Clin Colon Rectal Surg 2004; 17(2): 131-142
DOI: 10.1055/s-2004-828660
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Stapled Hemorrhoidopexy: The Argument for Usage

Marc Singer1 , Herand Abcarian1
  • 1Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
Further Information

Publication History

Publication Date:
27 May 2004 (online)

Stapled hemorrhoidopexy is a new procedure for the treatment of symptomatic internal hemorrhoids. Experience and prospective trials are helping to define this procedure's role. Published data confirm that stapled hemorrhoidopexy offers similar control of symptoms with the benefits of reduced postoperative pain when compared with excisional techniques. Reduction in pain is the most significant benefit of this operation. Clearly, the cost of the stapling device exceeds the cost of the sutures required to perform an excisional hemorrhoidectomy. Patients should undergo medical therapy and rubber band ligation first; however, patients being considered for excisional hemorrhoidectomy should be offered stapled hemorrhoidectomy as a less painful alternative.

REFERENCES

  • 1 Ho Y-H, Cheong W-K, Tsang C, Ho J, Tang C-L, Seow-Choen F. Stapled hemorrhoidectomy-cost and effectiveness: randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months.  Dis Colon Rectum. 2000;  43 1666-1675
  • 2 Mehigan B J, Monson J R, Hartley J E. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial.  Lancet. 2000;  355 782-785
  • 3 Rowsell M, Bello M, Hemingway D M. Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomized controlled trial.  Lancet. 2001;  355 779-781
  • 4 Boccasanta P, Capretti P G, Venturi M et al.. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular haemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse.  Am J Surg. 2001;  182 64-68
  • 5 Brown S R, Ballan K, Ho E, Ho Fams Y H, Seow-Choen F. Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy.  Colorectal Disease. 2001;  3 175-178
  • 6 Shalaby R, Desoky A. Randomized clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy.  Br J Surg. 2001;  88 1049-1053
  • 7 Correa-Rovelo J M, Tellez O, Obregon L, Miranda-Gomez A, Moran S. Stapled rectal mucosectomy vs. closed hemorrhoidectomy: a randomized, clinical trial.  Dis Colon Rectum. 2002;  45 1367-1375
  • 8 Hetzer F H, Demartines N, Handschin A E, Clavien P A. Stapled vs. excision hemorrhoidectomy: Long-term results of a prospective randomized trial.  Arch Surg. 2002;  137 337-340
  • 9 Ortiz H, Marzo J, Armendariz P. Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy.  Br J Surg. 2002;  89 1376-1381
  • 10 Pavlidis T, Papaziogas B, Souparis A, Patsas A, Koutelidakis I, Papaziogas T. Modern stapled Longo procedure vs. conventional Milligan-Morgan hemorrhoidectomy: a randomized controlled trial.  Int J Colorectal Dis. 2002;  17 50-53
  • 11 Wilson M S, Pope V, Doran H E, Fearn S J, Brough W A. Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial.  Dis Colon Rectum. 2002;  45 1437-1444
  • 12 Cheetham M J, Cohen C RG, Kamm M A, Phillips R KS. A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up.  Dis Colon Rectum. 2003;  46 491-497
  • 13 Kairaluoma M, Nuorva K, Kellokumpu I. Day-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome.  Dis Colon Rectum. 2003;  46 93-99
  • 14 Maw A, Concepcion R, Eu K W et al.. Prospective randomized study of bacteraemia in diathermy and stapled haemorrhoidectomy.  Br J Surg. 2003;  90 222-226
  • 15 Palimento D, Picchio M, Attanasio U, Lombardi A, Bambini C, Renda A. Stapled and open hemorrhoidectomy: randomized controlled trial of early results.  World J Surg. 2003;  27 203-207
  • 16 Senagore A J, Singer M, Abcarian H et al.. A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one year results. American Society of Colon and Rectal Surgeons Annual Meeting, New Orleans June 21-26, 2003
  • 17 Ho Y H, Sewo-Choen F, Tan M, Leong A F. Randomized controlled trial of open and closed haemorrhoidectomy.  Br J Surg. 1997;  84 1729-1730
  • 18 Senagore A, Mazier W P, Luchtefeld M A, MacKeigan J A, Wengert T. Treatment of advanced haemorrhoidal disease: A prospective randomized comparison of cold scalpel vs. Nd: YAG laser.  Dis Colon Rectum. 1995;  36 1042-1049
  • 19 Mathai V, Ong B C, Ho Y H. Randomised controlled trial of lateral internal sphincterotomy.  Br J Surg. 1996;  83 380-382
