Skip to main content
SpringerLink
Log in

Stapled Hemorrhoidectomy With Local Anesthesia can be Performed Safely and Cost-Efficiently

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

PURPOSE:

This prospective study was designed to assess the feasibility of performing the procedure for prolapsing hemorrhoids, or stapled hemorrhoidectomy, under local anesthesia supplemented with conscious sedation.

METHODS:

Seventy consecutive patients (mean age, 56 years; 37 males) with Grade 3 or 4 hemorrhoids underwent the procedure for prolapsing hemorrhoids after perianal infiltration of 0.5 percent lidocaine with 1:200,000 epinephrine and supplemental conscious sedation. The procedure was performed in an outpatient setting, with the patient being discharged within two hours of checking into the ambulatory facility. All patients were assessed the following day by telephone, and then in the office at three weeks and two months for degree of postoperative pain, bleeding, continence, and time back to work or social activities. Additionally, all excised mucosal anastomotic rings were analyzed for presence or absence of muscle.

RESULTS:

Each patient rated the pain as minimal or none. Five patients complained of mild, transient perineal pressure, and three complained of fecal urgency and seepage before their first office visit; one complained of external skin tags at the second office visit. All subjects were back to work or social activities within three to four days—most within 48 hours. Complications included urinary retention in five patients, two of whom had a concomitant urinary tract infection, and one had urosepsis requiring hospitalization. One patient required immediate reoperation for bleeding from the staple line. Another patient was admitted for postoperative bleeding and packed with a hemostatic agent the evening of surgery. Muscularis propria fibers were identified in 68 of 70 pathologic specimens.

CONCLUSIONS:

Administration of general, spinal, or epidural anesthesia for the procedure for prolapsing hemorrhoids is well described. This study suggests that the use of local anesthesia supplemented with conscious sedation for the procedure for prolapsing hemorrhoids yields results equivalent to those achieved with general or regional anesthesia without the attendant risks and additional costs. This study also suggests that the presence of muscle fibers in the pathologic specimen does not seem to lead to increased pain or impaired continence, although it was not specifically designed to address this issue.

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

Similar content being viewed by others

REFERENCES

  1. J Goligher (1984) Surgery of the anus, rectum and colon EditionNumber5th ed Ballière Tindall London

    Google Scholar 

  2. WL Law KW Chu (1999) ArticleTitleTriple rubber band ligation for hemorrhoids: prospective, randomized trial of use of local anesthetic injection Dis Colon Rectum 42 363–7

    Google Scholar 

  3. JA Murie AJ Sim I Mackenzie (1982) ArticleTitleRubber band ligation versus haemorrhoidectomy for prolapsing haemorrhoids: a long term prospective clinical trial Br J Surg 69 536–8

    Google Scholar 

  4. BC Peng DG Jayne YH Ho (2003) ArticleTitleRandomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles Dis Colon Rectum 46 291–7

    Google Scholar 

  5. HM MacRae RS McLeod (1995) ArticleTitleComparison of hemorrhoidal treatment modalities: a meta-analysis Dis Colon Rectum 38 687–94

    Google Scholar 

  6. HD Kaufmann (1976) ArticleTitleOutpatient treatment of hemorrhoids by cryotherapy Br J Surg 63 462–3

    Google Scholar 

  7. ET Milligan CN Morgan (1937) ArticleTitleSurgical anatomy of the anal canal and operative treatment of hemorrhoids Lancet 2 1119–24

    Google Scholar 

  8. JA Ferguson JR Heaton (1959) ArticleTitleClosed hemorrhoidectomy Dis Colon Rectum 2 176–9

    Google Scholar 

  9. IT Khubchandani HD Trimpi JA Sheets (1972) ArticleTitleClosed hemorrhoidectomy with local anesthesia Surg Gynaecol Obstet 135 955–7

    Google Scholar 

  10. I Khubchandani (1988) ArticleTitleOperative hemorrhoidectomy Surg Clin North Am 68 1411–6

    Google Scholar 

  11. JM Watts RC Bennet HL Duthie JC Goligher (1965) ArticleTitlePain after haemorrhoidectomy Surg Gynaecol Obstet 120 1037–42

    Google Scholar 

  12. JM Watts RC Bennet HL Duthie JC Goligher (1964) ArticleTitleHealing and pain after different forms of haemorrhoidectomy Br J Surg 51 808–17

