PURPOSE
The aim of this prospective study was to compare the results of stapled hemorrhoidopexy with those of conventional diathermy excision for controlling symptoms in patients with fourth-degree hemorrhoids.
METHODS
Thirty-one patients with symptomatic, prolapsed irreducible piles were randomized to either stapled hemorrhoidopexy (n = 15) or diathermy excision (n = 16). The primary outcome measure was the control of hemorrhoidal symptoms one year after operation.
RESULTS
The two procedures were comparable in terms of pain relief and disappearance of bleeding. Recurrent prolapse starting from the fourth month after operation was confirmed in 8 of 15 patients in the stapled group and in none in the diathermy excision group: two-tailed Fisher’s exact test P = 0.002, RR 0.33, 95 percent confidence interval 0.19–0.59). Five of these patients responded well to a later conventional diathermy hemorrhoidectomy. Persistence of itching was reported in six patients in the stapled group and in one of the diathermy excision group (P = 0.03). On the other hand, six patients in the stapled group and none in the diathermy excision group experienced tenesmus (P = 0.007).
CONCLUSIONS
Stapled hemorrhoidopexy was not effective as a definitive cure for the symptoms of prolapse and itching in patients with fourth-degree hemorrhoids. Moreover, stapled hemorrhoidopexy induced the appearance of a new symptom, tenesmus, in 40 percent of the patients. Therefore conventional diathermy hemorrhoidectomy should continue to be recommended in patients with symptomatic, prolapsed, irreducible piles.
Similar content being viewed by others
REFERENCES
Longo A. Treatment of hemorrhoids 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; June 3–6, 1998; Rome
BJ Mehigan JR Monson JE Hartley (2000) ArticleTitleStapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial Lancet 355 782–5 Occurrence Handle10.1016/S0140-6736(99)08362-2 Occurrence Handle1:STN:280:DC%2BD3c7nsFSruw%3D%3D Occurrence Handle10711925
M Rowsell M Bello DM Hemingway (2000) ArticleTitleCircumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial Lancet 355 779–81 Occurrence Handle10.1016/S0140-6736(99)06122-X Occurrence Handle1:STN:280:DC%2BD3c7nsFSrug%3D%3D Occurrence Handle10711924
YH Ho WK Cheong C Tsang et al. (2000) ArticleTitleStapled hemorrhoidectomy—cost and effectiveness: randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months Dis Colon Rectum 43 1666–75 Occurrence Handle11156449 Occurrence Handle1:STN:280:DC%2BD3M%2FpvFGrtQ%3D%3D
P Boccasanta PG Capretti M Venturi et al. (2001) ArticleTitleRandomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse Am J Surg 182 64–8 Occurrence Handle10.1016/S0002-9610(01)00654-7 Occurrence Handle1:STN:280:DC%2BD3MvovFOnuw%3D%3D Occurrence Handle11532418
SR Brown K Ballan E Ho YH Ho Fams F Seow-Choen (2001) ArticleTitleStapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy Colorectal Dis 3 175–8 Occurrence Handle10.1046/j.1463-1318.2001.00224.x Occurrence Handle1:STN:280:DC%2BD3s3msFShsw%3D%3D Occurrence Handle12790985
E Ganio DF Altomare F Gabrielli G Milito S Canuti (2001) ArticleTitleProspective randomized multicentre trial comparing stapled with open haemorrhoidectomy Br J Surg 88 669–74 Occurrence Handle10.1046/j.0007-1323.2001.01772.x Occurrence Handle1:STN:280:DC%2BD3M3mslentw%3D%3D Occurrence Handle11350437
T Pavlidis B Papaziogas A Souparis A Patsas I Koutelidakis T Papaziogas (2002) ArticleTitleModern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial Int J Colorectal Dis 17 50–3 Occurrence Handle10.1007/s003840100342 Occurrence Handle1:STN:280:DC%2BD383nslGlsQ%3D%3D Occurrence Handle12018455
R Shalaby A Desoky (2001) ArticleTitleRandomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy Br J Surg 88 1049–53 Occurrence Handle10.1046/j.0007-1323.2001.01830.x Occurrence Handle1:STN:280:DC%2BD3MvktlWhsQ%3D%3D Occurrence Handle11488788
