The Effect of Circular Stapler Design Used in Hemorrhoidopexy on Medical Outcomes in terms of Medical Engineering

Abstract

Aim: The aim of this study is to examine the advantages and disadvantages of the design of the circular stapler device by sharing our hemorrhoidectomy results with circular stapler, and to examine whether changes in the design of the circular stapler device have an effect on these complications. Material and Methods: This study which was planned as retrospective archive search and approved by the Etlik Zubeyde Hanim Gynecology Training and Research Hospital Medical Specialization Education Board (TUEK) with decision number 17 dated November 15, 2019. Moreover, cases with missing or unclear data weren't included to the study. Descriptive patterns were revealed by examining the records of the patients in terms of length of hospital stay, pain level according to Visual Analogue Scale (VAS: 1-10), bleeding and other complications. In terms of descriptive analyses, percentage and frequency values were evaluated with mean and standard deviations in continuous variables. Results: Between January 2014 and July 2018, a total number of 21 hemorrhoid cases were treated with circular stapler hemorrhoidopexy. All of the patients were in the young male age group (21-26), with a mean age of 23.5±1.2. The mean hospital stay was 1.95±0.75 (1-4) days. In the intraoperative period, anal bleeding was observed only in one patient. When the pain occurring in the first 24 hours after surgery was examined according to the VAS, there were 11 patients (52%) painless, 7 patients (33%) had mild pain, 2 patients (10%) were moderate pain and 1 patient (5%) was describing severe pain. Conclusion: The circular stapler is a surgical instrument that stands out with its specific engineering features, and when used in the correct position and in the correct manner, it is an advantageous surgical tool with low complication rates for the surgeon in advanced hemorrhoids and mucosal sagging.

Keywords

• Hemorrhoidopexy
• circular stapler
• anorectal surgery
• surgery technique
• medical engineering
• hemorrhoid

Kaynakça

1. Wolff BG. Pemberton JH, Wexner SD, Fleshman JW. Hemoroidal Disease. In: The ASCRS Textbook of Colon and Rectal Surgery, 2007;156-77.
2. Goligher J, Duthie H, Nixon H. Surgery of the Anus, Rectum and Colon. 5th ed. Balliere Tindall, London; 1984.
3. Thompson WHF. The nature of hemorrhoids. Br J Surg. 1975;62:542-52.
4. Kilinc R, Karaeren N, Tuzun A, et al. The comparison of rubber band ligation, injection sclerotherapy, and infrared photocoagulation for the internal hemorrhoids. Gulhane Medical Journal. 2002;44:58-62.
5. MacRae HMM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum. 1995;38:687-94.
6. Baker RS, Foote J, Kemmeter P, et al. The science of stapling and leaks. Obes Surg. 2004;14:1290-8.
7. Bugra D. Surgical anatomy of the rectum and the anal area. In: Benign Diseases of the Anorectal Region. Turkish Colon and Rectal Surgery Association, 2011;5.
8. Wendell-Smith CP. Anorectal nomenclature. Dis Colon Rectum. 2000;43:1349-58.

9. Racalbuto A, Aliotta I, Corsaro G, et al. Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial. Int J Colorectal Dis. 2004;19:239-44.
10. Bugra D. Surgical anatomy of the rectum and the anal area. In: Benign Diseases of the Anorectal Region. Turkish Colon and Rectal Surgery Association, 2011;9-15.
11. Cheetam MJ, Cohen CR, Kamm MA, Phillips RK. A randomized, controlled trial of diathermy hemorrhoidectomy vs stapled hemorrhoidectomy in an intended daycare setting with longer-term follow-up. Dis Colon Rectum. 2003;46:491-7.
12. Wexner SD. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Tech Coloproctol. 2001;5:56-7.
13. Barlas IS. Stapled hemorrhoidopexy method in advanced hemorrhoids: short and long term results. Specialization thesis, T.R. Ministry of Health Okmeydani Training and Research Hospital, Istanbul, 2008.
14. Bozdag AD. Hemorrhoidopexy with stapler. Clinics J Gen Surg. 2012;5:73-7.
15. Finco C, Sarzo G, Savastano S, Degregori S. Stapled haemorrhoidopexy in fourth degree haemorrhoidal prolapse: is it worthwhile?. Colorectal Dis. 2006;8:130-4.
16. Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled vs excision hemorrhoidectomy: long-term results of a prospective randomized trial. Arch Surg. 2002;137:337-40.
17. Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet. 2000;355:782-5.
18. Cheetham MJ, Mortensen NJM, Nystrom PO, et al. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet 2000;356:730-3.
19. Ravo B, Amato A, Bianco V, et al. Complications after stapled hemorrhoidectomy: can they be prevented?. Tech Coloproctol. 2002;6:83-8.
20. Oughriss M, Yver R, Faucheron JL. Complications of stapled hemorrhoidectomy: a French multicentric study. Gastroenterol Clin Biol. 2005;29:429-33.
21. Thaha MA, Irvine LA, Steele RJ, Campbell KL. Postdefaecation pain syndrome after circular stapled anopexy is abolished by oral nifedipine. Br J Surg. 2005;92:208-10.
22. Langley GB, Sheppeard H. The visual analog scale: its use in pain measurement. Rheumatol Int. 1985;5:145-8.
23. Gecim IE. Hemorrhoidal disease. In: Benign Diseases of the Anorectal Region. Turkish Colon and Rectal Surgery Association page: 2011;53.
24. Catarci M, Guadagni S, Masedu F, et al. Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts. Int J Surg. 2023;109:2312-23.
25. Allen W, Wells CI, Greenslade M, et al. Association between circular stapler diameter and stricture rates following gastrointestinal anastomosis: systematic review and meta-analysis. World J Surg. 2018;42:3097-105.
26. Peeters K, Bronckaers M, Hendrickx T. Early complications after stapled hemorrhoidopexy: a retrospective study comparing three different circular staplers. Acta Chir Belg. 2016;116:213-6.
27. Yamana T. Japanese Practice Guidelines for Anal Disorders I. Hemorrhoids. J Anus Rectum Colon. 2018;1:89–99.
28. Chivate SD, Ladukar L, Ayyar M, Mahajan V, Kavathe S. Transanal Suture Rectopexy for Haemorrhoids: Chivate’s Painless Cure for Piles. Indian J Surg. 2012;74:412–7.