Skip to main content

Advertisement

SpringerLink
Log in

Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatment

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Objectives

To know the influence of the stapled line height (SLH) in the recurrence rate and the postoperative disturbances in stapled anopexy (SA) for the treatment of hemorrhoids.

Design

Simple randomized double-blind controlled clinical trial. Randomization with closed-envelope technique in two groups with two different SLH.

Setting

Colorectal Surgery Unit. Department of General Surgery. Hospital de Mataró (Barcelona, Spain).

Participants

119 patients with the diagnosis of symptomatic third- and fourth-grade hemorrhoids were included.

Intervention

SA was performed with two different SLH: group A, 4.5 cm (58 patients) and group B, 6 cm (61 patients) from the external anal verge. Postoperative disturbances were evaluated by a colorectal surgeon who was blind for the randomization and pain was measured (visual analogic scale) one week and 3 months after surgery. Mean operative time, number of hemostatic stitches performed and resected mucosal area were considered as well. Mean follow-up was 11.05 ± 1.6 years.

Results

Differences between the operative time and resected mucosa-submucosa area were not found. The patients of group A needed a significantly higher number of stitches for intraoperative bleeding control along the stapled line. We did not found differences between both groups in terms of postoperative pain neither anorectal disturbances. At the follow-up, persistence of symptomatology was 10.41% in group A and 10.71% in group B, without statistically significance. Neither mortality nor undesirable effects occurred in the series.

Conclusions

SLH do not influence the recurrence rate neither the postoperative evolution in SA.

Trial registration

Clinical Trials NCT03383926.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Milligan ETC, Morgan CN, Jones L (1937) Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet 2:1119–1124

    Article  Google Scholar 

  2. MacRae HM, McLeod RS (1995) Comparison of hemorrhoidal treatment modalities. Dis Colon Rectum 38(7):687–694

    Article  CAS  Google Scholar 

  3. Chen C-W, Lai C-W, Chang Y-J et al (2013) Results of 666 consecutive patients treated with ligasure hemorrhoidectomy for symptomatic prolapsed hemorrhoids with a minimum follow-up of 2 years. Surgery 153(2):211–218

    Article  Google Scholar 

  4. Longo A (1998) Treatment of hemorrhoidal disease by decrease of mucosa and hemorrhoidal prolapse with a circular suturing device: anew procedure In: Proceedings of the 6th World Congress of Endoscopic Surgery Rome

  5. Thomson WH (1975) The nature of haemorrhoids. Br J Surg 62:542–552

    Article  CAS  Google Scholar 

  6. Hass PA, Fox TA, Hass GP (1984) The pathogenesis of haemorrhoids. Dis Col Rectum 27(7):442–450

    Article  Google Scholar 

  7. NICE. Interventional procedure overview of circular stapled haemorrhoidectomy (2003) In: Guidance

  8. Burch J, Epstein D, Sari AB-A et al (2009) Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systematic review. Colorectal Dis 11(3):233–243

    Article  CAS  Google Scholar 

  9. Williams R, Kondylis RN, Geisler D et al (2007) Stapled hemorrhoidopexy height as outcome indicator. Am J Surg 193:336–340

    Article  CAS  Google Scholar 

  10. Goligher JC, Duthie HL, Nixon HH (eds) (1984) Surgery of the anus, rectum and colon, 5th edn. Baillière Tindall, London, pp 98–149

    Google Scholar 

  11. Hidalgo Grau LA, Heredia Budó A, Llorca Cardeñosa S et al (2012) Day-case stapled mucosal anopexy for the treatment of haemorrhoids and rectal mucosal prolapse. Colorrectal Dis 14:765–768

    Article  CAS  Google Scholar 

  12. Kam MH, Mathur P, Peng XH et al (2005) Correlation of histology with anorectal function following stapled hemorrhoidectomy. Dis Colon Rectum 48(7):1437–1441

    Article  CAS  Google Scholar 

  13. Hidalgo Grau LA, Ruiz Edo N, Llorca Cardeñosa S et al (2016) Anopexia Mucosa Circular: experiencia y consideraciones técnicas. Cir Esp 94:287–293

    Article  Google Scholar 

  14. Gallo G, Martellucci J, Sturiale A et al (2020) Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorhoidal disease. Tech Coloproctol 24:145–164

    Article  CAS  Google Scholar 

  15. Giordano G, Gravante G, Sorge R et al (2009) Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 144:266–272

    Article  Google Scholar 

  16. Hidalgo Grau LA, Budó AH, Fantova MJ et al (2005) Perirectal haematoma and hypovolaemic shock after rectal stapled mucosectomy for haemorrhoids. Int J Colorectal Dis 20:471–472

    Article  Google Scholar 

  17. Racalbuto A, Aliotta I, Santangelo M et al (2011) Hemoperitoneum as severe and unusual complication in the stapler recto-anopexy for hemorrhoidal prolapse. case report. G Chir 32:272–274

