Complications after Stapled Hemorrhoidectomy: A Single Center Experience

Background: A circumferential strip of mucosa about 1.5 to 2 centimetres above the dentate line is removed in stapled hemorrhoidectomy, a new technique for haemorrhoids treatments. Objective: The aim of the study was to evaluate complications after stapled hemorrhoidectomy.Methods:A total of 101 patients between the age group 20 to 70 years were diagnosed with grade 3 and grade 4 haemorrhoids. Patients are included in stapled haemorrhoidectomy. The questionnaire focused on stapled hemorrhoidectomy procedures performed in the period July 2018 to June 2020. Descriptive analysis was done based on the student抯 T-test using SPSS 24 software version. The level of significance was set at 5% (p < 0.05).Results:In the 2-years timeframe, out of 101 patients in the Immediate (within 1 week) complications of stapled hemorrhoidectomy, 84.16% were in None, 5.94% were severe pain, 3.96% were bleeding, 1.98% were Thrombosis, 0.99% were urinary retention, 1.98% were Anastomotic dehiscence 0.99% were Fissure, 0.99% were perineal intramural hematoma and 0.99% were submucosal abscess. Out of 90.09% were in none, 1.98% were Recurrent hemorrhoids, 0.99% were Severe pain, Stenosis, Fissure, Skin tag, Thrombosis, Staples problems, Intramural abscess and Intussusception.Conclusion:Although stapled hemorrhoidectomy appears to be promising, we believe that a multicenter randomized controlled trial with a long-term follow-up comparing stapled hemorrhoidectomy and banding is required before the treatment can be recommended. The majority of difficulties can be avoided by following the rectal wall anatomy during the surgery.

recurrent hemorrhoids-efficacy, utility and initial experience with the use of stapled hemorrhoidopexy in recurrent hemorrhoids

Overview: Hemorrhoidal disease (HD) is a common surgical disorder. The treatment modalities can be surgical or nonsurgical. Every surgical option has its own indications and limitations. Postsurgical symptomatic recurrence rates are low and vary between different techniques. The ideal way to deal with recurrent HD is not clear. Material and Methods: The present prospective case series enrolled a total of 87 patients (54male/33 female). Thirteen out of 87 patients (15%) had history of previous intervention for HD. Amodification of the standard technique was adopted for patients with recurrent HD. A mean follow-up of 22 months was achieved. Results: Stapled hemorrhoidectomy (SD)was performedin13patientswho had historyof previous surgical intervention for HD. There were no adverse events related to the technique. Patients with recurrent HD had severe pain scores with SH as compared to patients who underwent SH at the first time. There were no wound related complications. Conclusion: Stapled hemorrhoidectomy can be performed easily and offers good results in patients with recurrent HD. (AU)

Assessment of the Success Rates of Stapled Hemorrhoidopexy Intervention for Grade III and IV Hemorrhoids among Adult Patients of North India: An Observational Hospital-based Study

Introduction: Hemorrhoid disease therapy is effectively been treated with conventional excisional hemorrhoidectomy. Stapledhemorrhoidopexy (SH) revolutionized the traditional surgical approach by the introduction of the theory of dealing with the rectalmucosal prolapse by resecting a mucosal cylinder above the dentate line by means of mechanical stapling. It is a non-excisionalapproach for the surgical treatment of hemorrhoid disease.Materials and Methods: Ethical clearance was obtained from the institution. A total of 100 adult patients with Grade III/IVhemorrhoids indicated for surgery were recruited for the study purpose. Data collected were post-operative pain in the form ofVAS scale, immediate complications, duration, or length of stay in the hospital along with the time to resume work again. SPSS17.0 was used to carry out the analysis. All P < 0.05 were considered to be statistically significant.Results: The mean age of the study group was 45 ± 14.93 years. The mean length of hospital stays, postoperatively for 21%subjects, was mere 1 day; however, it was 2 days for the rest of population studied. The only complication was with 2% of thestudy population having excessive intraoperative bleeding. The mean time to return to work was 8 days. About 77% of thepatients resumed their work within 8 days of surgery.Conclusion: Within the given limitations of the study, we can conclude that SH is a successful procedure for Grade-III/IVhemorrhoids in terms of immediate post-operative complications, pain as well as the duration of hospital stay

