Stapled hemorrhoidopexy: clinical results for 65 cases

Abstract

Objectives: To present results of our patients underwent stapled hemorrhoidopexy due to hemorrhoidal disease and discuss in accompaniment with the literature. Material and methods: The patients, who diagnosed by 3rd-4th degree hemorrhoidal disease and underwent hemorrhoidopexy with Longo method between January, 2009 and April, 2011, were included. All data were prospectively collected and retrospectively examined. The patients were evaluated in terms of demographic properties, complaints on admission, and postoperative complications. Results: Forty-three (66%) of 65 patients were male, 22 (34%) were female. The mean age was 38±11.9 (range:23-76) years. The most frequent complaints were bleeding, swelling, itching, pain, constipation respectively. Third degree hemorrhoid was present in fifty-eight (89%) patients, 4th degree hemorrhoid was in 7 (11%) patients. The mean operation duration was 37.6±8.1(range:24-55) minutes, the mean hospitalization duration was 27±7.8 (range:20-76) hours. One or more complication developed in total 17 (26%) patients. As complication, bleeding was determined in 13 (20%) patients, pain was in 6 (9%), urinary retention was in 2 (3%), tenesmus was in 3 (5%), external hemorrhoidal thrombosis was in 1 (2%), and recurrence was in 4 (6%). Conclusions: The patients can return their daily activities early with stapled hemorrhoidopexy because of less pain and quick recovery period. We consider that appropriate patient selection and proper application of the technique are important in the success of this method. Particularly in 3rd degree hemorrhoidal disease, Longo\'s technique can be suggested as an alternative to classical methods.

Keywords

• Hemorrhoidal disease, stapled hemorrhoidopexy, Longo\'s procedure

Stapler hemoroidopeksi: 65 olguda klinik sonuçlar

Öz

Amaç: Hemoroidal hastalık sebebiyle stapler hemoroidopeksi uyguladığımız hastalarımızın sonuçlarını sunmak ve literatür eşliğinde tartışmak. Gereç ve yöntem: Ocak 2009- Nisan 2011 tarihleri arasında 3-4. derece hemoroidal hastalık tanısı konan ve Longo yöntemiyle hemoroidopeksi uygulanan hastalar çalışmaya dahil edildi. Tüm veriler prospektif toplanıp retrospektif olarak incelendi. Hastalar; demografik özellikler, başvuru sırasındaki şikayetler, ameliyat sonrası komplikasyonlar açısından değerlendirildi. Bulgular: Toplam 65 hastadan 43 (% 66)’ü erkek, 22 (% 34)’si kadındı. Ortalama yaş 38±11.9 (23-76) yıl idi. Olguların en sık başvuru şikayetleri sıklık sırasına göre kanama, şişlik, kaşıntı, ağrı, kabızlık şeklinde idi. Elli sekiz (% 89) hastada 3. derece, 7 (%11) hastada 4. derece hemoroid mevcuttu. Ortalama ameliyat süresi 37.6±8.1(24-55) dakika, ortalama yatış süresi 27±7.8 (20-76) saat idi. Toplam 17 (% 26) hastada bir ya da daha fazla komplikasyon gelişti. Komplikasyon olarak 13 (% 20) hastada kanama, 6 (%9)’sında ağrı, 2 (% 3)’sinde idrar retansiyonu, 3 (% 5)’ünde tenezm, 1 (% 2)‘inde eksternal hemoroidal tromboz, 4 (%6)’ünde ise nüks saptandı. Sonuç: Stapler hemoroidopekside ağrının az ve iyileşme sürecinin hızlı olması nedeniyle hastalar günlük aktivitelerine erken dönebilmektedirler. Bu yöntemin başarısında uygun hasta seçimi ve tekniğin doğru uygulanmasının önemli olduğunu düşünmekteyiz. Özellikle 3.derece hemoroidal hastalıkta Longo tekniği klasik yöntemlere alternatif olarak önerilebilir.

Anahtar Kelimeler

• Hemoroidal hastalık, stapler hemoroidopeksi, Longo yöntemi

Kaynakça

1. Demirbaş S, Aktaş O, Öğün İ, Yağcı G. Haemorrhoid- ectomy by using circular stapler in grade III-IV Hemor- rhoids. T Klin J Med Sci 2002;22(1):36-41.
2. Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial compar- ing stapled with open hemorrhoidectomy. Br J Surg 2001;88(5):669-74.
3. Boccasanta P, Capretti PG, Venturi M, et al. Ran- domised controlled trial between stapled circumfer- ential mucosectomy and conventional circular hemor- rhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 2001;182(1):64-8.
4. Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised con- trolled trial. Lancet 2000;355(9206):779-81.
5. Gravié JF, Lehur PA, Huten N, et al. Stapled hemor- rhoidopexy versus milligan-morgan hemorrhoid- ectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 2005;242(1):29-35.
6. Sutherland LM, Burchard AK, Matsuda K, et al. A sys- tematic review of stapled hemorrhoidectomy. Arch Surg 2002;137(12):1395-406.
7. Maw A, Eu KW, Seow-Choen F. Retroperitoneal sepsis complicating stapled hemorrhoidectomy: report of a case and review of the literature. Dis Colon Rectum 2002;45(6):826-8.
8. Wong LY, Jiang JK, Chang SC, Lin JK. Rectal perfora- tion: a life-threatening complication of stapled hem- orrhoidectomy: report of a case. Dis Colon Rectum 2003;46(1):116-7.

