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Primary and Repeated Stapled Hemorrhoidopexy for Prolapsing Hemorrhoids: Follow-Up to Five Years

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

Abstract

Purpose

Treating hemorrhoids by stapled hemorrhoidopexy has become increasingly common, because the procedure results in less pain and allows the patient to return to work earlier than with open hemorrhoidectomy. However, the durability of stapled hemorrhoidopexy has not been evaluated. This study was designed to assess initial results, analyze complications and failures, and document both the need for repeated procedures and the outcomes of follow-up to five years.

Methods

From 1998 to 2004, 258 patients underwent modified stapled hemorrhoidopexy. The appearance of the anus was scored preoperatively, immediately after the procedure, at three months, and at one to five years postoperatively. The anatomy score ranged from 1 (normal anus) to 7 (worst prolapse). We also evaluated operation time, analgesia, staple line position, postoperative pain score, technical failures, postoperative complications, need for repeated procedures, and patient satisfaction. Statistical analyses were used to identify correlations and differences, and the variables were analyzed in relation to the final outcome.

Results

The patients were observed for a median of 34 (range, 18–78) months. The median postoperative pain score was 4 (Visual Analog Scale 1–10) on the day of stapled hemorrhoidopexy; additional external procedures resulted in significantly higher pain (P < 0.05). Stapled hemorrhoidopexy was repeated in 31 patients (12 percent), and 38 patients (14.7 percent) had subsequent excisions. Technical failures occurred in 18 of 258 patients (7 percent). The median anatomy score decreased from 6 (range, 3–7) preoperatively to 1 (range, 1–6) at last follow-up, irrespective of one or a repeated stapled hemorrhoidopexy, surgical excision, or technical failure. The risk of reintervention was greatest during the first year after a stapled hemorrhoidopexy. Overall, patient satisfaction was high and correlated significantly with the anatomy score (r = 0.46, P < 0.05).

Conclusions

The pain after stapled hemorrhoidopexy was low, recovery was rapid, complications were few, and patient satisfaction was high. A recurrent (or persistent) prolapse was alleviated by a repeated stapled hemorrhoidopexy for cure. However, there was a high risk of reintervention after a stapled hemorrhoidopexy, and this should be further evaluated.

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Acknowledgments

The authors thank the Research Fund in Frederiksborg County and the Olga Bryde Nielsens Fund for research grants, Christine Petersen M.D. for her aid with histologic specimens, and Jens Albrechtsen M.D. for doing the examinations.

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Authors and Affiliations

  1. Department of Surgery, Colorectal Laboratory, Copenhagen University North Sealand Hospital, 3000, Helsingore, Denmark

    Dennis Raahave M.D., D.M.Sci., Lars V. Jepsen M.D. & Ib K. Pedersen M.D.

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  1. Dennis Raahave M.D., D.M.Sci.
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  2. Lars V. Jepsen M.D.
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  3. Ib K. Pedersen M.D.
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Correspondence to Dennis Raahave M.D., D.M.Sci..

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Raahave, D., Jepsen, L.V. & Pedersen, I.K. Primary and Repeated Stapled Hemorrhoidopexy for Prolapsing Hemorrhoids: Follow-Up to Five Years. Dis Colon Rectum 51, 334–341 (2008). https://doi.org/10.1007/s10350-007-9102-6

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  • DOI: https://doi.org/10.1007/s10350-007-9102-6

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