Experiencia inicial en el tratamiento quirúrgico de la enfermedad hemorroidal con la engrapadora PPH / First experience in surgical treatment of hemorrhoidal disease using the PPH stapler

Background. Haemorrhoidal disease is a frequent entity worldwide. The surgical management is indicated in third or fourth degree internal hemorrhoidal disease. The conventional hemorrhoidectomy has showed good results but the severe postoperative pain is an important complain. Currently diverse surgical alternatives have been described, mainly to avoid the postoperative pain that follows surgical hemorrhoidectomy. One of these new options is the stapled hemorrhoidectomy using the PPH stapler. This procedure may produce less postoperative pain, with a shorter inpatient stay and faster return to work. Objective. The aim of this paper is to analyze the results of using the Procedure for Prolapsed Hemorrhoids (PPH) as treatment in Hemorrhoidal Disease. Material and methods. This is an observational and descriptive study, where 17 patients underwent stapled hemorrhoidectomy with PPH procedure, between march 2000 and august 2003. Results. 52.8% of this patients presented grade three internal hemorrhoids and 47.2% grade four; 52.9% presented mild postoperative pain; 41.2% moderate and 5.9% severe pain. In a short and median follow up, due to the persistence of hemorrhoidal disease symptoms two patients required surgical re-intervention. Two more patients presented incontinency. One patient presented stenosis in the line of staples treated satisfactory with an anal dilatation session. Conclusions. The use of PPH is a feasible and safe procedure and it could be a surgical alternative in the treatment of hemorrhoidal disease, even before than conventional hemorrhoidectomy.

Introducción. La enfermedad hemorroidal tiene una prevalencia elevada en nuestro medio. El tratamiento quirúrgico está indicado cuando se presenta enfermedad hemorroidal interna grado III y IV. La hemorroidectomía convencional ha demostrado tener buenos resultados; sin embargo, el dolor postoperatorio es un inconveniente frecuente. Por ello se han propuesto otras alternativas entre las que se encuentra la hemorroidectomía con engrapadora (PPH), que puede ocasionar menor dolor postoperatorio y una recuperación más rápida. Objetivo. El objetivo de este trabajo es analizar los resultados a corto y mediano plazos del uso de la engrapadora PPH en la enfermedad hemorroidal. Material y métodos. Se realizó un estudio descriptivo y observacional de 17 pacientes sometidos a tratamiento quirúrgico con engrapadora PPH entre marzo de 2000 a agosto de 2003. Resultados. De los pacientes, 52.8% presentó hemorroides internas grado III y 47.2% grado IV. Presentaron dolor mínimo postoperatorio, 52.9%; 41.2% moderado y 5.9% dolor intenso. Debido a persistencia sintomática dos pacientes fueron reintervenidos quirúrgicamente. Dos más presentaron incontinencia. Un paciente presentó estenosis en la línea de grapas, tratado satisfactoriamente mediante una sesión de dilatación anal. Conclusiones. El empleo de la engrapadora PPH es un método factible y seguro que puede proponerse como una alternativa de elección antes de la hemorroidectomía convencional.

Ferguson versus Stapled Hemorrhoidectomy

PURPOSE: The circular stapled hemorrhoidectomy is a newly introduced treatment modality for hemorrhoids. This study was aimed to prove the clinical efficacy of a stapled hemorrhoidectomy. METHODS: This prospective study analyzed 100 patients who underwent a hemorrhoidectomy from Jan 2002 to June 2004 at Ajou University Hospital. Among them, 50 patents underwent a stapled hemorrhoidectomy and the remaining patients underwent Ferguson's closed hemorrhoidectomy. The surgical severity and the postoperative complications were analyzed based on the medical records. RESULTS: Neither groups showed significant postoperative complications. In the stapled hemorrhoidectomy group, the hospital stay and the mean operation time were shorten during the postoperative period, and the analagesic requirement was lower (P<0.05). CONCLUSIONS: The circular stapled hemorrhoidectomy is safe, less painful, and those related easy to perform. Also, the complications related to this procedure are similar to those related to a conventional hemorrhoidectomy. Considering the advantages, the circular stapled hemorrhoidectomy is an acceptable modalities for hemorrhoids requiring surgical treatment.

