Advertisement

Long-term results after stapled hemorrhoidopexy: a survey study with mean follow-up of 12 years

  • A. Sturiale
  • B. Fabiani
  • C. Menconi
  • D. Cafaro
  • F. Fusco
  • G. Bellio
  • M. Schiano di Visconte
  • G. Naldini
Original Article
  • 58 Downloads

Abstract

Background

Hemorrhoidal prolapse is a common benign disease. The introduction of circular-stapled hemorrhoidopexy as an alternative to the conventional hemorrhoidectomy led to a new spectrum of postoperative outcomes and complications. The aim of the present study was to evaluate long-term results after stapled hemorrhoidopexy.

Methods

All the patients who had stapled hemorrhoidopexy using a PPH03 stapler, from January 2003 to December 2005, were retrospectively collected in a dedicated database. Between March and May 2016, all the patients were asked by phone to complete a questionnaire. The study evaluated anatomical recurrence, symptom recurrence and frequency, and satisfaction after surgery. The postoperative complications recorded were hemorrhage, hematoma, urinary retention, anastomotic stenosis, persistent anal pain, tenesmus, and impaired anal continence evaluated also with the Faecal Incontinence Severity Index score.

Results

One hundred and ninety four patients were identified and 171 completed the questionnaire. The mean follow-up was 12 ± 0.8 years (range 11–13 years). Anatomical self-reported prolapse recurrence was 40.9% (n = 70). In 75.6% (n = 129) of patients, the severity and frequency of symptoms improved. The overall complication rate was 56.7% (n = 40) with a serious adverse event rate of 8.7% (n = 15). The overall tenesmus rate was 38.2% (n = 65) and the overall impaired continence rate was 39.1% (n = 67). Medical therapy was still required occasionally by 40.3% (n = 69) of the patients and 9.3% (n = 16) of the patients underwent surgery for recurrence. Patient satisfaction rate was good (≥ 3 on a scale of 1 to 5) in 81.2% (n = 139) of cases.

Conclusions

The study showed that stapled hemorrhoidopexy using the first-generation devices is safe and feasible but associated with a high recurrence and incontinence rate. More stringent selection criteria in association with the use of large volume devices can lead to better results in the future.

Keywords

Hemorrhoids Hemorrhoidal prolapse Stapled hemorrhoidopexy Prolapsectomy Long-term follow-up 

Notes

Author contributions

Gabriele Naldini, Alessandro Sturiale, and Bernardina Fabiani contribute to the conception and of the study and to the drawing up of the manuscript; Alessandro Sturiale Ferdinando Fusco, Michele Schiano di Visconte, Gabriele Bellio, and Danilo Cafaro contribute to the data acquisition, analysis, and interpretation; Alessandro Sturiale, Claudia Menconi, Bernardina Fabiani, and Gabriele Naldini contribute to the critical revision of the manuscript and to the approval of the version to be published.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All the patients were detailed informed about the aim of the study at the beginning of the phone call and all of the participants answered “yes” to the question “Would you answer the questionnaire and join to this study”.