  • 20 Andrews B T, Layer G T, Jackson B T et al.. Randomized trial comparing diathermy haemorrhoidectomy with the scissor dissection.  Dis Colon Rectum. 1993;  36 580-583
  • 21 Seow-Choen F, Ho Y H, Ang H G, Goh H S. Prospective, randomized trial comparing pain and clinical function after conventional scissors/ligation vs diathermy excision without ligation for symptomatic prolapsed hemorrhoids.  Dis Colon Rectum. 1992;  35 1165-1169
  • 22 Carapeti E A, Kamm M A, McDonald P J et al.. Randomised trial of open versus closed day-case haemorrhoidectomy.  Br J Surg. 1999;  86 612-613
  • 23 Davies J, Duffy D, Boyt N, Aghahoseini A, Alexander D, Leveson S. Botulinum toxin (Botox®) reduces pain after hemorrhoidectomy: results of a double-blind, randomized study.  Dis Colon Rectum. 2003;  46 1097-1102
  • 24 Ho Y H, Seow-Cheon F, Low J Y, Tam M, Leong A PFK. Randomized controlled trial of trimebutine (anal sphincter relaxant) for pain after haemorrhoidectomy.  Br J Surg. 1997;  84 377-379
  • 25 Khan S, Pawlak S E, Eggenberger J C et al.. Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the harmonic scalpel technique of excisional hemorrhoidectomy.  Dis Colon Rectum. 2001;  44 845-849
  • 26 Tan J J, Seow-Choen F. Prospective, randomized trial comparing diathermy and harmonic scalpel hemorrhoidectomy.  Dis Colon Rectum. 2001;  44 677-679
  • 27 Carapeti E A, Kamm M A, McDonald P J, Phillips R K. Double-blind randomized controlled trial of effect of metronidazole on pain after day-case haemorrhoidectomy.  Lancet. 1998;  351 169-172
  • 28 Goldstein E T, Williamson P R, Larach S W. Subcutaneous morphine pump for postoperative hemorrhoidectomy pain management.  Dis Colon Rectum. 1993;  36 439-446
  • 29 Chester J F, Stanford B J, Gazet J C. Analgesic benefit of locally injected bupivacaine after hemorrhoidectomy.  Dis Colon Rectum. 1990;  33 487-489
  • 30 Hussein M K, Taha A M, Haddad F F, Bassim Y R. Bupivacaine local injection in anorectal surgery.  Int Surg. 1998;  83 56-57
  • 31 London N J, Bramley P D, Windle R. Effect of four days of preoperative lactulose on posthaemorrhoidectomy pain: results of placebo controlled trial.  BMJ. 1987;  295 363-364
  • 32 Longo A. Treatment of hemorrhoid disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery, Rome, Italy Bologna; Monduzzi Publishing 1998: 777-784
  • 33 Peck D A. Endoanal stapled hemorrhoidectomy [poster]. Presented at American Society of Colon and Rectal Surgeons, Washington, DC April 5-10, 1987
  • 34 Wilson M S, Pope V, Doran H E, Fearn S J, Brough W A. Objective comparison of stapled anopexy and open hemorrhoidectomy: a randomized, controlled trial.  Dis Colon Rectum. 2002;  45 1437-1444
  • 35 Ganio E, Altomare D F, Gabrielli F, Milito G, Canuti S. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy.  Br J Surg. 2001;  88 669-674
  • 36 Kolbert G W, Raulf F. Evaluation of the results of hemorrhoidectomy with Longo's technique by Doppler ultrasound of the arteria rectalis superior.  Proktologia. 2001;  1 37
  • 37 Singer M A, Cintron J R, Fleshman J W et al.. Early experience with stapled hemorrhoidectomy in the United States.  Dis Colon Rectum. 2002;  45 360-369
  • 38 Seow-Choen F. Stapled haemorrhoidectomy: pain or gain.  Br J Surg. 2001;  88 1-3
  • 39 Thomson W H. Stapled haemorrhoidectomy.  Colorectal Disease. 2000;  2 310
  • 40 Fazio V W. Early promise of stapling technique for haemorrhoidectomy.  Lancet. 2000;  355 768-769
  • 41 Wexner S D. The quest for painless surgical treatment of hemorrhoids continues.  J Am Coll Surg. 2001;  193 174-178
  • 42 O'Bichere A, Khalil K, Sellu D. Stapled haemorrhoidectomy: pain or gain (correspondence).  Br J Surg. 2001;  88 1418-1419
  • 43 Altomare D F, Rinaldi M, Sallustio P L, Martino P, De Fazio M, Memeo V. Long-term effects of stapled haemorrhoidectomy on internal anal function and sensitivity.  Br J Surg. 2001;  88 1487-1491
  • 44 Beattie G C. Stapled haemorrhoidectomy offers substantial benefits.  BMJ. 2001;  322 303
  • 45 Carapeti E A. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy (correspondence).  Br J Surg. 2001;  88 1547-1548
  • 46 Wexner S D. Persistent pain and faecal urgency after stapled haemorrhoidectomy.  Tech Coloproctol. 2001;  5 56-57
  • 47 Pescatori M. Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy (correspondence).  Br J Surg. 2002;  89 122-123
  • 48 Cipriani S, Pescatori M. Acute rectal obstruction after PPH stapled haemorrhoidectomy.  Colorectal Disease. 2001;  4 367-370
