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.
KEYWORDS
Hemorrhoidectomy - stapled hemorrhoidopexy - hemorrhoids
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