    Google Scholar 

  13. IT Khubchandani (2002) ArticleTitleInternal sphincterotomy with hemorrhoidectomy does not relieve pain: a prospective, randomized study Dis Colon Rectum 45 1452–7

    Google Scholar 

  14. YH Ho F Seow-Choen JY Low M Tan AP Leong (1997) ArticleTitleRandomized trial of trimbutine (anal sphincter relaxant) for pain after hemorrhoidectomy Br J Surg 84 377–9

    Google Scholar 

  15. E Carapeti M Kamm P McDonald R Phillips (1998) ArticleTitleDouble-blind randomised control of effect of metronidazole on pain after day-case hemorrhoidectomy Lancet 351 169–72

    Google Scholar 

  16. L Balfour SG Stojkovic ID Botterill DA Burke PJ Finan PM Sagar (2002) ArticleTitleA randomized, double-blind trial of the effect of metronidazole on pain after closed hemorrhoidectomy Dis Colon Rectum 45 1186–91

    Google Scholar 

  17. HJ Wasvary J Hain M Mosed-Vogel P Benedick DC Barkel SN Klein (2001) ArticleTitleRandomized, prospective, double-blind, placebo-controlled trial of effect of nitroglycerin ointment on pain after hemorrhoidectomy Dis Colon Rectum 44 1069–73

    Google Scholar 

  18. WJ Hodgson J Morgan (1995) ArticleTitleAmbulatory hemorrhoidectomy with CO2 laser Dis Colon Rectum 38 1265–9

    Google Scholar 

  19. DN Armstrong WL Ambroze ME Schertzer GR Orangio (2001) ArticleTitleHarmonic Scalpel vs. electrocautery hemorrhoidectomy: a prospective evaluation Dis Colon Rectum 44 558–64

    Google Scholar 

  20. JJY Tan F Seow-Choen (2001) ArticleTitleProspective, randomized trial comparing diathermy and Harmonic Scalpel® hemorrhoidectomy Dis Colon Rectum 44 677–9

    Google Scholar 

  21. S Khan SE Pawlak JC Eggenberger et al. (2001) ArticleTitleSurgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy Dis Colon Rectum 44 845–9

    Google Scholar 

  22. J Sayfan A Becker L Koltun (2001) ArticleTitleSutureless closed hemorrhoidectomy: a new technique Ann Surg 234 21–4

    Google Scholar 

  23. W Whitehead (1882) ArticleTitleThe surgical treatment of hemorrhoids BMJ 1 148–50

    Google Scholar 

  24. AA Rand (1969) ArticleTitleThe sliding skin-flap graft operation for hemorrhoids: a modification of the Whitehead procedure Dis Colon Rectum 12 265–76

    Google Scholar 

  25. G Barrios M Khubchandani (1979) ArticleTitleWhitehead operation revisited Dis Colon Rectum 22 330–2

    Google Scholar 

  26. J Hodedadi A Kurgan J Jersky (1979) ArticleTitleThe Whitehead operation for advanced hemorrhoids Dis Colon Rectum 22 238–40

    Google Scholar 

  27. BG Wolff CE Culp (1988) ArticleTitleThe Whitehead hemorrhoidectomy. An unjustly maligned procedure Dis Colon Rectum 31 587–90

    Google Scholar 

  28. JC Bonello (1988) ArticleTitleWho’s afraid of the dentate line? The Whitehead hemorrhoidectomy Am J Surg 156 182–6

    Google Scholar 

  29. G Allegra (1990) ArticleTitleExperiences with mechanical staplers: hemorrhoidectomy using a circular stapler G Chir 11 95–7

    Google Scholar 

  30. M Pescatori U Favetta S Dedola S Orsini (1997) ArticleTitleTransanal stapled excision of rectal mucosa prolapse Tech Coloproctol 1 96–8

    Google Scholar 

  31. Longo A. Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular stapling device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery. Bologna: Monduzzi Editore, 1998:777–84.