Rectovaginal Fistula Complicating Stapled Hemorrhoidectomy

There are few reports on major complications after stapled hemorrhoidectomy, because it recently has been introduced to treat hemorrhoids and rectal mucosal prolapse. This presentation is a case of rectovaginal fistula that developed four days after stapled hemorrhoidectomy which was performed at another clinic. In this case, a relatively simple local repair with layered closure via a transanal approach was used. It worked well and satisfied the patient, while relieving her unpleasant, distressing symptoms. In my opinion, early surgical repair of a relatively large postoperative rectovaginal fistula is valid.

Clinical Expriences of Circumferential Stapled Hemorrhoidectomy

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.

Clinical Expriences of Circumferential Stapled Hemorrhoidectomy

PURPOSE: Conventional hemorrhoidectomy is inevitably painful as a result of an anodermal wound. Circumferential stapled hemorrhoidectomy may be associated with less postoperative pain than conventional hemorrhoidectomy. The aim of this study is to evaluate whether a circumferential stapled hemorrhoidectomy, which uses PPH (Procedure for Prolapse and Hemorrhoids), offers any advantage over the conventional hemorrhoidectomy. METHODS: We analyzed the clinical results of hemorrhoidectomy of 122 patients with symptomatic hemorrhoids. There were two categories of patients: those receiving a circumferential stapled hemorrhoidectomy (n=50) and those receiving a conventional hemorrhoidectomy (n=72). The majority of cases were carried out under spinal anesthesia. The operation time, hospital stay, pain score, complications, and the number of days before returning to normal activity were recorded. A follow up was done using a questionnaire or through a telephone interview two weeks and six weeks after the operation. RESULTS: The mean distance from the dentate line to the completion line of stapling was 1.3+/-0.1 cm. There were two cases of the incomplete doughnut. The circumferential stapled hemorrhoidectomy took less time to perform (20.5+/-4.5 vs. 24.3+/-7.1 min). The mean visual analogue pain score (0~10) on the 2nd day and two weeks after operation was lower in the stapled group (4.1 and 1.5 vs. 6.1 and 3.1)(P<0.05). The stapled group had a shorter duration of hospital stay (4.1 days vs. 5.3 days)(P<0.05) and had a faster recovery to normal activity (7.6 days vs. 13.6 days)(P<0.05). Circumferential stapled hemorrhoidectomy controlled the symptoms of prolapse, pain, and bleeding in all patients. There were 2 cases of urinary retention in both groups, respectively, but there were no postoperative bleeding. CONCLUSION: Even though long term follow up is required, no major complications were observed in our series. The results of our experience for circumferential stapled hemorrhoidectomy appear encouraging. We assume that circumferential stapled hemorrhoidectomy is a safer and faster technique which can replace conventional hemorrhoidectomy techniques.

Circular Stapled Hemorrhoidectomies in the Treatment of Hemorrhoids

The circular stapled hemorrhoidectomy is a new treatment modality for hemorrhoids requiring surgical management. This study reviews the available information concerning the present results of this procedure. A medline search and a review of the literature wene conducted to identify available information on the procedure, with a special attention being given to on-going or published randomized clinical trials. The advantages of circular stapled hemorrhoidectomy were analyzed based on different areas of concern, including postoperative pain, operating time, duration of hospital stay and recovery of normal activity, postoperative wound care, and types and rates of complications. Continence status and patient satisfaction following a circular stapled hemorrhoidectomy are also reported. The circular stapled hemorrhoidectomy is safe, easy to perform, and effective in the treatment of advanced hemorrhoids with an external mucosal prolapse. Other advantages include minimal postoperative complications, easier postoperative management, and a shorter time to return to work congenial to a conventional hemorrhoidectomy. Despite the higher cost and difficult access, this study confirms the feasibility of using a circular stapled hemorrhoidectomy in the treatment of hemorrhoids. The circular stapled hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach. A longer follow-up is required to confirm the true efficacy of this surgical method.

