Stapled Hemorrhoidectomy versus Conventional Excision Hemorrhoidectomy for Acute Hemorrhoidal Crisis

Abstract

We compared the safety and clinical outcomes of stapled hemorrhoidectomy and conventional excision hemorrhoidectomy in the treatment of acute hemorrhoidal crisis, and analyzed various factors associated with complications in stapled hemorrhoidectomy. Forty patients underwent stapled hemorrhoidectomy and forty underwent conventional excision hemorrhoidectomy. All had the operation under local anesthesia with conscious sedation within 24 h of admission. The length of surgery, hospital stay, disability, postoperative pain, and the use of analgesics were significantly less for patients in the stapled hemorrhoidectomy group. Stapled hemorrhoidectomy did not significantly increase the rate of complications. Five patients in the stapled group (12.5%) required further surgical intervention: three with thrombosed hemorrhoids and two with recurrent prolapse. No serious complications were reported in either group. Patient satisfaction was similar in the two groups. Increased age was identified as a factor that significantly elevated the risk of complications in the stapled group (OR, 1.06; 95% CI, 1.01-1.13). Anemia and time between the onset of prolapsed hemorrhoids and hospital admission were also risk factors for complications, although they were not significant. Stapled hemorrhoidectomy is a feasible treatment for selected patients with an acute hemorrhoidal crisis and has a similar complication rate to that of conventional excision hemorrhoidectomy. Stapled hemorrhoidectomy is superior in less-postoperative pain, shorter operation time, shorter hospital stay, and earlier return to normal activity. However, we suggest that older patients with anemia or a prolonged hemorrhoidal crisis are unsuitable for stapled hemorrhoidectomy.

Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement

“…Stapled hemorrhoidectomy is superior as regards postoperative pain, operation time, hospital stay, and return to normal activity. However, older patients with anemia or a prolonged hemorrhoidal crisis are unsuitable for this procedure [87][88][89].…”

Documented Complications of Staple Hemorrhoidopexy: A Systematic Review

“…7,8 Few complications were specific to stapled hemorrhoidopexy; however, these included failure of the stapling gun, urosepsis, and pelvic sepsis. The most common complication was early bleeding, with the overall rate following the procedure ranging from 0 to 68%.…”

“…In a number of cases, blood transfusion was needed in order to restore hemoglobin levels. 3,8,23,49,50 The incidence of early bleeding was greatly reduced following the introduction of the second wave of stapling instruments (PPH01 to PPH03). The introduction of this new instrument resulted in a smaller staple width, which also reduced the necessity for oversewing of the staple line.…”

“…However, whether this complication was transient or permanent was often not always specified. 8 Fecal urgency was also noted with an incidence range of 0.2 to 25% of cases. 3,32 A sensation of painful, incomplete, or difficult evacuation was also commonly reported following stapled hemorrhoidectomy.…”

“…6,21,25,26,27 Early complications including anastomotic dehiscence and edema of the anastomotic ring were also reported. 3,8,20,28 Late Complications Late complications were those occurring postoperatively after 7 days, listed in Table 2. Patient followup ranged from 1 month to 7 years.…”