Journal of Gastrointestinal Surgery

, Volume 11, Issue 12, pp 1654–1661 | Cite as

Stapled Hemorrhoidectomy versus Conventional Excision Hemorrhoidectomy for Acute Hemorrhoidal Crisis

  • Huang-Jen Lai
  • Shu-Wen Jao
  • Chin-Cheng Su
  • Ming-Che Lee
  • Jung-Cheng Kang


We compared the safety and clinical outcomes of stapled hemorrhoidectomy and conventional excision hemorrhoidectomy in the treatment of acute hemorrhoidal crisis, and analyzed various factors associated with complications in stapled hemorrhoidectomy. Forty patients underwent stapled hemorrhoidectomy and forty underwent conventional excision hemorrhoidectomy. All had the operation under local anesthesia with conscious sedation within 24 h of admission. The length of surgery, hospital stay, disability, postoperative pain, and the use of analgesics were significantly less for patients in the stapled hemorrhoidectomy group. Stapled hemorrhoidectomy did not significantly increase the rate of complications. Five patients in the stapled group (12.5%) required further surgical intervention: three with thrombosed hemorrhoids and two with recurrent prolapse. No serious complications were reported in either group. Patient satisfaction was similar in the two groups. Increased age was identified as a factor that significantly elevated the risk of complications in the stapled group (OR, 1.06; 95% CI, 1.01–1.13). Anemia and time between the onset of prolapsed hemorrhoids and hospital admission were also risk factors for complications, although they were not significant. Stapled hemorrhoidectomy is a feasible treatment for selected patients with an acute hemorrhoidal crisis and has a similar complication rate to that of conventional excision hemorrhoidectomy. Stapled hemorrhoidectomy is superior in less-postoperative pain, shorter operation time, shorter hospital stay, and earlier return to normal activity. However, we suggest that older patients with anemia or a prolonged hemorrhoidal crisis are unsuitable for stapled hemorrhoidectomy.


Procedure for prolapse and hemorrhoids Stapled hemorrhoidectomy Hemorrhoids Crisis 


