 1 was 8.6 in group I and 6.6 in group II, D2 was 6.8 in group I and 3.2 in group III and on day 3 was 5.5 in group I and 2.6 in group II. Hospital stay was 4.37 days in group I and 1.9 days in group II. Post- operative complications was reactionary haemorrhage 2 in group I, secondary haemorrhage 1 in group I and faecal Incontinence 2 in group I and 1 in group II. The difference was significant (P< 0.05). Stapler technique has significantly less requirement of analgesics on day 21, 6 weeks and 3 months compared to conventional technique. More satisfaction in the stapled haemorrhoidectomy group patients indicates that the merits of the stapled technique outweigh those of the conventional technique. Conclusion: Authors found stapled haemorrhoidectomy make it a better technique than the conventional haemorrhoidectomy for managing grade II and grade III hemorrhoids such as lesser operating time, postoperative pain, analgesics required, complications like postoperative urinary retention, postoperative hemorrhage and urinary or faecal incontinence.

Our Experience of Stapler Hemorrhoidopexy in the Treatment of Hemorrhoids.

Purpose: Hemorrhoid surgeries performed with stapler hemorrhoidopexy are frequently preferred in the treatment of patients with stage III-IV hemorrhoids, with less pain and shorter hospital stay. The aim of this study is to evaluate our clinical experiences in patients underwent SH.

Superior rectal artery embolization for bleeding internal hemorrhoids.

The aim of the present study was to evaluate clinical efficacy and safety of superselective embolization of the superior rectal artery (SRA) for the treatment of internal hemorrhoidal bleeding. Patients with stage II and stage III internal hemorrhoids, treated by interventional embolization of the SRA in our department between January 2017 and June 2019 were retrospectively evaluated. All patients suffering from disabling chronic hematochezia and some with relative contraindications for operation (n = 17) orrejectionofconventional hemorrhoidectomy (n = 15). Superselective SRA branch embolization was performed using gelatin sponge particles (350-560μm) and metallic coils (2-3mm). This treatment process was planned by a multidisciplinary team consisting of proctologist,gastroenterologist and radiologist. The surgical efficacy, postoperative complications and follow-up outcomes were observed. There were 32 patients (18 males, mean age 52 ± 12years, range: 22-78years), 12 (37%) with stage II hemorrhoids and 20 (63%) with stage III hemorrhoids. Embolization was successful in all patients, and bleeding symptoms resolved in 27 (84.4%) patients. The remaining 5 (15.6%) patients underwent either stapled hemorrhoidopexy (n = 4) or sclerotherapy (n = 1). Some patients experienced different degrees of pain (n = 4;12.5%), low fever (n = 11;34.4%), and tenesmus (n = 17;53.1%), which all spontaneously regressed without further treatment. All patients were followed up for at least 1year. There were no serious complications, such as infection, intestinal ischemia or massive hemorrhage. Four patients (14.8%) had rebleeding during the first months of follow-up. All patients with re-bleeding were successfully treated with internal iliac arteriography and branch embolization and did not experience further bleeds after a minimum follow up 3months follow-up. The short-term efficacy of superselective SRA embolization for grade II-III internal hemorrhoids is good, and this method is safe and feasible.

To study postoperative complications between circular stapler hemorrhoidopexy and conventional hemorrhoidectomy

Method: Per-rectal examination with gentle dilatation done after lubrication with xylocaine jelly. Rigid sigmoidoscopy is done to look for any pathology in recto sigmoid region. After doing preliminary painting and draping anal verge is held by three atraumatic forceps at the three points where the prolapse is smaller and the anoderm is slightly everted. Such a maneuver facilitates the introduction of circular anal dilator (CAD 33) after lubrication with xylocaine-Jelly. The introduction of the circular anal dilator-33 along with the obturator cause the reduction of the prolapse of the anoderm and points of anal mucous membrane. After removing the obturator prolapsed. All remaining prolapsing tissue should be pushed back with atraumatic forceps through the window of the circular anal dilator-33.Result: The comparison of mean age between the open hemorrhoidectomy and stapler hemorrhoidopexy groups. The mean age in the open hemorrhoidectomy group was 41.00 ± 6.47 years and in the stapler hemorrhoidopexy group was 41.55 ± 11.38 years. The comparison of age between the two groups was found to be statistically not significant (p>0.05), showing a comparable age between the two groups. Reactionary hemorrhage was seen in 30% patients of open hemorrhoidectomy, while it was seen in 20% patients of stapler hemorrhoidopexy group. There was a statistically no significant association seen between reactionary hemorrhage and the groups (p>0.05), showing a comparable distribution of patients with reactionary hemorrhage in both the groups.Conclusion: In stapler hemorrhoidopexy functional outcome is good as compared to conventional hemorrhoidectomy. Stapler hemorrhoidopexy is associated with less morbidity with fewer complications due to minimal tissue trauma and handling. Although the conventional hemorrhoidectomy is still performed in many higher centers but in this era of minimal invasive surgery the stapler hemorrhoidopexy is fast replacing the conventional hemorrhoidopexy.

