Long-Term Results After Stapled Hemorrhoidopexy: High Patient Satisfaction Despite Frequent Postoperative Symptoms

Purpose

Stapled hemorrhoidopexy has been demonstrated to be advantageous in the short term compared with the traditional techniques. We aimed to evaluate long-term results after stapled hemorrhoidopexy and to assess patient satisfaction in association with postoperative hemorrhoidal symptoms.

Methods

This prospective study included 216 patients with Grade 2 or 3 hemorrhoids, who had stapled hemorrhoidopexy using the circular stapled technique. The results were evaluated by a standardized questionnaire at least 12 months after the operation. The primary end point was patient satisfaction; secondary end points included specific hemorrhoidal symptoms.

Results

Followup data were obtained for 193 of 216 patients (89 percent) with a median follow-up of 28 (range, 12–53) months, most of whom (89 percent) were satisfied or very satisfied with the surgery. The main preoperative symptom was no longer present postoperatively in 66 percent of patients, was relieved in 28 percent, and had worsened in 2 percent. Postoperative complaints included symptoms of hemorrhoidal prolapse (24 percent of patients), anal bleeding (20 percent), anal pain (25 percent) fecal soiling/leakage (31 percent), fecal urgency (40 percent), and local discomfort (38 percent). Bivariate analysis showed significant associations between each of these symptoms and patient satisfaction. Nine patients (5 percent) were reoperated on during the follow-up period.

Conclusions

Long-term patient satisfaction was high in most of patients after stapled hemorrhoidopexy for second-degree and third-degree hemorrhoids. However, an unsatisfactory outcome was significantly related to postoperative hemorrhoidal symptoms such as prolapse, fecal soiling/leakage, and new onset of fecal urgency.

Appendix: Standardized Questionnaire

1.	Have the symptoms you had before the operation
	disappeared
	been relieved
	remained unchanged
	worsened?
2.	Do you have a hemorrhoidal prolapse during defecation?
	not present
	light
	moderate
	severe
3.	Do you have bleeding during defecation?
	not present
	light
	moderate
	severe
4.	Do you have anal pain?
	not present
	light
	moderate severe
5.	Do you have loss of feces (fecal soiling/leakage)?
	not present
	light
	moderate
	severe
6a.	How long can you wait to do a bowel movement when feeling the urge?
	equal to before surgery
	longer than before surgery
	shorter than before surgery
	6b.	If shorter than before surgery: disturbing?
no
moderately
severely
7.	Do you have local discomfort (itching, discharge)?
	not present
	light
	moderate
	severe
8. Has hemorrhoidal thrombosis occurred since the operation?	Has hemorrhoidal thrombosis occurred since the operation?
	yes
	no
9.	Have you been reoperated for hemorrhoids or other anal diseases?
	no
	yes
	if yes, when? _____________________________________________________
	if yes, where? _____________________________________________________
	Reason for reoperation?
	hemorrhoids
	marisc (skin tags)
	fissure
	fistula
	abscess
	anal polyp
	other
	I don’t know
10.	Are you satisfied with the results of the surgery?
	yes, very much
	yes
	only fair
	no
11.	Would you undergo surgery again, if necessary?
	yes
	no

1. The original questionnaire was written in German.