MS Wilson V Pope HE Doran SJ Fearn WA Brough (2002) ArticleTitleObjective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial Dis Colon Rectum 45 1437–44 Occurrence Handle10.1007/s10350-004-6446-z Occurrence Handle1:STN:280:DC%2BD38nntFShuw%3D%3D Occurrence Handle12432288
JM Correa-Rovelo O Tellez L Obregón A Miranda-Gomez S Moran (2002) ArticleTitleStapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial Dis Colon Rectum 45 1367–74 Occurrence Handle12394436
FH Hetzer N Demartines AE Handschin PA Clavien (2002) ArticleTitleStapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial Arch Surg 137 337–40 Occurrence Handle10.1001/archsurg.137.3.337 Occurrence Handle11888463
I Goulimaris I Kanellos E Christoforidis I Mantzoros Ch Odisseos D Betsis (2002) ArticleTitleStapled haemorrhoidectomy compared with Milligan-Morgan excision for the treatment of prolapsing haemorrhoids: a prospective study Eur J Surg 168 6215 Occurrence Handle10.1080/11024150201680009
H Ortiz J Marzo P Armendariz (2002) ArticleTitleRandomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy Br J Surg 89 1376–81 Occurrence Handle1:STN:280:DC%2BD38njt1agtA%3D%3D Occurrence Handle12390376
MJ Cheetham CR Cohen MA Kamm RK Phillips (2003) ArticleTitleA randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up Dis Colon Rectum 46 491–7 Occurrence Handle1:STN:280:DC%2BD3s7msVeisg%3D%3D Occurrence Handle12682543
M Kairaluoma K Nuorva I Kellokumpu (2003) ArticleTitleDay-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome Dis Colon Rectum 46 93–9 Occurrence Handle12544528
Z Krska J Kvasnièka J Faltyn et al. (2003) ArticleTitleSurgical treatment of haemorrhoids according to Longo and Milligan Morgan: an evaluation of postoperative tissue response Colorectal Dis 5 573–6 Occurrence Handle1:STN:280:DC%2BD3srjslWnsQ%3D%3D Occurrence Handle14617243
EF Smyth RP Baker BJ Wilken JE Hartley TJ White JR Monson (2003) ArticleTitleStapled versus excision haemorrhoidectomy: long-term follow up of a randomised controlled trial Lancet 361 1437–8 Occurrence Handle12727401
D Palimento M Picchio U Attanasio A Lombardi C Bambini A Renda (2003) ArticleTitleStapled and open hemorrhoidectomy: randomized controlled trial of early results World J Surg 27 203–7 Occurrence Handle12616437
I Au-Yong M Rowsell DM Hemingway (2004) ArticleTitleRandomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrhoidectomy; a three and a half year follow up Colorectal Dis 6 37–8 Occurrence Handle10.1111/j.1463-1318.2004.00496.x Occurrence Handle1:STN:280:DC%2BD3snhtVaqsg%3D%3D Occurrence Handle14692951
Goligher J. Surgery of the anus, rectum, and colon. 5th ed. London: Balliére Tindall, 1984
H Ortiz J Marzo M de Miguel P Armendáriz (2001) ArticleTitleHemorroidectomía mediante máquina de sutura automática (técnica de Longo) son reproducibles los resultados de esta técnica? Cir Esp 69 22–4
JM Jorge SD Wexner (1993) ArticleTitleEtiology and management of fecal incontinence Dis Colon Rectum 36 77–97 Occurrence Handle1:STN:280:DyaK3s7gsFOnug%3D%3D Occurrence Handle8416784
ML Corman JF Gravié T Hager et al. (2003) ArticleTitleStapled haemorrhoidopexy: a consensus position paper by an international working party—indications, contra-indications and technique Colorectal Dis 5 304–10 Occurrence Handle10.1046/j.1463-1318.2003.00483.x Occurrence Handle1:STN:280:DC%2BD3szkslajtw%3D%3D Occurrence Handle12814406
ACKNOWLEDGMENT
The authors thank Marta Pulido, M.D., for assistance.
Author information
Authors and Affiliations
About this article
Cite this article
Ortiz, H., Marzo, J., Armendáriz, P. et al. Stapled Hemorrhoidopexy vs. Diathermy Excision for Fourth-Degree Hemorrhoids: A Randomized, Clinical Trial and Review of the Literature. Dis Colon Rectum 48, 809–815 (2005). https://doi.org/10.1007/s10350-004-0861-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-0861-z