The Significance of Staple Line Height in a Stapled Hemorrhoidopexy

ABSTRACT

PURPOSE: In 1998, Longo introduced a novel operative technique for hemorrhoids. That technique uses a prolapse and hemorrhoid (PPH) stapler. His results showed minimal pain, short hospital stay, and rapid return to normal social life. However, a higher height of staple line yields less postoperative pain, but more residual piles, and vice versa. This study was designed to find the optimal height of the staple line for a PPH hemorrhoidopexy. METHODS: A total of 65 consecutive patients scheduled for a PPH hemorrhoidopexy on grade II or higher internal hemorrhoids were included in this study. The hemorrhoidopexy was performed as in the literature. A purse-string suture was made 5 cm from the anal verge. Remaining piles were excised immediately after the firing of the PPH stapler. Patients were divided into 2 groups. In group A, the staple line was located above 2 cm proximal to the dentate line, and in group B, it was located below 2 cm proximal to the dentate line. RESULTS: The mean subjective pain score of group A was 2.00, and that of group B was 1.98 (P=0.898). The mean hospital stay of group A was 2.5 days, and that of group B was 2.7 days (P=0.431). Group A returned to normal life in a mean of 7.1 days whereas group B returned to normal life in a mean of 6.8 days (P=0.474). Complications included 6 cases of voiding difficulty, 3 cases of heavy sensation in anus, 1 case of temporary fecal incontinence, and 1 case of anal pain caused by long-standing residual staples. CONCLUSION: No meaningful relationship was found to exist between the staple line height and either pain or the number of days to return to normal life. However, the incidence of residual piles was lower in cases with a low staple line height. Therefore, the level of the staple line should be lower than it is for a conventional Longo procedure.