Stapled Haemorrhoidopexy: From Pathology To Clinical Outcome And Reinterventions

Stapled haemorrhoidopexy (SH) is an attractive alternative to conventional haemorrhoidectomy (CH) because of reduced postoperative pain, shorter hospital stay and earlier return to normal activities. Over the last decade, SH gained wide acceptance but this enthusiastic use has been tempered by increasing reports of specific technique related complications including occasional life threatening sepsis and deaths. Complications rate has been reported as high as 31%.Data on patients undergoing haemorrhoidectomy at our unit or referred to us are prospectively entered in a database.Patients and methods: We report our experience on 425 symptomatic patients who underwent haemorrhoidectomy at our Institution: 110 underwent SH while 315 underwent conventional haemorrhoidectomy with similar follow-up period (25+/-14 vs 32+/-16 months).Clinical outcome was assessed by a validated questionnaire on postoperative symptoms and satisfaction supplemented by the Wexner incontinence score. Data on bleeding, body temperature, pain after defecation, prolapse, incontinence, faecal urgency was prospectively recorded and analysed using Fisher exact and Mann-Whitney tests.Results: Operating time between SH and CH was similar being 28.3+/-8.7 and 26+/-8.8 minutes respectively. Hospitalization rates were similar between SH and CH (2.7% vs 1.6%).Likewise, no differences were observed in terms of ER admissions (7.3% vs 3.8%) and hospital readmissions (3.6% vs 2.2%) between SH and CH.Overall early and late complication rates were similar between SH and CH.Despite an increased quote of anal fissure, disabling chronic pain and recurrences were observed after SH when compared to CH, no significative differences were observed in terms of early and late complications between SH and CH (please refer to tables I and II).Significant differences were observed in terms of pain (expressed as VAS) during the first postoperative week (please refer to figures 1 and 2). Patients who underwent CH experienced more severe pain (expressed as VAS score >7) than SH at 5, 6 and 7 postoperative day. We did not observed differences between SH and CH in terms of postoperative pain and severe pain (VAS >7) among third and fourth degree haemorrhoids.Postoperative symptoms duration including pain, bleeding, soiling and hitching lasted more after CH compared to SH reaching significant differences for soiling and bleeding (please refer to figure 3).Postoperative fever was similar between the two groups. No differences were observed in terms of return to work expressed in days between the SH and CH.Urgency after 3 months was significantly more frequent after SH compared to CH (8.2% vs 0.6%), despite this difference disappeared at 1 year (0.9% vs 0.3%).Three patients (2.7%) experienced severe disabling chronic pain after SH that lasted >1 year since surgery without the expected improvement over the follow-up. Early haemorrhoidal recurrences (as thrombosis) occurred 4 and 12 days after surgery. Six patients developed late haemorrhoidal recurrence after 16 5 months from previous surgery. Twelve patients experienced transient urgency (10.9%) that resolved within 4 months in all patients but one in which lasted 13 months. Two patients (1.8%) developed symptomatic rectal stricture with urgency and frequency and responded to anal dilatation with anal dilators. Overall reinterventions rate after SH was 9.1% (vs 4.8% of CH, not significant).