Abstract
PURPOSE: We present a retrospective clinical study concerning the preliminary experience with the circular stapler in the treatment of hemorrhoids. Early results, complications, and long-term follow-up are revisited. METHODS: Fifty-six consecutive patients with second-, third-, and fourth-degree hemorrhoids were included in the study. Data about operation, early postoperative results, and follow-up at one, two, and four weeks were collected. Patients were also contacted by phone after a long-term follow-up (mean, 33 (range, 5–120) months). RESULTS: Every operation attempted was successfully terminated. The length of the operation was less than 15 minutes. No major bleeding or anastomotic disruption occurred. Six patients (13 percent) who underwent spinal or epidural anesthesia had urinary retention. One patient (1.7 percent) had minor bleeding, and four patients (7.1 percent) experienced transient edema of the anastomotic ring after the operation. None needed further treatments. The mean analgesic requirement was 1.4 (range, zero to eight) ketorolac 30-mg injections; 23 patients (41 percent) received no analgesics, and seven patients (12 percent) required a single extra dose of opiates (10 mg morphine cloridrate). Length of hospital stay was between 0 and 11 (mean, 2.7) days, but 20 patients (35 percent) received an additional operation for coexisting surgical disease. At one week, almost all patients experienced little pain at digital inspection and little bleeding after defecations. No anastomotic leakage, wound infection, or healing delay was found. Three patients (5.3 percent) experienced wound edema and pain during defecation. Two weeks later, one patient (1.7 percent) suffered from painful defecation and ten patients (17 percent) reported minor bleeding, but all returned to normal activities. No pain during defecation, bleeding, stenosis, soiling, incontinence, or other anal symptoms were found at one month after the operation, and all patients were well. All patients were contacted by phone 5 to 120 (mean, 33) months later, and all were pleased with the results of this procedure. There were no symptomatic recurrences. DISCUSSION: Our study confirms the feasibility of circular stapler hemorrhoidectomy in the treatment of hemorrhoids. Complications and postoperative pain were minimal. There were no recurrences during long-term follow-up. CONCLUSION: Mechanical hemorrhoidectomy is a promising new option in the treatment of all patients eligible for a surgical approach.
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References
The Standards Task Force, American Society of Colon and Rectal Surgeons. Practice parameters for the treatment of hemorrhoids. Dis Colon Rectum 1993;36:1118–20.
Carapeti EA, Kamm MA, McDonald PJ, Chadwick SJ, Phillips RK. Randomized trial of open versus closed day-case haemorrhoidectomy. Br J Surg 1999;86:612–3.
Hosch SB, Knoefel WT, Pichlmeier U,et al. Surgical treatment of piles: prospective, randomized study of Parks vs. Milligan-Morgan hemorrhoidectomy. Dis Colon Rectum 1998;41:159–64.
Barrios G, Khubchandani M. Whitehead operation revisited. Dis Colon Rectum 1979;22:330–2.
Hodedadi J, Kurgan A, Jersky J. The Whitehead operation for advanced hemorrhoids. Dis Colon Rectum 1979;22:238–40.
Wolff BG, Culp CE. The Whitehead hemorrhoidectomy: an unjustly maligned procedure. Dis Colon Rectum 1988;31:587–90.
Bonello JC. Who's afraid of the dentate line? The Whitehead hemorrhoidectomy. Am J Surg 1988;156:182–6.
Allegra G. Esperienze particolari con le suturatrici meccaniche: emorroidectomia con stapler circolare. G Chir 1990;11:95–7.
Thomson WH. The nature of haemorrhoids. Br J Surg 1975;62:542–52.
Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomized controlled trial. Lancet 2000;355:779–81.
Mehigan BJ, Monson JR, Hartley JE. Stapled procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial. Lancet 2000;355:782–5.
Altomare DF, Rinaldi M, Chiumarulo C, Palasciano N. Treatment of external anorectal mucosal prolapse with circular stapler: an easy and effective new surgical technique. Dis Colon Rectum 1999;42:1102–5.
Longo A. Mechanical haemorrhoidectomy using a circular stapler technique and results. Workshop on Hemorrhoidal Disease Therapy, Uppsala, Sweden, February 26 to 27, 1998.
Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: A new procedure. Sixth World Congress of Endoscopic Surgery, Rome, Italy. Bologna: Monduzzi Publishing Co., 1998:777–84.
Boccasanta P, Venturi M, Orio A,et al. Circular hemorrhoidectomy in advanced hemorrhoidal disease. Hepatogastroenterology 1998;45:969–72.
Whitehead W. The surgical treatment of hemorrhoids. Br Med J (Clin Res) 1882;1:148–50.
Rand AA. The sliding skin-flap graft operation for hemorrhoids: a modification of the Whitehead procedure. Dis Colon Rectum 1969;12:265–76.
Arullani A, Capello G. Diagnosis and current treatment of hemorrhoidal disease. Angiology 1994;45:560–5.
Roveran A, Susa A, Patergnani M. Emorroidectomia con suturatrice circolare nella patologia emorroidaria avanzata. G Chir 1998;19:239–40.
Gravié JF. Traitement des hèmorroïdes de Stade III et IV par la technique de Longo. Ann Chir 1999;53:245–7.
Kohlstadt CM, Weber J, Prohm P. Die Stapler-Hämorrhoidektomie eine neue Alternative zu den konventionellen Method. Zentralbl Chir 1999;124:238–43.
Marti MC. Mechanical hemorrhoidectomy using circular staples: warning to colleagues. Swiss Surg 1999;5:151–4.
Beck DE, Wexner SD. Fundamentals of anorectal surgery. New York: McGraw-Hill, 1999:192–214.
Fazio VW. Early promise of stapling technique for haemorrhoidectomy. Lancet 2000;355:768–9.
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Supported by the University of Florence research funds, assigned to the Dipartimento di Area Critica Medico Chirurgica, Sezione Chirurgia.
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Pernice, L.M., Bartalucci, B., Bencini, L. et al. Early and late (ten years) experience with circular stapler hemorrhoidectomy. Dis Colon Rectum 44, 836–841 (2001). https://doi.org/10.1007/BF02234704
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DOI: https://doi.org/10.1007/BF02234704