Stapled haemorrhoidopexy: is it time to move on?

Abstract

Stapled haemorrhoidectomy was proposed as an 'ideal' solution for symptomatic haemorrhoids, with minimal postoperative pain, no perianal wound requiring postoperative wound care and a relatively short operative time. Some randomised controlled trials and reviews confirmed these findings, claiming that stapled haemorrhoidopexy is the most effective and safe procedure for haemorrhoids. However, there are increasing number of publications highlighting that the technique is associated with serious and life threatening complications. Maybe it is now the time to accept that stapled haemorrhoidopexy has done its role in directing our attention to the fact that modern surgical treatment of haemorrhoids should avoid excision of anorectal skin but should instead aim at treatment intervention above the dentate line.

Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes

“…Despite the availability of several procedures, the current management of hemorrhoidal disease (HD) is still controversial, especially in the middle degree of HD not responsive to conservative treatment. Stapled hemorrhoidopexy (SH) is declining due to higher recurrence rate and the risk of rare but severe complications [ 1 , 2 ]. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy (THD) seems associated with decreased postoperative pain and fast recovery in comparison with SH and hemorrhoidectomy, but shows higher pain and higher rate of bleeding requiring transfusion in comparison with rubber band ligation (RBL) [ 3 , 4 ].…”

Evolution of Surgical Management of Hemorrhoidal Disease: An Historical Overview

“…The higher long-term recurrences compared to hemorrhoidectomy and the report of serious, albeit rare, complications have reduced the adoption of the technique in many centers ( 67 ). Nevertheless, stapled hemorrhoidopexy highlighted two key concepts on which many new surgical techniques for HD are based: avoiding skin excision, as one of the main contributors of postoperative pain, and directing the operation above the dentate line, recognizing the functional role of hemorrhoidal tissue ( 68 ).…”

Selection of Patients to the Surgical Treatment of Hemorrhoids

“…A drawback of hemorrhoidopexy, to be discussed with the patient or taken into consideration as an institution, is cost of the stapler although it can be argued that earlier return to work compensates it, where it does (Simillis et al 2015). However, the main concern with this option has been the report of severe complications in the short and long-term that, to some authors (Aly 2015), even puts into question if stapled hemorrhoidopexy is still a reasonable option for the treatment of hemorrhoids. In any case, the role this technique has played in the idea of pain control by avoiding excision of perianal skin and focusing above the dented line has been well recognized.…”