  • 49 Pescatori M. Stapled rectal prolapsectomy.  Dis Colon Rectum. 2000;  43 876-877
  • 50 Beattie G C, Loudon M A. Follow-up confirms sustained benefits of circumferential stapled anoplasty in the management of prolapsing haemorrhoids.  Br J Surg. 2001;  88 850-852
  • 51 Arnaud J P, Pessauz P, Huten N et al.. Treatment of hemorrhoids with circular stapler, a new alternative to conventional methods: a prospective study of 140 patients.  J Am Coll Surg. 2001;  193 161-165
  • 52 Gabrielli F, Chiarelli M, Cioffi U et al.. Day surgery for mucosal-hemorrhoidal prolapse using a circular stapler and modified regional anesthesia.  Dis Colon Rectum. 2001;  44 842-844
  • 53 Wong L-Y, Jiang J-K, Chang S-C, Lin J-K. Rectal perforation: a life threatening complication of stapled hemorrhoidectomy. Report of a case.  Dis Colon Rectum. 2003;  46 116-117
  • 54 Ripetti V, Caricato M, Arullani A. Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations.  Dis Colon Rectum. 2002;  45 268-270
  • 55 Lehur P A, Gravie J F, Meurette G. Circular stapled anopexy for haemorrhoidal disease: results.  Colorectal Disease. 2001;  3 374-379
  • 56 Roos P. Haemorrhoid surgery revised.  Lancet. 2000;  355 1648
  • 57 Orrom W, Hayashi A, Rusnak C, Kelly J. Initial experience with stapled anoplasty in the operative management of prolapsing hemorrhoids and mucosal rectal prolapse.  Am J Surg. 2002;  183 519-524
  • 58 Sutherland L M, Burchard A K, Matsuda K et al.. A systematic review of stapled hemorrhoidectomy.  Arch Surg. 2002;  137 1395-1406
  • 59 O'Bichere A, Laniado M, Sellu D. Stapled haemorrhoidectomy: a feasible day-case procedure.  Br J Surg. 1998;  85 377-378
  • 60 Bleday R, Pena J P, Rothenberger D A et al.. Symptomatic hemorrhoids: current incidence and complications of operative therapy.  Dis Colon Rectum. 1992;  35 477-481
  • 61 Beck D E. Hemorrhoidal disease. In: Beck DE, Wexner SD Fundamentals of Anorectal Surgery. London; WB Saunders 1998: 237-253
  • 62 Ho Y H, Tsang C, Tang C L, Nyam D, Eu K W, Seow-Choen F. Anal sphincter injuries from stapling instruments introduced transanally: randomized, controlled study with endoanal ultrasound and anorectal manometry.  Dis Colon Rectum. 2000;  43 169-173
  • 63 Ho Y H, Tan M, Leong A, Eu K W, Nyam D, Seow-Choen F. Anal sphincter function impaired after stapler insertion for colorectal anastomosis: a randomized, controlled trial.  Dis Colon Rectum. 1999;  42 89-95
  • 64 Farouk R, Duthie G S, Lee P WR, Monson J RT. Endosonographic evidence of injury to the internal anal sphincter after low anterior resection: long-term follow-up.  Dis Colon Rectum. 1998;  41 888-891
  • 65 Adami B, Eckardt V F, Suermann R B, Karbach U, Ewe K. Bacteremia after proctoscopy and hemorrhoidal injection sclerotherapy.  Dis Colon Rectum. 1981;  24 373-374
  • 66 Bonardi R A, Rosin J D, Stonesifer Jr G L, Bauer F W. Bacteremias associated with routine hemorrhoidectomies.  Dis Colon Rectum. 1976;  19 233-236
  • 67 Clay III L D, White Jr J J, Davidson J T, Chandler J J. Early recognition and successful management of pelvic cellulitis following hemorrhoidal banding.  Dis Colon Rectum. 1986;  29 579-581
  • 68 Quevedo-Bonilla G, Farkas A M, Abcarian H, Hambrick E, Orsay C P. Septic complications of hemorrhoidal banding.  Arch Surg. 1988;  123 650-651
  • 69 Scarpa F J, Hillis W, Sabetta J R. Pelvic cellulitis: a life-threatening complication of hemorrhoidal banding.  Surgery. 1988;  103 383-385
  • 70 Shemesh E I, Kodner I J, Fry R D, Neufeld D M. Severe complication of rubber band ligation of internal hemorrhoids.  Dis Colon Rectum. 1987;  30 199-200
  • 71 Molloy R G, Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy.  Lancet. 2001;  355 810
  • 72 MacRae H M, McLeod R S. Comparison of hemorrhoidal treatment modalities: a meta-analysis.  Dis Colon Rectum. 1995;  38 687-694
  • 73 Peng B C, Jayne D G, Ho Y-H. Randomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles.  Dis Colon Rectum. 2003;  46 291-297
  • 74 Ho Y H, Seow-Choen F, Tsang C, Eu K-W. Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy.  Br J Surg. 2001;  88 1449-1455
  • 75 Guy R J, Seow-Choen F. Septic complications after treatment of haemorrhoids.  Br J Surg. 2003;  90 147-156

Herand AbcarianM.D. 

University of Illinois at Chicago, Department of Surgery

840 S. Wood, Room 518

Chicago, IL 60612

Email: abcarian@uic.edu

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