Perirectal Hematoma and Intra-Abdominal Bleeding after Stapled Hemorrhoidopexy and STARR-A Proposal for a Decision-Making Algorithm.

Background and Objectives: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. Materials and methods: A systematic literature review was performed that combined the published and the obtained original data after a search of PubMed, Web of Science, and SCOPUS. Results: The present systematic review includes 16 articles with 37 patients. Twelve papers report perirectal and six report intra-abdominal bleeding. Stapled hemorrhoidopexy (SH) was performed in 57% of cases (3 PPH 01 and 15 PPH 03), stapled transanal rectal resection (STARR) in 13%, and for 30% information was not available. The median age was 49 years (±11.43). The sign and symptoms of perirectal bleeding were abdominal pain (43%), pelvic discomfort without rectal bleeding (36%), urinary retention (14%), and external rectal bleeding (21%). The median time to bleeding was 1 day (±1.53 postoperative days), with median hemoglobin at diagnosis 8.8 ± 1.04 g/dL. Unstable hemodynamic was reported in 19%. Computed tomography scan (CT) was the first examination in 77%. Only two cases underwent the abdominal US, but subsequently, a CT scan was also conducted. Non-operative management was performed in 38% (n = 14) with selective arteriography and percutaneous angioembolization in two cases. A surgical treatment was performed in 23 cases—transabdominal surgery (3 colostomies, 1 Hartmann’ procedure, 1 low anterior resection of the rectum, 1 bilateral ligation of internal iliac artery and 1 ligation of vessels located at the rectal wall), transanal surgery (n = 13), a perineal incision in one, and CT-guided paracoccygeal drainage in one. Conclusions: Because of the rarity and lack of experience, no uniform tactic for the treatment of perirectal hematomas exists in the literature. We propose an algorithm similar to the approach in pelvic trauma, based on two main pillars—hemodynamic stability and the finding of contrast CT.

Promising new technique for treatment of hemorrhoids- Our experience

Background: Stapled Hemorrhoidopexy (SH) is a new technique with less pain than conventional hemorrhoidectomy and can be used in the management of second, third and fourth degree hemorrhoidal disease.&#x0D; Objective: To show the effectiveness of Stapled Hemorrhoidopexy as a treatment option of symptomatic hemorrhoid.&#x0D; Methods: This is an observational study. The medical records of 72 patients who had under gone Stapled Hemorrhoidopexy for symptomatic hemorrhoid disease from July 2011 to June 2013 in BIRDEM General Hospital under a same surgeon were evaluated. Data regarding postoperative pain, early and late postoperative outcome were recorded. Patient's satisfaction assessed at 18 months follow up.&#x0D; Results: The study included 72 patients (50 men, 22 women) between 22 - 74 years of age (median age 39 years). The operating time was around 35 minutes. The median hospital stay was 40 hours (11- 72 hours). Early complications were fecal urgency (13.8%), urinary retention (22%), and rectal bleeding (2.77%). Late complication was pruritus ani (12.5%), thrombosis external hemorrhoids (1.38%), staple line stenosis (1.38%), recurrent hemorrhoid (2.77%), anal fissure (2.77%), and persistent mucous discharge (5.55%). The recurrence rate was 2.77% at 18 months follow up.&#x0D; Conclusion: Stapled hemorrhoidopexy can be safely performed with low recurrence and complication rates while offering a relatively painless postoperative period for the patient.&#x0D; Journal of Surgical Sciences (2017) Vol. 21 (2): 65-69

Prospective Comparative Analysis of the Incidence of Vasovagal Reaction and the Effect of Rectal Submucosal Lidocaine Injection in Stapled Hemorrhoidopexy: A Randomized Controlled Trial.