  32. M Rowsell M Bello DM Hemingway (2000) ArticleTitleCircumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial Lancet 355 779–81

    Google Scholar 

  33. BJ Mehigan JR Monson JE Hartley (2000) ArticleTitleStapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial Lancet 355 782–5

    Google Scholar 

  34. 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

    Google Scholar 

  35. LM Pernice B Bartalucci L Bencini A Borri S Catarzi K Kröning (2001) ArticleTitleEarly and late (ten years) experience with circular stapler hemorrhoidectomy Dis Colon Rectum 44 836–41

    Google Scholar 

  36. JP Arnaud P Pessaux N Huten et al. (2001) ArticleTitleTreatment of hemorrhoids with circular stapler, a new alternative to conventional methods: a prospective study of 140 patients J Am Coll Surg 193 161–5

    Google Scholar 

  37. GC Beattie MA Loudon (2001) ArticleTitleFollow-up confirms sustained benefit of circumferential stapled anoplasty in the management of prolapsing haemorrhoids Br J Surg 88 850–2

    Google Scholar 

  38. KH Khalil A O’Bichere D Sellu (2000) ArticleTitleRandomized clinical trial of sutured versus stapled closed haemorrhoidectomy Br J Surg 87 1352–5

    Google Scholar 

  39. 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

    Google Scholar 

  40. R Shalaby A Desoky (2001) ArticleTitleRandomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy Br J Surg 88 1049–53

    Google Scholar 

  41. 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

    Google Scholar 

  42. 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 1367–75

    Google Scholar 

  43. 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

    Google Scholar 

  44. LM Sutherland AK Burchard K Matsuda et al. (2002) ArticleTitleA systematic review of stapled hemorrhoidectomy Arch Surg 137 1395–406

    Google Scholar 

  45. MC Marti (1999) ArticleTitleMechanical hemorrhoidectomy using circular staples: warning to colleagues Swiss Surg 5 151–4

    Google Scholar 

  46. H Ortiz J Marzo P Armendariz (2002) ArticleTitleRandomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy Br J Surg 89 1376–81

    Google Scholar 

  47. 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

    Google Scholar 

  48. MJ Cheetham NJ Mortensen PO Nystrom MA Kamm RK Phillips (2000) ArticleTitlePersistent pain and faecal urgency after stapled haemorrhoidectomy Lancet 356 730–3

    Google Scholar 

  49. 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

    Google Scholar 

  50. RG Molloy DK Kingsmore (2000) ArticleTitleLife threatening pelvic sepsis after stapled haemorrhoidectomy Lancet 355 810

    Google Scholar 

  51. V Ripetti M Caricato A Arullani (2002) ArticleTitleRectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations Dis Colon Rectum 45 268–70

    Google Scholar 

  52. LY Wong JK Jiang SC Chang JK Lin (2003) ArticleTitleRectal perforation: a life-threatening complication of stapled hemorrhoidectomy: report of a case Dis Colon Rectum 46 116–7

    Google Scholar 

  53. MA Singer JR Cintron JW Fleshman et al. (2002) ArticleTitleEarly experience with stapled hemorrhoidectomy in the United States Dis Colon Rectum 45 360–9

    Google Scholar 

  54. F Gabrielli M Chiarelli U Cioffi et al. (2001) ArticleTitleDay surgery for mucosal-hemorrhoidal prolapse using a circular stapler and modified regional anesthesia Dis Colon Rectum 44 842–4

    Google Scholar 

  55. F Gabrielli T DiSibio M Chiarelli et al. (1996) ArticleTitleThe posterior perineal block in proctological day-surgery Coloproctology 18 133–9

    Google Scholar 

  56. MC Marti (1976) ArticleTitleL’anesthésie locale en proctologie Nouv Presse Med 5 2075–7

    Google Scholar 

  57. JG Petros TM Bradley (1990) ArticleTitleFactors influencing postoperative urinary retention in patients undergoing surgery for benign anorectal disease Am J Surg 159 374–6

    Google Scholar 

  58. TE Read SE Henry RM Hovis et al. (2002) ArticleTitleProspective evaluation of anesthetic technique for anorectal surgery Dis Colon Rectum 45 1553–60

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lehigh Valley Hospital, Allentown, Pennsylvania

    Steven Esser M.D., Indru Khubchandani M.D. & Mikhail Rakhmanine M.D.

Authors
  1. Steven Esser M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Indru Khubchandani M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikhail Rakhmanine M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Indru Khubchandani M.D..

Additional information

Reprints are not available.

About this article

Cite this article

Esser, S., Khubchandani, I. & Rakhmanine, M. Stapled Hemorrhoidectomy With Local Anesthesia can be Performed Safely and Cost-Efficiently. Dis Colon Rectum 47, 1164–1169 (2004). https://doi.org/10.1007/s10350-004-0550-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0550-y

Key words

Search

Navigation