Skip to main content

Advertisement

Log in

Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III–IV prolapsing hemorrhoids: a two-year prospective controlled study

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Circular stapled hemorrhoidopexy (CSH) is an effective technique for treating prolapsing hemorrhoids; but urgency and anal stenosis are common postoperative complications. The aim of this study was to assess the efficacy and postoperative outcomes of partial stapled hemorrhoidopexy (PSH), compared with CSH.

Methods

Seventy-two consecutive patients with grade III and IV hemorrhoids who met the inclusion/exclusion criteria were divided in a non-randomized manner to undergo either PSH (n = 34) or CSH (n = 38). Intraoperative and postoperative parameters in both groups were collected and compared.

Results

The postoperative visual analog score for pain at first defecation was significantly lower in the PSH group than that in the CSH group (P = 0.001). Fewer patients in the PSH group experienced postoperative urgency, compared with those in the CSH group at 12 h, 1 day, and 7 days after surgery (P = 0.025, P = 0.019, and P = 0.043, respectively). Gas incontinence occurred in 3 patients (7.9%) in the CSH group, but in none of patients in the PSH group (P = 0.242). Postoperative anal stenosis developed in one patient (2.6%) in the CSH group, but in none of the patients in the PSH group (P = 1.0). The 2-year recurrence rate was 2.9 and 5.3%, respectively, in the PSH and CSH groups (P = 1.0).

Conclusions

The 2-year recurrence rate is similar in patients with grade III–IV hemorrhoids treated with PSH or CSH. However, PSH is associated with less postoperative pain, fewer episodes of urgency, and no anal incontinence or anal stenosis.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG (1992) Symptomatic hemorrhoids: current incidence and complications of operative surgery. Dis Colon Rectum 35:477–481

    Article  PubMed  CAS  Google Scholar 

  2. Wolff BG, Culp CE (1988) The Whitehead hemorrhoidectomy. An unjustly maligned procedure. Dis Colon Rectum 31:587–590

    Article  PubMed  CAS  Google Scholar 

  3. Ommer A, Wenger FA, Rolfs T, Walz MK (2008) Continence disorders after anal surgery—a relevant problem? Int J Colorectal Dis 23:1023–1031

    Article  PubMed  CAS  Google Scholar 

  4. Arbman G, Krook H, Haapaniemi S (2000) Closed vs. open hemorrhoidectomy—is there any difference? Dis Colon Rectum 43:31–34

    Article  PubMed  CAS  Google Scholar 

  5. Ho YH, Seow-Choen F, Tan M, Leong AF (1997) Randomized controlled trial of open and closed haemorrhoidectomy. Br J Surg 84:1729–1730

    Article  PubMed  CAS  Google Scholar 

  6. Longo A (1998) Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th world congress of endoscopic surgery. Bologna: Monduzzi Editore, pp 777–784

  7. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ (2008) Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg 95:147–160

    Article  PubMed  Google Scholar 

  8. Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G (2009) Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review. Int J Colorectal Dis 24:335–344

    Article  PubMed  CAS  Google Scholar 

  9. Fueglistaler P, Guenin MO, Montali I et al (2007) Long-term results after stapled hemorrhoidopexy: high patient satisfaction despite frequent postoperative symptoms. Dis Colon Rectum 50:204–212

    Article  PubMed  CAS  Google Scholar 

  10. Brisinda G, Vanella S, Cadeddu F et al (2009) Surgical treatment of anal stenosis. World J Gastroenterol 15:1921–1928

    Article  PubMed  Google Scholar 

  11. Goligher JC (1980) Surgery of the anus rectum and colon, 4th edn. Bailliere, Tindall, London, pp 93–149

    Google Scholar 

  12. Z’graggen K, Maurer CA, Birrer S, Giachino D, Kern B, Büchler MW (2001) A new surgical concept for rectal replacement after low anterior resection. Ann Surg 234:780–787

    Article  PubMed  Google Scholar 

  13. Katdare MV, Ricciardi R (2010) Anal stenosis. Surg Clin North Am 90:137–145

    Article  PubMed  Google Scholar 

  14. Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 89:1376–1381

    Article  PubMed  CAS  Google Scholar 

  15. Naldini G, Martellucci J, Talento P, Caviglia A, Moraldi L, Rossi M (2009) New approach to large haemorrhoidal prolapse: double stapled haemorrhoidopexy. Int J Colorectal Dis 24:1383–1387

    Article  PubMed  Google Scholar 

  16. Petersen S, Jongen J, Schwenk W (2011) Agraffectomy after low rectal stapling procedures for hemorrhoids and rectocele. Tech Coloproctol 15:259–264

    Article  PubMed  CAS  Google Scholar 

  17. Gao XH, Fu CG, Nabieu PF (2010) Residual skin tags following procedure for prolapse and hemorrhoids: differentiation from recurrence. World J Surg 34:344–352

    Article  PubMed  Google Scholar 

  18. Gerjy R, Nyström PO (2007) Excision of residual skin tags during stapled anopexy does not increase postoperative pain. Colorectal Dis 9:754–757

    Article  PubMed  CAS  Google Scholar 

  19. Gravié JF, Lehur PA, Huten N et al (2005) Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35

    Article  PubMed  Google Scholar 

  20. Mlakar B, Kosorok P (2003) Complications and results after stapled haemorrhoidopexy as a day surgical procedure. Tech Coloproctol 7:164–168

    Article  PubMed  CAS  Google Scholar 

  21. Ruhl A, Thewissen M, Ross HG, Cleveland S, Frieling T, Enck P (1998) Discharge patterns of intramural mechanoreceptive afferents during selective distension of the cat’s rectum. Neurogastroenterol Motil 10:219–225

    Article  PubMed  CAS  Google Scholar 

  22. Yao LQ, Zhong YS, Xu JM et al (2006) Rectal stenosis following procedure for prolapse and hemorrhoids. Zhonghua Wai Ke Za Zhi 44:897–899

    PubMed  Google Scholar 

  23. Brisinda G (2000) How to treat haemorrhoids. Prevention is best; haemorrhoidectomy needs skilled operators. BMJ 321:582–583

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None of the authors declares any conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D.-L. Ren.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lin, HC., Ren, DL., He, QL. et al. Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III–IV prolapsing hemorrhoids: a two-year prospective controlled study. Tech Coloproctol 16, 337–343 (2012). https://doi.org/10.1007/s10151-012-0815-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-012-0815-8

Keywords

Navigation