Title: Stapler Haemorrhoidopexy for Treatment of Haemorrhoids– Our Initial Experience

Authors: Ashish Agrawal, Amit Katlana, Vinita Agrawal, Prateek Porwal

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i4.106

Abstract

Background: Stapler haemorrhoidopexy is relatively painless alternative to conventional haemorrhoidectomy by avoiding multiple excision and suture line in perianal region.

Aims: to report and analyse intra and postoperative results of stapler haemorrhoidopexy (SH).

Methods: 34 patients were managed by Stapler haemorrhoidopexy (SH) over two and half year. The primary outcome measured were the analgesic requirement in postoperative period and time taken to resume ADL.

Results: 34 patients with grade III and IV haemorrhoids underwent SH under spinal anaesthesia. In the first 24 h 6 patients required a single dose of Injection Diclofenac Sodium while 18 patients required two doses and 10 patients had to be given three doses. 12 patients (35.3%) achieved Katz Index of Independence in Activities of Daily Living score of 6 on the first post-operative day and another 18 (52.9%) on the second post-operative day. By the fourth post-operative day all patients had achieved a score of 6.

Keyword: Activities of daily living (ADL), Haemorrhoids, Stapler haemorrhoidopexy:

References

1.   1.      Gearhart S.L. Diverticular disease and common anorectal disorders. In: Longo, Fauci, Kasper, Hauser, Jameson, Loscalzo, editors. Harrison's Principles of Internal Medicine. 18th ed. McGraw Hill; 2012. pp. 2502–2510.

2.      Habr-Gama A, Silva-e-Sousa Jr AH, Rovelo JMC, Souza JS, Benício F, Regadas FSP, Wainstein C, Cunha TMR, Marques CFS, Bonardi RA, Ramos JR, Pandini LC, Kiss DR. Stapled hemorrhoidectomy: initial experience of a Latin American group. J Gastrointest Surg. 2003;7:809-13.

3.      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.

4.      Nahas SC, Borba MR, Brochado MCT, Marques CFS, Nahas CSR, Miott-Neto B. Stapled hemorrhoidectomy for the treatment of hemorrhoids. Arq Gastroenterol. 2003;40:35-9

5.      Sobrado CW, Bringel RWA, Nahas SC. Tratamentocirúrgico da doençahemor-roidária. In: Cruz GMG, editor. Coloproctologiaterapêutica. Rio de Janeiro: Revinter; 2000. v.3, p.2148-60.

6.      Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular-suturing device: a new procedure.  Proce-edings of the Sixth World Congress of Endoscopic Surgery, Rome, Italy; 1998:777.

7.      Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial comparing stapled with open hemorrhoidectomy. Br J Surg. 2001;88:669-74.

8.      Ho YH, Seow-Choen F, Tsang C, Eu KW. Randomized trial assessing sphincter injuries after stapled hemorrhoidectomy. Br J Surg. 2001;88:1449-55.

9.      Khalil KH, O’Bichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed hemorrhoidectomy. Br J Surg. 2000;87:1352-5.

10.  Ortiz H, Marzo J, Armendariz P. Randomized clinical trial of stapled hemorrhoidopexy versus conventional diathermy hemorrhoidectomy. Br J Surg. 2002;89:1376-81.

11.  Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan hemorrhoidectomy. Br J Surg. 2001;88:1049-53.

12.  Sutherland LM, Burchard AK, Matsuda K, Sweeney JL, Bokey EL, Childs PA, Roberts AK, Waxman BP, Maddern GJ. A systematic review of stapled hemorrhoi-dectomy. Arch Surg. 2002;137:1395-406.

13.  Sultan S., Rabahi N., Etienney I., Atienza P. Stapled haemorrhoidopexy: 6 years' experience of a referral centre. Colorectal Dis. 2010 Sep;12(9):921–926. [PubMed]

14.  Senagore A.J., Singer M., Abcarian H. A prospective, randomized, controlled multi-center trial comparing stapled hemorrh-oidopexy and Ferguson hemorrhoide-ctomy: perioperative and one-year results. Dis Colon Rectum. 2004; 47(11):1824–1836. [PubMed]

15.  Wilson M.S., Pope V., Doran H.E. Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial. Dis Colon Rectum. 2002;45(11):1437–1444. [PubMed]

16.  Pavlidis T., Papaziogas B., Souparis A. Modern stapled Longo procedure vs. conventional Milligan–Morgan hemorrhoi-dectomy: a randomized controlled trial. Int J Colorectal Dis. 2002;17(1):50–53. [PubMed]

17.  Pescatori M. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg.  2002;89(1):122. [PubMed]

18.  Wong L.Y., Jiang J.K., Chang S.C. Rectal perforation: a life-threatening complication of stapled hemorrhoidectomy: report of a case. Dis Colon Rectum. 2003;46(1):116–117. [PubMed]

19.  Ripetti V., Caricato M., Arullani A. Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling proce-dure for prolapsed hemorrhoids: report of a case and subsequent considerations. Dis Colon Rectum. 2002;45(2):268–270.  [PubMed]

20.  Molloy R.G., Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet. 2000;355(9206):810. [PubMed]

21.  Cipriani S., Pescatori M. Acute rectal obstruction after PPH stapled haemorrhoidectomy. Colorectal Dis. 2002;4(5):367–370. [PubMed]

22.  Pernice LM, Bartalucci B, Bencini L, Borri A, Catarzi S, Kröning K. Early and late (ten years) experience with circular stapled hemorrhoidectomy. Dis Colon Rectum. 2001;44:836-41.

23.  Smyth EF, Baker RP, Wilken BJ, Hartley JE, White TJ, Monson JR. Stapled versus excision haemorrhoidectomy: long-term follow-up of a randomized controlled trial. Lancet. 2003;361:1437-8.

Corresponding Author

Ashish Agrawal

Professor, Department of General Surgery, 

IMCHRC, Indore, M.P. INDIA