Diseases of the Colon & Rectum

, Volume 44, Issue 6, pp 842–844 | Cite as

Day surgery for mucosal-hemorrhoidal prolapse using a circular stapler and modified regional anesthesia

  • Francesco Gabrielli
  • Marco Chiarelli
  • Ugo Cioffi
  • Angelo Guttadauro
  • Matilde De Simone
  • Piero Di Mauro
  • Alessandro Arriciati
Original Contributions

Abstract

PURPOSE: In 1993, prolapse reduction using the circular stapler for the treatment of hemorrhoidal disease was proposed. The procedure is characterized by minimal postoperative pain. In this study we evaluated the above technique using regional anesthesia to identify the advantages and feasibility of stapled hemorrhoidectomy, with special focus on the efficacy of same-day discharge. METHODS: From December 1997 to November 1999, we performed 70 consecutive reduction corrections of mucosal hemorrhoidal prolapse using the circular stapler with regional anesthesia (a technical modification of Marti's posterior perineal block). Our series included 41 males and 29 females with a mean age of 43.4 (range, 25–74) years. Three patients were affected by second-degree hemorrhoids and 67 by third-degree hemorrhoids. RESULTS: Sixty-two patients were discharged three hours after the operation in good general condition and without pain, whereas eight patients were discharged the day after for early complications, consisting of two cases of early bleeding, three cases of urinary retention, and three cases of persistent severe pain requiring prolonged medical treatment. CONCLUSION: Our study shows that, in selected cases, it is possible to perform day surgery for patients with hemorrhoidal disease using a circular stapler device when combined with regional anesthesia.

Key words

Hemorrhoids Day surgery Regional anesthesia Stapler device 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery 1998:777–84.Google Scholar
  2. 2.
    Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 2000;355:779–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet 2000;355:782–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Marti MC. L'anesthésie locale en proctologie. Nouv Presse Med 1976;5:2075–7.PubMedGoogle Scholar
  5. 5.
    Gabrielli F, Di Sibio T, Chiarelli M,et al. The posterior perineal block in proctological day-surgery. Coloproctology 1996;18:133–9.Google Scholar
  6. 6.
    McClure JH. Ropivacaine. Br J Anaesth 1996;76:300–7.PubMedGoogle Scholar
  7. 7.
    Goligher JC. Haemorrhoids or piles. In: Goligher JC, ed. Surgery of the anus, rectum and colon. 4th ed. London: Baillière Tindall, 1985:98–149.Google Scholar
  8. 8.
    Petros JG, Bradley TM. Factors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease. Am J Surg 1990;159:374–6.PubMedGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2001

Authors and Affiliations

  • Francesco Gabrielli
    • 1
  • Marco Chiarelli
    • 1
  • Ugo Cioffi
    • 1
  • Angelo Guttadauro
    • 1
  • Matilde De Simone
    • 1
  • Piero Di Mauro
    • 1
  • Alessandro Arriciati
    • 1
  1. 1.From the Department of General and Thoracic SurgeryUniversity of Milan, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore PoliclinicoMilanItaly

Personalised recommendations