References

  1. 1.
    Riss S, Weiser FA, Schwameis K, Riss T, Mittlbock M, Steiner G, Stift A (2012) The prevalence of hemorrhoids in adults. Int J Colorectal Dis 27:215–220CrossRefGoogle Scholar
  2. 2.
    Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG (1992) Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 35:477–481CrossRefGoogle Scholar
  3. 3.
    Longo A (1998) Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular-suturing device: a new procedure. In: Proceedings of the sixth world congress of endoscopic surgery, Rome, ItalyGoogle Scholar
  4. 4.
    Naldini G (2011) Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis 13:323–327CrossRefGoogle Scholar
  5. 5.
    Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C (2015) Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol 19:567–575CrossRefGoogle Scholar
  6. 6.
    Nisar PJ, Acheson AG, Neal KR, Scholefield JH (2004) Stapled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 47:1837–1845CrossRefGoogle Scholar
  7. 7.
    Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305CrossRefGoogle Scholar
  8. 8.
    Altomare DF, Roveran A, Pecorella G, Gaj F, Stortini E (2006) The treatment of hemorrhoids: guidelines of the Italian Society of Colorectal Surgery. Tech Coloproctol 10:181–186CrossRefGoogle Scholar
  9. 9.
    Fazio VW, O’Riordain MG, Lavery IC, Church JM, Lau P, Strong SA, Hull T (1999) Long-term functional outcome and quality of life after stapled restorative proctocolectomy. Ann Surg 230:575–584CrossRefGoogle Scholar
  10. 10.
    Rockwood TH, Church JM, Fleshman JW, Kane RL, Mavrantonis C, Thorson AG, Wexner SD, Bliss D, Lowry AC (2000) Fecal Incontinence Quality of Life Scale: quality of life instrument for patients with fecal incontinence. Dis Colon Rectum 43:9–16CrossRefGoogle Scholar
  11. 11.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefGoogle Scholar
  12. 12.
    Abramowitz L, Godeberge P, Staumont G, Soudan D (2001) Recommendations for the treatment of hemorrhoidal disease in clinical practice. Gynecol Obstet Fertil 29:942–951CrossRefGoogle Scholar
  13. 13.
    Naldini G, Martellucci J, Moraldi L, Romano N, Rossi M (2009) Is simple mucosal resection really possible? Considerations about histological findings after stapled hemorrhoidopexy. Int J Colorectal Dis 24:537–541CrossRefGoogle Scholar
  14. 14.
    Festen S, Molthof H, van Geloven AA, Luchters S, Gerhards MF (2012) Predictors of recurrence of prolapse after procedure for prolapse and haemorrhoids. Colorectal Dis 14:989–996CrossRefGoogle Scholar
  15. 15.
    Watson AJ, Hudson J, Wood J, Kilonzo M, Brown SR, McDonald A, Norrie J, Bruhn H, Cook JA (2016) Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial. Lancet 388:2375–2385CrossRefGoogle Scholar
  16. 16.
    Porrett LJ, Porrett JK, Ho YH (2015) Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg 100:44–57CrossRefGoogle Scholar
  17. 17.
    Boccasanta P, Capretti PG, Venturi M, Cioffi U, De SM, Salamina G, Contessini-Avesani E, Peracchia A (2001) Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 182:64–68CrossRefGoogle Scholar
  18. 18.
    Ortiz H, Marzo J, Armendariz P, De MM (2005) Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 48:809–815CrossRefGoogle Scholar
  19. 19.
    Zacharakis E, Kanellos D, Pramateftakis MG, Kanellos I, Angelopoulos S, Mantzoros I, Betsis D (2007) Long-term results after stapled haemorrhoidopexy for fourth-degree haemorrhoids: a prospective study with median follow-up of 6 years. Tech Coloproctol 11:144–147CrossRefGoogle Scholar
  20. 20.
    Kanellos I, Zacharakis E, Kanellos D, Pramateftakis MG, Tsachalis T, Betsis D (2006) Long-term results after stapled haemorrhoidopexy for third-degree haemorrhoids. Tech Coloproctol 10:47–49CrossRefGoogle Scholar
  21. 21.
    Aytac E, Gorgun E, Erem HH, Abbas MA, Hull TL, Remzi FH (2015) Long-term outcomes after circular stapled hemorrhoidopexy versus Ferguson hemorrhoidectomy. Tech Coloproctol 19:653–658CrossRefGoogle Scholar
  22. 22.
    Sultan S, Rabahi N, Etienney I, Atienza P (2010) Stapled haemorrhoidopexy: 6 years’ experience of a referral centre. Colorectal Dis 12:921–926CrossRefGoogle Scholar
  23. 23.
    Arroyo A, Perez-Legaz J, Miranda E, Moya P, Ruiz-Tovar J, Lacueva FJ, Candela F, Calpena R (2011) Long-term clinical results of double-pursestring stapled hemorrhoidopexy in a selected group of patients for the treatment of chronic hemorrhoids. Dis Colon Rectum 54:609–614CrossRefGoogle Scholar
  24. 24.
    Brown S, Tiernan J, Biggs K, Hind D, Shephard N, Bradburn M, Wailoo A, Alshreef A, Swaby L, Watson A, Radley S, Jones O, Skaife P, Agarwal A, Giordano P, Lamah M, Cartmell M, Davies J, Faiz O, Nugent K, Clarke A, MacDonald A, Conaghan P, Ziprin P, Makhija R (2016) The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation. Health Technol Assess 20:1–150CrossRefGoogle Scholar
  25. 25.
    Pucher PH, Sodergren MH, Lord AC, Darzi A, Ziprin P (2013) Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis 15:e284–e294CrossRefGoogle Scholar
  26. 26.
    Wijffels NA, Collinson R, Cunningham C, Lindsey I (2010) What is the natural history of internal rectal prolapse? Colorectal Dis 12:822–830CrossRefGoogle Scholar
  27. 27.
    Brusciano L, Ayabaca SM, Pescatori M, Accarpio GM, Dodi G, Cavallari F, Ravo B, Annibali R (2004) Reinterventions after complicated or failed stapled hemorrhoidopexy. Dis Colon Rectum 47:1846–1851CrossRefGoogle Scholar
  28. 28.
    Cheetham MJ, Cohen CR, Kamm MA, Phillips RK (2003) A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 46:491–497CrossRefGoogle Scholar
  29. 29.
    Tjandra JJ, Chan MK (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50:878–892CrossRefGoogle Scholar
  30. 30.
    Goldstein SD, Meslin KP, Mazza T, Isenberg GA, Fitzgerald J, Richards A, Delong B, Sollenberger L (2007) Stapled hemorrhoidopexy: outcome assessment. Am Surg 73:733–736PubMedGoogle Scholar
  31. 31.
    Khubchandani I, Fealk MH, Reed JF (2009) III: Is there a post-PPH syndrome? Tech Coloproctol 13:141–144CrossRefGoogle Scholar
  32. 32.
    Liu W, Sturiale A, Fabiani B, Giani I, Menconi C, Naldini G (2017) Internal Delorme’s procedure for treating ODS associated with impaired anal continence. Surg Innov 24:566–573CrossRefGoogle Scholar
  33. 33.
    Ganio E, Altomare DF, Milito G, Gabrielli F, Canuti S (2007) Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. Br J Surg 94:1033–1037CrossRefGoogle Scholar
  34. 34.
    Nystrom PO, Qvist N, Raahave D, Lindsey I, Mortensen N (2010) Randomized clinical trial of symptom control after stapled anopexy or diathermy excision for haemorrhoid prolapse. Br J Surg 97:167–176CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018
corrected publication October 2018

Authors and Affiliations

  • A. Sturiale
    • 1
  • B. Fabiani
    • 1
  • C. Menconi
    • 1
  • D. Cafaro
    • 1
  • F. Fusco
    • 1
  • G. Bellio
    • 2
  • M. Schiano di Visconte
    • 2
  • G. Naldini
    • 1
  1. 1.Proctological and Perineal Surgical UnitCisanello University HospitalPisaItaly
  2. 2.Colo-proctological Surgical UnitS. Maria dei Battuti HospitalConeglianoItaly

Personalised recommendations