The role of hemorrhoidopexy in the management of 3rd degree hemorrhoids

Abstract

Introduction

Hemorrhoidopathy is a very common benign surgical pathology. Hemorrhoids are divided into 4 stages, depending on symptoms and degree of prolapse. Hemorrhoidopexy is a technique developed for the treatment of 3rd degree hemorrhoids, but its application has been extended to the treatment of 4th degree hemorrhoids as well. Nevertheless, recent studies identify weaknesses of the PPH in the treatment of 4th degree hemorrhoids.

Patients

One hundred and twenty-six consecutive patients with 3rd degree hemorrhoids underwent stapled hemorrhoidopexy. All procedures were performed under general anesthesia with the patient in lithotomy position. A phosphate enema was given to the patient 2 h before the procedure, and cephalosporine and metronidazole were administered at anesthesia induction. Most patients were discharged the day after the operation. All patients were reassessed at 1, 6 weeks, 6 and 12 months after the procedure.

Results

The mean operating time was 16.3 min. Of all patients, 5.8% complained of mild rectal pain for a post-operative period of 5–12 days, 5.8% developed post-operative urinary retention, managed with catheterization, 13.3% experienced fecal urgency while 5.8% experienced gas incontinence, which subsided 2–8 weeks from surgery. The mean hospital stay was 1.2 days. Most patients returned to daily activities within 2–5 days. Ninety-five percent of patients returned for their follow-up visits. Recurrence of the disease occurred in 8 patients (6.6%). It was managed conservatively in 2 patients, 3 underwent redo hemorrhoidopexy and 3 underwent classic hemorrhoidectomy.

Conclusion

According to our results, stapled hemorrhoidopexy seems to be a safe, pain-free and, in the long-term, effective technique for the treatment of 3rd degree hemorrhoids.