9. Cheetham MJ, Mortensen NJM, Nystom PO, Kamm MA, Phillips RKS. Persistent pain and faecal ur- gency after stapled haemorrhoidectomy. Lancet 2000;356(9231):730-3.
10. Herold A, Kirsch JJ. Pain after stapled haemorrhoid- ectomy. Lancet 2000;356(9231):2187-90.
11. Fazio VW. Early promise of stapling technique for haemorrhoidectomy. Lancet. 2000;355(9206):768-9
12. Ravo B, Amato A, Bianco V, et al. Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol 2002;6(2):83-8.
13. Longo A. Treatment of hemorrhoidal disease by re- duction of mucosa and hemorrhoidal prolapse with a circular-suturing device: a new procedure. In: Pro- ceedings of the 6th World Congress of Endoscopic. Rome, Italy: Surgery; 1998.
14. Terzi C, Füzün M. Anorektumun Benign Hastalıkları. Sayek İ. Temel Cerrahi 3. Baskı. Ankara: Güneş Kita- bevi, 2004:1256-68
15. Nisar PJ, Acheson AG, Neal KR, Scholefield JH. Sta- pled hemorrhoidopexy compared with conventional hemorrhoidectomy: systematic review of randomized, controlled trials. Dis Colon Rectum 2004;47(11):1837- 45.
16. Palimento D, Picchio M, Attanasio U, Lombardi A, Bambini C, Renda A. Stapled and open hemorrhoid- ectomy: randomized controlled trial of early results. World J Surg 2003;27(2):203-7.
17. Oughriss M, Yver R, Faucheron JL. Complications of stapled hemorrhoidectomy: a French multicentric study. Gastroenterol Clin Biol 2005;29(4):429-33.
18. Papillon M, Arnaud JP, Descottes B, Gravie JF, Huten X, De Manzini N. Treatment of hemorrhoids with the Longo technique. Preliminary results of a prospective study on 94 cases. Chirurgie 1999;124(6):666-9.
19. Orrom W, Hayashi A, Rusnak C, Kelly J. Initial experi- ence with stapled anoplasty in the operative manage- ment of prolapsing hemorrhoids and mucosal rectal prolapse. Am J Surg 2002;18385):519-24.
20. Cheetham MJ, Cohen CR, Kamm MA, Phillips RK. A randomized, controlled trial of diathermy hemorrhoid- ectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 2003;46(4):491-7.
21. Habr-Gama A, e Sous AH Jr, Roveló JM, et al. Stapled hemorrhoidectomy: initial experience of a Latin Ameri- can group. J Gastrointest Surg 2003;7(6):809-13.
22. Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg 2002;137(3):337-40.
23. Khalil KH, O’Bichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed hemorrhoidec- tomy. Br J Surg 2000;87(10):1352-5.
24. Mehigan BJ, Monson JR, Hartley JE. Stapling proce- dure for haemorrhoids versus Milligan-Morgan haem- orrhoidectomy: randomized controlled trial. Lancet 2000;355(9206):782-5.
25. Nahas SC, Borba MR, Brochado MCT, Marques CFS, Nahas CSR, Miott-Neto B. Stapled hemorrhoidecto- my for the treatment of hemorrhoids. Arq Gastroen- terol 2003;40(1):35-9.
26. Shalaby R, Desoky A. Randomized clinical trial of sta- pled versus Milligan-Morgan hemorrhoidectomy. Br J Surg 2001;88(8):1049-53.
27. Corman ML, Gravié JF, Hager T, et al. Stapled haem- orrhoidopexy: a consensus position paper by an inter- national working party - indications, contra-indications and technique. Colorectal Dis 2003;5(4):304-10.
28. Ho YH, Tsang C, Tang CL, Nyam D, Eu KW, Seow- Choen F. Anal sphincter injuries from stapling instru- ments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal ma- nometry. Dis Colon Rectum. 2000;43(2):169-73.
29. Ortiz H, Marzo J, Armendariz P. Randomized clini- cal trial of stapled hemorrhoidopexy versus con- ventional diathermy hemorrhoidectomy. Br J Surg 2002;89(11):1376-81.
30. Molloy RG, Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet 2000;355(9206):810.
31. Smith EF, Baker RP, Wilken BJ, Hartley JE, White TJ, Monson JR. Stapled versus excision haemorrhoidec- tomy: long-term follow-up of a randomised controlled trial. Lancet 2003;361(9367):1437-8.
32. Mattana C, Coco C, Manno A, et al. Stapled hemor- rhoidopexy and Milligan Morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids: long-term evaluation and clinical results. Dis Colon Rectum 2007;50(11):1770-5.
33. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long- term recurrence rate of internal hemorrhoids com- pared with conventional excisional hemorrhoid sur- gery. Dis Colon Rectum 2007;50(9):1297-305.