STAPLED HEMORRHOIDECTOMY

Stapled hemorrhoidectomy has been recently advocated as a procedure of choicefor prolapsed hemorrhoids. Studies consistently show that this newer technique is associatedwith less postoperative pain and may be cost effective; however others have questioned its moregeneralized application. Study Design: Randomized controlled trial. Setting: Tertiary hospitalsettings at Services Institute of Medical Sciences, and Ittefaq Hopsital Trust, Lahore. Period:2002 to 2007. Patients & Methods: Short and long-term outcomes of stapled and conventionalhemorrhoidectomy were compared. 538 patients with Grade II, III & IV hemorrhoids wererandomized to undergo either stapled (n=251) or conventional hemorrhoidectomy (n=287).Perioperative and postoperative complications, length of hospital stay, patient satisfactionand long-term recurrence rates for at least 5 postoperative years were analyzed. Results:In the short term, patients undergoing stapled hemorrhoidectomy (n=251) were associatedwith less operative time, less postoperative pain, shorter hospital stay and acceptable overallfirst post-op year patient satisfaction score as compared to patients undergoing conventionalhemorrhoidectomy (n=287). In the long-term however; there were significantly higher ratesof recurrence and tenesmus in stapled group. Over the postoperative years, these rates ofcomplications increased significantly among patients undergoing stapled hemorrhoidectomy.The subgroup analysis showed that Grade IV patients undergoing stapled hemorrhoidectomyhad higher long term postoperative complication rate and poor patient satisfaction scores asopposed to Grade III hemorrhoid patients and had to undergo secondary surgical interventions.Conclusions: The stapled hemorrhoidectomy is an acceptable treatment for selected patientswith Grade II & III hemorrhoids in terms of less postoperative pain and shorter hospital stayat expense of mildly higher long- term recurrence rate; however for grade IV hemorrhoidsstapled hemorrhoidectomy is clearly is an ‘under treatment’ in the long-term as opposed toconventional hemorrhoidectomy.