PurposeThis study was performed to evaluate the incidence of vasovagal reactions (VVRs) and the efficacy of lidocaine injection for prevention.MethodsOne hundred seventeen patients diagnosed with hemorrhoids and scheduled to undergo a stapled hemorrhoidopexy (SH) were randomly divided according to submucosal injection to the rectum: lidocaine group (n = 53, lidocaine injected just before full closure of the stapler) and control group (n = 58). Outcomes included baseline patient characteristics (American Society of Anesthesiologists physical status classification, body mass index, diabetes mellitus, hypertension, and previous VVR history), vital signs during the operation, incidence of VVRs (hypotension, bradycardia, dizziness, diaphoresis, and nausea/vomiting), and postoperative complications (pain, bleeding, and urinary retention).ResultsBaseline characteristics were similar between groups. The number of patients with lower abdominal pain after firing the stapler and incidence of dizziness were lower for the lidocaine group than for the control group (9.4% vs. 25.9%, P = 0.017; 0% vs. 8.6%, P = 0.035, respectively). However, there were no significant between-group differences in incidence of nausea and diaphoresis (0% vs. 3.4%, P = 0.172) and syncope (1.9% vs. 3.4%, P = 0.612). Fewer patients in the lidocaine group complained of postoperative pain (41.5% vs. 58.6%, P = 0.072), and these patients used analgesics less frequently than those in the control group (28.3% vs. 36.2%, P = 0.374).ConclusionPatients who received a submucosal lidocaine injection prior to SH experienced less lower abdominal pain and dizziness compared with those who received standard treatment. A larger, more detailed prospective study is needed for further analysis.

Complications of stapled hemorrhoidectomy

Background: Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. Immediate complications (first week) were: severe pain in all patients, bleeding, thrombosis, urinary retention, anastomotic Dehiscence, fissurePerineal intramural hematoma, and submucosal abscess The most common complication after 1 week was recurrence of hemorrhoids in of patients, severe pain, stenosis, fissure, bleeding, skin tag, thrombosis, papillary hypertrophy, fecal urgency, staples problems, gas flatus and fecal incontinence, intramural abscess, partial dehiscence, mucosal septum, and intussusceptions. The most common complication in the first 25 cases of the surgeon’s experience was the pain. Even though SH and banding are necessary before recommending the procedure. It was a prospective and retrograde study conducted in R.D. Gardi Medical College, Ujjain. Study Duration was from November 2017 to November 2019. All the patients who were post-op (stapled hemorrhoidectomy) case of hemorrhoid disease. The total number of patients operated with stapled hemorrhoidectomy in the 2 years period (2017-2019) was 400.

Postoperative recovery; Stapled Hemorrhoidopexy versus Conventional haemorrhoidectomy.

Conventional haemorrhoidectomy, a usual procedure for hemorrhoids in our set up have many short and long term complications. Some patients complained pain many weeks after surgery and are unable to do their routine work. Anal stenosis and recurrence are long term issues. There is need for some other procedure which can decrease postoperative pain and hospital stay. Objectives: To compare the postoperative recovery between stapled hemorrhoidopexy and conventional hemorrhoidectomy. Study Design: Randomized Clinical trial. Setting: Surgery Department of Nishtar Medical University Multan. Period: from 01-01-2018 to 31-12-2018. Material &amp; Methods: Randomly 02 equal groups of the patients, A and B were made. Stapled hemorrhoidopexy (SH) and conventional haemorrhoidectomy was done in group A and B respectively. SPSS version 20 used for data analysis. Mean and standard deviation were used for quantitative variables including postoperative pain, age and hospital stay. Independent Student t test used for comparison of hospital stay and postoperative pain. Effect modifier including gender, age, duration and grade of hemorrhoids were controlled by stratification and Chi square test was applied. P value less than 0.05 was taken as significant. Results: Out of 60 patients, 32 were males and 28 females. In Group A (Stapled Hemorrhoidopexy), mean age was 37.37 + 6.36 years and 39.17 + 5.53 years in Group-B. Postoperative pain in Group A was 3.60 + 1.27 and 6.03 + 1.73 in Group B. Postoperative pain was significantly high in Group B (CH) and P value =0.000. Mean hospital stay was 0.90 + 0.48 days in Group A and 1.87 + 0.57 days in Group B with P value= 0.000. Conclusion: Stapled hemorrhoidopexy is associated with shorter hospital stay and decrease postoperative pain irrespective of age, sex and grade of the hemorrhoids.