Benefits of Stapled Hemorrhoidectomy Compared with Ultrasonic Dissector and Milligan's Hemorrhoidectomy

PURPOSE: Surgical hemorrhoidectomy has a reputation for being a painful procedure. Many surgical methods have been devised for reducing posthemorrhoidectomy pain. Nevertheless, the result are unsatisfactory. Stapled hemorrhoidectomy is performed without leaving painful perianal wounds. The aim of this study was to assess any benefits, compared among three hemorrhoidectomy methods. METHODS: A total of 150 consecutive patients with 3rd and 4th degree of prolapsed hemorrhoids underwent hemorrhoidectomy with stapler group (n=50) or hemorrhoidectomy with ultrasonic dissector group (n=50) or Milligan's hemorrhoidectomy using by diathermy (n=50) (by same surgeon between January and September 2001). We evaluated the difference among three techniques in operative time, postoperative pain, and patient satisfaction (using visual analogue scale). RESULTS: Mean operative time for hemorrhoidectomy with ultrasonic dissector was 19 minute; for stapler group, it was 18 minute; for Milligan's group, it was 23.6 minute (P<0.05). There was significant difference in operative time between stapler and Milligan's group. There were significant difference in pain measurement reported on immediate (5.8 for stapler, 7.2 for ultrasonic dissector, and 9.2 for Milligan's group, P<0.01), day 1 (4.3, 5.5, and 6.8, P<0.01), day 2 (3.7, 4.7, and 6, P<0.01), day 3 (3.0, 3.6, and 4.6, P<0.01), day 4 (3.1, 3.5, and 4.6, P<0.01), day 5 (2.5, 3.4, and 4.6, P<0.01), day 6 (2.0, 3.2, and 4.3, P<0.01), day 7 (1.8, 3, and 4.2, P<0.01), and defecation (4.0, 7.0, and 8.9, P<0.01). The mean analgesic (piroxicam 20 mg) requirement was 0.3 times for stapler, 1.9 for Ultrasonic dissector, and 3.1 for Milligan's group (P<0.01). Mean hospital stay was 1.6 days for stapler, 1.7 for ultrasonic dissector, 2.8 for Milligan's group (P<0.01). Patient satisfaction on day 7 was 8.2 for stapler, 6.2 for ultrasonic dissector, and 5.2 for Milligan's group (P<0.01). There was no difference in catheterization for urinary retention. It is probably due to spinal anesthesia. CONCLUSION: The study demonstrates significantly reduced postoperative pain and shorter hospital day after stapled hemorrhoidectomy compared among three groups. This resulted in an earlier return to working activities for stapled technique.

Clinical Results of Conventional Versus Circular Stapled Hemorrhoidectomy

PURPOSE: A circular stapled hemorrhoidectomy involves the simultaneous excision of hemorrhoids and wound closure without perianal dissection, thereby eliminating a potential contamination of the anal wound. This study was designed to investigate whether a closed hemorrhoidectomy using the circular stapled technique offers any advantage over the conventional technique. METHODS: Twenty-three patients with prolapsed symptomatic hemorrhoids were treated by either a conventional (n=13) (conventional group) or a circular stapled (n=11) hemorrhoidectomy (stapled group). The operation time was recorded and the excised tissue was examined histologically. The pain score, any complications, the number of days before returning to normal activity and the patients' satisfaction were recorded. A follow up was done using a questionnaire or by telephone interview a week after the operation, and satisfaction was checked a month after the operation. RESULTS: The conventional operation was quicker to perform (mean 23.1 min vs 26.8 min), but did not reach a significant value (P>0.05). In the stapled group, the analgesic requirement was less than for the conventional group (4.4 times vs 6.9 times), but again did not reach a significant value (P>0.05). There were 4 cases of postoperative complications in the conventional group (30.7%) and 3 cases in the stapled group (27.3%) with no significant difference between two groups (P>0.05). The mean pain score was lower in the stapled group (3.5 vs 4.8)(P0.05). CONCLUSION: A circular stapled hemorrhoidectomy is an effective treatment for third and forth degree prolapsed hemorrhoids, offering the significant advantages of reduced postoperative pain and an earlier return to normal activity.