    CAS  PubMed  Google Scholar 

  18. Molloy RG, Kingsmore D (2000) Life threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet 355:810

    Article  CAS  Google Scholar 

  19. Botey M, Piñol M, Troya J et al (2012) First severe complication described after longo hemorrhoidopexy. Rev Esp Enferm Dig 104:390–391

    Article  Google Scholar 

  20. Faucheron JL, Voirin D, Abba J (2012) Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Br J Surg 99:746–753

    Article  Google Scholar 

  21. Calomino N, Martellucci J, Fontani A et al (2011) Care with regard to details improves the outcome of Longo mucoprolapsectomy: long term follow-up. Updates Surg 63:151–154

    Article  Google Scholar 

  22. Morgan CN, Thompson HR (1956) Surgical anatomy of anal canal with special reference to surgical importance of internal sphincter and conjoint longitudinal muscle. Am Roy Coll Surg Engl 19:88

    CAS  Google Scholar 

  23. Jorge JMN, Habr-Gama A (2007) Anatomy and embryology of the colon, rectum, and anus. In: Wolff BG et al (eds) The ASCRS textbook of colon and rectal surgery. Springer, New York, NY, pp 1–22

    Google Scholar 

  24. Margaret D, Plocek MD, Laurie Ann Kondylis RN, Nadine Duhan-Floyd BS et al (2006) Hemorrhoidopexy staple line height predicts return to work. Dis Colon Rectum 49:1905–1909

    Article  Google Scholar 

  25. Chen S-Q, Cai A-Z, Wang N et al (2012) Single purse string with four-point traction for better haemorrhoid retraction. ANZ J Surg 82:742–746

    Article  Google Scholar 

  26. Correa-Rovelo JM, Tellez O, Obregón L et al (2003) Prospective study of factors affecting postoperative pain and symptom persistence after stapled rectal mucosectomy for hemorrhoids: a need for preservation of squamous epithelium. Dis Colon Rectum 46(7):955–962

    Article  Google Scholar 

  27. Luglio G, Bucci L, D’Antonio D et al (2014) Stapled haemorrhoidopexy: correlation among histology, intraoperative morphology and interindividual anatomic variability in muco-haemorrhoidal prolapse. Ann Ital Chir 85(2):143–147

    PubMed  Google Scholar 

  28. Voigtsberger A, Popovicova L, Bauer G et al (2016) Stapled hemorrhoidopexy: funtional results, recurrence rate, and prognostic factors in a single center analysis. Int J Colorectal Dis 31:35–39

    Article  Google Scholar 

  29. Cheetham MJ, Mortensen JM, Nystrom PO et al (2000) Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet 356:730–733

    Article  CAS  Google Scholar 

  30. Lehur PA, Didnée AS, Faucheron JL et al (2016) Cost-effectiveness of new surgical treatments for hemorrhoidal disease. a multicentre randomized controlled trial comparing transanal doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy. Ann Surg 264(5):710–716

    Article  Google Scholar 

  31. Pigot F, Dao-Quang M, Castinel A, Juguet F et al (2006) Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence. Tech Coloproctol 10:329–333

    Article  CAS  Google Scholar 

  32. Hidalgo-Grau LA, Llorca-Cardeñosa S, Heredia-Budó A et al (2014) Does stapled anopexy for bleeding haemhorroids cure associated anaemia? Colorectal Dis 16(10):O356–O359

    Article  CAS  Google Scholar 

  33. Iida Y, Saito H, Takashima Y et al (2017) Procedure for prolapse and hemorrhoids (PPH) with low rectal anastomosis using a PPH 03 stapler: low rate of recurrence and postoperative complications. Int J Colorectal Dis 32(12):1687–1692

    Article  Google Scholar 

  34. Yang J, Cui PJ, Han HZ et al (2013) Meta-analysis of stapled hemorrhoidopexy versus ligasure hemorrhoidectomy. World J Gastroenterol 19(29):4799–4807

    Article  Google Scholar 

Download references

Funding

This work has been carried out within the framework of the Doctorate in Surgery of the Universitat Autònoma de Barcelona.

Author information

Authors and Affiliations

  1. Colorectal Surgery Unit, Department of General and Digestive, Hospital de Mataró, Barcelona, Spain

    Luis Antonio Hidalgo-Grau, Encarna Piedrafita-Serra, Neus Ruiz-Edo, Sara Llorca-Cardeñosa, Adolfo Heredia-Budó, Oscar Estrada-Ferrer & Xavier Suñol-Sala

  2. Department of Surgery and Morphological Sciences, Universitat Autónoma de Barcelona, Barcelona, Spain

    Encarna Piedrafita-Serra

Authors
  1. Luis Antonio Hidalgo-Grau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Encarna Piedrafita-Serra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neus Ruiz-Edo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sara Llorca-Cardeñosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adolfo Heredia-Budó
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oscar Estrada-Ferrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xavier Suñol-Sala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Encarna Piedrafita-Serra.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hidalgo-Grau, L.A., Piedrafita-Serra, E., Ruiz-Edo, N. et al. Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatment. World J Surg 44, 3936–3942 (2020). https://doi.org/10.1007/s00268-020-05676-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05676-y

Search

Navigation