Stapled haemorrhoidopexy—Complications and patient satisfaction

Jasim Amin, Ali Amin, Gerrit Denys, Allan Meldrum

Department of General Surgical, Inverclyde Royal Infirmary, NHS Greater Glasgow and Clyde, Greenock, UK.

DOI: 10.4236/ojgas.2012.23023                

Abstract

Background: Surgical haemorrhoidectomy is recognised as an effective but often painful intervention for haemorrhoids. Performed in a district hospital setting, this survey studied the success rates of stapled haemorrhoidopexy (SH) technique according to reported symptoms and patient satisfaction, post operatively. Methods: A cohort of 108 patients admitted for cir- cular stapled procedure at Inverclyde Royal Hospital between June 2006 and December 2011 gave their consent to be interviewed over the telephone after their procedure. 101 out of the 108 patients responded. Assessment of patient satisfaction was made on the basis of pre operative symptoms, postoperative results and complications. Results: Preoperatively, all patients had Grade lll or lV haemorrhoids complicated by haemorrhage. 33% of patients reported associated pain, and 25% complained of anal leakage. Mean follow up time was 23.8 months (7 - 38 months). Overall reported complication rate was 17%, with 9% reporting short term bleeding, 4% reporting shortlived post-operative pain and 3% with recurrence of prolapsed haemorrhoids. 88% of patients were happy with results, with 87% of patients happy to recommend the procedure to others. Conclusion: Stapled anopexy is a relatively new procedure. It has been found to be a successful and well-tolerated procedure for prolapsing haemorrhoids in this district general setting. It has a low recurrence rate, low incidence of post operative pain and a high level of patient satisfaction. However, there are associated complications and it has a steep training curve.

Keywords

Haemorrhoidectomy; Haemorrhoidopexy; Anopexy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Haas, P.A., Fox, T.A., Jr. and Haas, G.P. (1984) The pathogenesis of haemorrhoids. Diseases of the Colon & Rectum, 27, 442-450. doi:10.1007/BF02555533
[2]	Hancock, B.D. (1977) Internal sphincter and the nature of hemorrhoids. Gut, 18, 651-655. doi:10.1136/gut.18.8.651
[3]	Thompson, W.H. (1975) The nature of hemorrhoids. British Journal of Surgery, 62, 542-552. doi:10.1002/bjs.1800620710
[4]	Gibbons, C.P., Trowbridge, E.A., Bannister, J.J. and Read, N.W. (1986) The role of the anal cushions in maintaining continence. Lancet, 1, 886-888. doi:10.1016/S0140-6736(86)90990-6
[5]	Longo, A. (1998) Treatment of haemorrhoid disease by reduction of mucosa and haemorrhoidal prolapse with a circular stapling device: A new procedure. 6th World Congress of Endoscopic Surgery, Rome, 777-784.
[6]	Oughriss M, Yver R, Faucheron JL (2005) Complications of stapled hemorrhoidectomy: A French multicentric study. Gastroentérologie Clinique et Biologique, 29, 429-433. doi:GCB-04-2005-29-4-0399-8320-101019-200513284
[7]	Maw, A., Eu, K.W. and Seow-Choen, F. (2002) Retroperitoneal sepsis complicating stapled hemorrhoidectomy: Report of a case and review of the literature. Diseases of the Colon & Rectum, 45, 826-828. doi:10.1007/s10350-004-6304-z
[8]	Wong, L.Y., Jiang, J.K., Chang, S.C. and Lin, J.K. (2003) Rectal perforation: A life threatening complication of stapled hemorrhoidectomy: Report of a case. Diseases of the Colon & Rectum, 46, 116-117. doi:10.1007/s10350-004-6505-5
[9]	Pescatori, M. (2003) PPH stapled hemorrhoidectomy—A cautionary note [comment]. Diseases of the Colon & Rectum, 46, 131
[10]	(2007) publications.nice.org.uk/stapled-haemorrhoidopexy...haemorrhoids-ta128
[11]	Pescatori, M. and Gagliardi, G. (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Techniques in Coloproctology, 12, 7-19. doi:10.1007/s10151-008-0391-0. PMC 2778725
[12]	Laughlan, K., Jayne, D.G., Jackson, D., Rupprecht, F. and Ribaric, G. (2009) Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: A systematic review. International Journal of Colorectal Disease, 24, 335-344. doi:10.1007/s00384-008-0611-0
[13]	Shao, W.J., Li, G.C., Zhang, Z.H., et al. (2008) Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. British Journal of Surgery, 95, 147-160. doi:10.1002/bjs.6078
[14]	Sutherland, L.M., Burchard, A.K., Matsuda, K., et al. (2002) A systematic review of stapled hemorrhoidectomy. Archives of Surgery, 137, 1395-1407. doi:10.1001/archsurg.137.12.1395
[15]	Tjandra, J.J. and Chan, M.K. (2007) Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Diseases of the Colon & Rectum, 50, 878-892. doi:10.1007/s10350-006-0852-3
[16]	Pavlidis, T., Papaziogas, B., Souparis, A., Patsas, A., Koutelidakis, I. and Papaziogas, T. (2002) Modern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: Randomized controlled trial. International Journal of Colorectal Disease, 17, 50-53. doi:10.1007/s003840100342
[17]	Hill, A. (2004) Stapled haemorrhoidectomy—No pain, no gain? The New Zealand Medical Journal, 117, U1104.
[18]	Law, W.L., Tung, H.M., Chu, K.W. and Lee, F.C. (2003) Ambulatory stapled haemorrhoidectomy: A safe and feasible surgical technique. Hong Kong Medical Journal, 9, 103-107.
[19]	Williams, L. (2012) Hemorrhoid surgery outcome marred by long-term pain. Colorectal Disease, 14, 356-361.
[20]	Hidalgo G.L.A., Heredia, B.A. and Sunol, S.X. Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse. Colorectal Disease, 14, 765-768. doi:10.1111/j.1463-1318.2011.02751.x
[21]	Hetzer, F.H., Demartines, N., Handschin, A.E. and Clavien, P.A. (2002) Stapled vs excision hemorrhoidectomy: Long-term results of a prospective randomized trial. Archives of Surgery, 137, 337-340. doi:10.1001/archsurg.137.3.337
[22]	Altomare, D.F., Rinaldi, M., Sallustio, P.L., et al. (2001) Long-term effects of stapled haemorrhoidectomy on internal anal function and sensitivity. British Journal of Surgery, 88, 1487-1491. doi:10.1046/j.0007-1323.2001.01898.x
[23]	Guy, R.J. and Seow-Choen, F. (2003) Septic complications after treatment of haemorrhoids. British Journal of Surgery, 90, 147-156. doi:10.1002/bjs.4008
[24]	Peng, B.C., Jayne, D.G. and Ho, Y.H. (2003)Randomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles. Diseases of the Colon & Rectum, 46, 291-297. doi:10.1007/s10350-004-6543-z
[25]	Mehigan, B.J., Monson, J.R.T. and Hartley JE. (2000) Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: Randomized controlled trial. Lancet, 355, 782-785. doi:10.1016/S0140-6736(99)08362-2
[26]	Ganio, E., Altomare, D.F., Gabrielli, F., et al. (2001) Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. British Journal of Surgery, 88, 669-674. doi:10.1046/j.0007-1323.2001.01772.x
[27]	Racalbuto, A., Aliotta, I., Corsaro, G., et al. (2004) Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: A long-term randomized trial. International Journal of Colorectal Disease, 19, 239-244. doi:10.1007/s00384-003-0547-3