  1. 1.
    Nieves PM, Perez J, Suarez JA. Hemorrhoidectomy—how I do it: experience with the St. Mark’s Hospital technique for emergency hemorrhoidectomy. Dis Colon Rectum 1977;20:197–201.PubMedCrossRefGoogle Scholar
  2. 2.
    Eisenstat T, Salvati EP, Rubin RJ. The outpatient management of acute hemorrhoidal disease. Dis Colon Rectum 1979;22:315–317.PubMedCrossRefGoogle Scholar
  3. 3.
    Grace RH, Creed A. Prolapsing thrombosed haemorrhoids: outcome of conservative management. Br Med J 1975;3:354.PubMedCrossRefGoogle Scholar
  4. 4.
    Ceulemans R, Creve U, Van Hee R, Martens C, Wuyts FL. Benefit of emergency haemorrhoidectomy: a comparison with results after elective operations. Eur J Surg 2000;166:808–812.PubMedCrossRefGoogle Scholar
  5. 5.
    Eu KW, Seow-Choen F, Goh HS. Comparison of emergency and elective haemorrhoidectomy. Br J Surg 1994;81:308–310.PubMedCrossRefGoogle Scholar
  6. 6.
    Mazier WP. Emergency hemorrhoidectomy—a worthwhile procedure. Dis Colon Rectum 1973;16:200–205.PubMedCrossRefGoogle Scholar
  7. 7.
    Longo A. Treatment of haemorrhoidal disease by reduction of mucosa and haemorrhoidal prolapse with a circular stapling device: a new procedure. 6th World Congress of Endoscopic Surgery. Mundozzi Editore 1998;777–784.Google Scholar
  8. 8.
    Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomized controlled trial. Lancet 2000;355:779–781.PubMedCrossRefGoogle Scholar
  9. 9.
    Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg 2001;88:669–674.PubMedCrossRefGoogle Scholar
  10. 10.
    Wilson MS, Pope V, Doran HE, Fearn SJ, Brough WA. Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial. Dis Colon Rectum 2002;45:1437–1444.PubMedCrossRefGoogle Scholar
  11. 11.
    Cheetham MJ, Cohen CR, Kamm MA, Phillips RK. A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 2003;46:491–497.PubMedCrossRefGoogle Scholar
  12. 12.
    Singer MA, Cintron JR, Fleshman JW, Chaudhry V, Birnbaum EH, Read TE, Spitz JS, Abcarian H. Early experience with stapled hemorrhoidectomy in the United States. Dis Colon Rectum 2002;45:360–367.PubMedCrossRefGoogle Scholar
  13. 13.
    Brown SR, Ballan K, Ho E, Fams YH, Seow-Choen F. Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy. Colorectal Dis 2001;3:175–178.PubMedCrossRefGoogle Scholar
  14. 14.
    Kang JC, Chung MN, Chao PC, Lee CC, Hsiao CW, Jao SW. Emergency stapled haemorrhoidectomy for haemorrhoidal crisis. Br J Surg 2005;92:1014–1016.PubMedCrossRefGoogle Scholar
  15. 15.
    Carapeti EA, Kamm MA, McDonald PJ, Phillips RK. Double-blind randomized controlled trial of effect of metronidazole on pain after day-case hemorrhoidectomy. Lancet 1998;351:169–172.PubMedCrossRefGoogle Scholar
  16. 16.
    Wong LY, Jiang JK, Chang SC, Lin JK. Rectal perforation: a life-threatening complication of stapled hemorrhoidectomy: report of a case. Dis Colon Rectum 2003;46:116–117.PubMedCrossRefGoogle Scholar
  17. 17.
    Maw A, Eu KW, Seow-Choen F. Retroperitoneal sepsis complicating stapled hemorrhoidectomy: report of a case and review of the literature. Dis Colon Rectum 2002;45:826–828.PubMedCrossRefGoogle Scholar
  18. 18.
    Bonner C, Prohm P, Storkel S. Fournier gangrene as a rare complication after stapler hemorrhoidectomy. Case report and review of the literature. Chirurg 2001;72:1464–1466.PubMedCrossRefGoogle Scholar
  19. 19.
    Ravo B, Amato A, Bianco V, Boccasanta P, Bottini C, Carriero A, Milito G, Dodi G, Mascagni D, Orsini S, Pietroletti R, Ripetti V, Tagariello GB. Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol 2002;6:83–88.PubMedCrossRefGoogle Scholar
  20. 20.
    Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth 2001;86:859–868.PubMedCrossRefGoogle Scholar
  21. 21.
    Kumar N, Paulvannan S, Billings PJ. Rubber band ligation of haemorrhoids in the out-patient clinic. Ann R Coll Surg Engl 2002;84:172–174.PubMedGoogle Scholar
  22. 22.
    Tinckler LF, Baratham G. Immediate haemorrhoidectomy for prolapsed piles. Lancet 1964;14:1145–1146.CrossRefGoogle Scholar
  23. 23.
    Lal D, Levitan R. Bacteremia following proctoscopic biopsy of a rectal polyp. Arch Intern Med 1972;130:127–128.PubMedCrossRefGoogle Scholar
  24. 24.
    LeFrock JL, Ellis CA, Turchik JB, Weinstein L. Transient bacteremia associated with sigmoidoscopy. N Engl J Med 1973;289:467–469.PubMedCrossRefGoogle Scholar
  25. 25.
    Correa-Rovelo JM, Tellez O, Obregon L, Miranda-Gomez A, Moran S. Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial. Dis Colon Rectum 2002;45:1367–1374.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Huang-Jen Lai
    • 2
  • Shu-Wen Jao
    • 1
  • Chin-Cheng Su
    • 2
  • Ming-Che Lee
    • 2
  • Jung-Cheng Kang
    • 1
    • 2
  1. 1.Division of Colorectal Surgery, Department of SurgeryTri-Service General HospitalTaipeiTaiwan
  2. 2.Division of Colorectal Surgery, Department of Surgery, Buddhist Tzu Chi General HospitalTzu Chi UniversityHualienTaiwan

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