Surgical outcome and ethics in adopting new surgical technique in low resource settings: A case study in haemorrhoid surgery

Introduction: Our aim was to evaluate the surgical outcome and ethical considerations in adopting stapled hemorrhoidopexy (SH) in low-resource settings. Methods: This prospective comparative study of patients with Grade III hemorrhoids was conducted at our institute from December 2017 to July 2019. Short-term surgical outcome and the results of a short questionnaire associated with ethics were evaluated. Results: Sixty patients were operated on for third-degree hemorrhoids, thirty each in Group conventional hemorrhoidectomy (CH) and Group SH. The SH group had better postoperative pain control at 0, 1, and 4 weeks (P = 0.001), but this difference became insignificant at 12 weeks. Overall recurrence was more in SH group (11.37%) as compared to CH group (2.7%), and it was statistically significant (P = 0.01). The mean operative time was significantly less in the SH group (43 min vs. 50 min, P = 0.006). Similarly, the mean hospital stay was significantly less in the SH group as compared to the CH group (2.27 days vs. 3.83 days, P = 0.001). Survey of the operating surgeons revealed that all the three surgeons involved assessed the effectiveness and safety of SH through literature; the main motivation behind performing new technique in resource-poor settings was learning a new technique and teaching purpose. Conclusion: The main value of this research is to describe the adoption of surgical stapler into clinical practice in low-resource settings. Our analysis suggests that, in a rapidly developing area of surgical innovation, adoption of SH in resource-poor settings can give the same outcome as in expert hands.

Stapled hemorrhoidopexy: A single-center 8 years' experience

Purpose: Stapled hemorrhoidopexy (SH) is associated with shorter operative time, reduced inpatient stay, less pain, and earlier return to normal activities. The present study was conducted to assess the clinical consequences of SH and to establish the suitability of SH for all patients of grade III or IV hemorrhoids.Patients and Methods: This study included 250 patients who underwent SH at Aarogya Hospital, Raipur, India, from January 1, 2012 to December 31, 2017 and follow-up completed on December 31, 2019. SH procedure was performed according to the LONGO technique. The pain was assessed using a visual analog scale (VAS). Patients were followed up after 1 week, then monthly for 2 months, and 6 monthly for 2 years.Results: There were 163 males (65.2%) and 87 (34.8) females. Preoperatively, 87.2% of cases had anal bleeding, constipation in 73.2% cases, and associated pain in 52.4% cases. Operative time duration ranged between 25 and 50 min. Two-hundred and twenty-one (88.4%) patients were discharged within 24 h postoperatively and remaining within 48 h.Discussion: The most important advantage of SH as cited by various studies is a profound reduction in postoperative pain analgesia requirement and better quality of life. The postoperative pain rapidly decreased in severity to the VAS score of 2, in 73.6 cases within 24 h, facilitating early discharge of the patients our recurrence rates were nil in SH.Conclusion: Our study demonstrates that SH is a safe, effective, and well-tolerated procedure with minimum postoperative pain and complication rates.

Who needs a stapling device for haemorrhoidectomy, if one has the radiofrequency device?

Abstract Background Multiple operations exist to treat haemorrhoids. Although comparisons of conventional excision and other techniques have been performed, there are less comparative outcome data available for stapled haemorrhoidopexy (SH) and radiofrequency haemorrhoidectomy (RFH). Use of a radiofrequency energy device for haemorrhoidectomy is an alternative to standard diathermy, scissors or scalpel. It provides vessel sealing between the jaws of the instrument and aims to minimise wider tissue damage. Objective To systematically review the literature comparing SH and RFH, assessing complications, outcomes, patient experience and costs. Methods A tailored search of medical databases identified literature containing relevant primary and secondary data comparing SH and RFH. Papers were screened for relevance and completeness of published data. Those missing methodological information, outcome data or statistical analysis were subsequently excluded. A narrative review was then performed. Results The primary data in this review originate from six randomised control trials (RCTs) and five meta-analyses. Evidence was conflicting, with a trend towards more early postoperative pain in the RFH vs. the SH group (three RCTs reported increased early pain scores in the RFH group). Significantly higher rates of residual and recurrent haemorrhoids and prolapse in the SH group were observed in two RCTs and four meta-analyses. Bleeding, urinary retention, incontinence and anal stenosis did not significantly differ. No detailed contemporary cost analysis was found. Conclusion The trials are small, with significant heterogeneity in the techniques used and outcome data recorded. However, despite the limited available evidence, RFH appears superior to SH due to significantly lower rates of residual and recurrent haemorrhoids and prolapse.

