Saleem Arif, Talat Waseem, Javaid-ur Rehman Ashraf, Farooq Ahmad.
Stapled hemorrhoidectomy; is it really superior to conventional hemorrhoidectomy? a longterm analysis.
Professional Med J Jan ;23(12):1505-12.

Stapled hemorrhoidectomy has been recently advocated as a procedure of choice for prolapsed hemorrhoids. Studies consistently show that this newer technique is associated with less postoperative pain and may be cost effective; however others have questioned its more generalized application. Study Design: Randomized controlled trial. Setting: Tertiary hospital settings at Services Institute of Medical Sciences, and Ittefaq Hopsital Trust, Lahore. Period: 2002 to 2007. Patients & Methods: Short and long-term outcomes of stapled and conventional hemorrhoidectomy were compared. 538 patients with Grade II, III & IV hemorrhoids were randomized to undergo either stapled (n=251) or conventional hemorrhoidectomy (n=287). Perioperative and postoperative complications, length of hospital stay, patient satisfaction and long-term recurrence rates for at least 5 postoperative years were analyzed. Results: In the short term, patients undergoing stapled hemorrhoidectomy (n=251) were associated with less operative time, less postoperative pain, shorter hospital stay and acceptable overall first post-op year patient satisfaction score as compared to patients undergoing conventional hemorrhoidectomy (n=287). In the long-term however; there were significantly higher rates of recurrence and tenesmus in stapled group. Over the postoperative years, these rates of complications increased significantly among patients undergoing stapled hemorrhoidectomy. The subgroup analysis showed that Grade IV patients undergoing stapled hemorrhoidectomy had higher long term postoperative complication rate and poor patient satisfaction scores as opposed to Grade III hemorrhoid patients and had to undergo secondary surgical interventions. Conclusions: The stapled hemorrhoidectomy is an acceptable treatment for selected patients with Grade II & III hemorrhoids in terms of less postoperative pain and shorter hospital stay at expense of mildly higher long- term recurrence rate; however for grade IV hemorrhoids stapled hemorrhoidectomy is clearly is an ‘under treatment’ in the long-term as opposed to conventional hemorrhoidectomy.

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