Stapled anopexy and STARR in surgical treatment of haemorrhoidal disease

Abstract

The treatment of hemorrhoidal disease using stapled anopexy (SA) is still burdened by a high incidence of recurrence. Probably this condition is secondary to inadequate removal of the prolapsed tissue due to the reduced capacity of resection from the adopted device. In order to limit the incidence of failures by providing a removal of a greater amount of prolapsed tissue was considered the opportunity to use the STARR technique even in the presence of haemorrhoidal disease not burdened by symptoms of obstructed defecation. We evaluated the early and at a distance results of 285 patients who had undergone in 2007-2011 surgical resection with trans-anal circular stapler for symptomatic III-IV degree haemorrhoids without obstructed defecation disorders. 237 patients were subjected to SA, while in the remaining 48, since on intervention prolapse committed the CAD more than half of the device, we performed a STARR. adopted the Chi square test (C) considering significant p-values less than 0.05. The anamnestic preoperative evaluation allowed to put the correct indication for surgical treatment in 80% of patients. Mean operative times, hospital stay, incidence of early and more important complications, the symptomatic recurrence of disease (5%) were not dissimilar in the two groups under consideration. Conversely (p < 0.05) the relief of residual asymptomatic disease (24 vs. 10%) was significant . The overall satisfaction was significantly higher in the ST group (73.5 vs 58.6%). The STARR in case of massive prolapse who express themselves with only haemorrhoidal disease is a safe technique, able to optimize the long-term effectiveness of trans-anal resection surgery, limiting the incidence of symptomatic recurrences. The information offered to the patient at the time of the consent to surgery must be extensive and detailed, always considering the possibility of adopting the two techniques alternately and that, at completion of the intervention, could be necessary also the removal of persistent skin tags.

European Society of ColoProctology: guideline for haemorrhoidal disease

“…Three RCTs (Corsale et al, [74]; Zanella et al, [75]; Boccasanta et al, [76]), including a total of 691 patients, compared SH with the STARR procedure.…”

Protocol for the development of a Core Outcome Set (COS) for hemorrhoidal disease: an international Delphi study

“…When these treatment options fail, a common next treatment step is rubber band ligation (RBL) [ 4 , 5 ]. Grade III and IV hemorrhoidal disease is often directly treated by more invasive surgical interventions including the sutured hemorrhoidopexy [ 6 ], the stapled hemorrhoidopexy [ 7 , 8 ], the Doppler-guided hemorrhoidal artery ligation (DGHAL) [ 9 – 11 ], and the traditional hemorrhoidectomy [ 12 , 13 ].…”