Analysis of stapled hemorrhoidopexy outcomes: A single-institution based study

Background: Although traditional surgery is the gold standard treatment for hemorrhoids, stapled hemorrhoidopexy (SH) is an alternative surgical technique. However, this technique has concerns of recurrence. We conducted this study to assess the clinical outcomes and complications of SH in patients visiting our institutionMethods: A prospective study was conducted on 115 patients from 2010 to 2012 who underwent SH with PPH03 kit under spinal anesthesia. Clinical outcomes assessed included the operation time, hospital stay and rate of post-operative pain.Results: SH had lower operative procedural time (30 minutes), post- operative pain and hospital stay (1.8 days) along with minimal procedural complications and were comparable to the previous reports.Conclusions: Stapled hemorrhoidopexy is an effective alternative to traditional surgical technique in treating 3rd and 4th degree hemorrhoids, in terms of lesser operative procedural time, post-operative pain, use of analgesics and hospital stay along with reduced procedure related complication.

Comparison between circular stapler hemorrhoidopexy and conventional hemorrhoidectomy with regards to duration of surgery

Background: The aim of the study is to compare circular Stapler Hemorrhoidopexy and Conventional Hemorrhoidectomy with regards to duration of Surgery, conducted in the Department of Surgery, Bundelkhand Medical College, Sagar. Result: The comparison of mean duration of surgery between the open hemorrhoidectomy and stapler hemorrhoidopexy groups. The mean duration of surgery in the open hemorrhoidectomy group was 43.55 ± 5.39 minutes and in the stapler hemorrhoidopexy group was 30.05 ± 2.65 minutes. The comparison of mean duration of surgery between the two groups was found to be statistically significant (p

Postoperative Pain as a Decision-Making Tool in Treating Hemorrhoids on an In- or Out-Patient Basis After Stapled Mucosectomy (Longo Procedure)

ObjectiveStapled mucosectomy (Longo operation) is a frequently used procedure for the treatment of hemorrhoidal disease. It is a simple procedure yet similar to resective techniques for patients who frequently suffer from relevant postoperative pain. The aim of our present study is to examine patient satisfaction based on the operative setting (outpatient versus inpatient treatment) in patients undergoing the Longo operation for Grade III or IV hemorrhoids.Materials and methodsOutcomes of all patients undergoing stapled mucosectomy for Grade III and IV hemorrhoids at 3 different Swiss public hospitals was analyzed retrospectively and compared with respect to in- or outpatient treatment. Patient satisfaction was recorded by subsequent telephone interviews.ResultsFrom a total of 213 patients with stapled mucosectomies, datasets of 144 patients (67.6%) were available for full analysis. A total of 124 patients (86.1%) were satisfied with the treatment and 110 (76%) would choose to undergo the Longo procedure again (P &amp;lt; 0.01). Recurrence of recurrent hemorrhoidal symptoms is negatively correlated with the willingness of undergoing the Longo procedure again (r = −0.187, P = 0.025). Patient satisfaction was not associated with the operative setting (inpatient vs. out-patient setting). Postoperative pain increased the willingness to be hospitalized overnight (r = 0.227, P &amp;lt; 0.01).ConclusionPatient satisfaction after stapled mucosectomy is mainly related to postoperative pain and recurrence of hemorrhoidal symptoms regardless of inpatient or outpatient treatment.

Which is better: stapler haemorrhoidopexy vs traditional excisional surgery?

Background: Haemorrhoids are tortuous dilated veins within the submucosa of anal canal. They are external, internal or internoexternal. External haemorrhoids cause pain. Internal haemorrhoids are characterised by painless bleeding or prolapse. Various treatment options are available- dietary modification, band ligation, sclerosant therapy, cryosurgery, traditional excisional surgery (Milligan/Ferguson), stapler haemorrhoidopexy, Doppler guided haemorrhoidal artery ligation (DGHAL), application of harmonicscalpel and ligasure.Methods: Adult patients (&gt;18 yrs) with grade II, III &amp; grade IV haemorrhoids are randomly allotted in equal numbers to receive either stapler haemorrhoidopexy or traditional excisional surgery from July 2017 to December 2018. Post-operative complications, pain (using visual analogue scale), recurrence rate and the need for further surgery with these procedures were analysed in this 1 and half year study period.Results: Patients who underwent stapler haemorrhoidopexy had better temporary quality of life, but patients who underwent traditional excisional surgery had lesser recurrence.Conclusions: Overall, traditional excisional surgery should be the choice when compared to stapler haemorrhoidopexy.