Scientific Articles on Hemorrhoidectomy - 2001

Evidence-based practice in haemorrhoidectomy.

Cheetham MJ, Phillips RK.

Department of Surgery, St Mark's Hospital, Harrow, UK.

Colorectal Dis. 2001 Mar; 3(2): 126-34.

OBJECTIVE: Haemorrhoidectomy has proven long-term efficacy in the treatment of haemorrhoids, albeit at the price of increased pain and complications compared with other modalities. This study reviews the literature and describes best practice in the surgical treatment of haemorrhoids. METHODS: A Medline search was conducted using the keywords haemorrhoids or haemorrhoidectomy to identify clinical trials comparing different surgical treatments for haemorrhoids. RESULTS: Many studies were small and follow up was often short-term only. Surrogate measures such as post-operative pain scores and changes in anorectal physiology were commonly assessed in preference to efficacy in symptom reduction. Haemorrhoidectomy may be safely performed under general, local or regional anaesthesia according to patient fitness and local practice. Results of randomized controlled trials indicate that there open and closed techniques of haemorrhoidectomy are equivalent. There is no evidence to support the practice of laser haemorrhoidectomy. Diathermy haemorrhoidectomy achieves good haemostasis and permits an anal dressing to be omitted, but is not superior to conventional techniques. The use of preoperative lactulose and post-operative oral metronidazole is supported by randomized controlled trials. CONCLUSION: Haemorrhoidectomy is currently the most effective treatment for prolapsing haemorrhoids. There is little evidence to support the use of one surgical technique over another. With attention to detail and adjuncts to reduce post-operative pain, haemorrhoidectomy may be performed as day surgery.

Stapled mucosectomy for acute thrombosed circumferentially prolapsed piles: a prospective randomized comparison with conventional haemorrhoidectomy.

Brown SR, Ballan K, Ho E, Ho Fams YH, Seow-Choen F.

Department of Colorectal Surgery, Singapore General Hospital, Singapore.

Colorectal Dis. 2001 May; 3(3): 175-8.

OBJECTIVE: Stapled mucosectomy has been developed as an alternative to conventional haemorrhoidectomy for the elective treatment of haemorrhoids, but has not been assessed in the emergency setting. The aim of this study was to compare this technique with a conventional procedure for acute thrombosed circumferential prolapsed haemorrhoids. PATIENTS AND METHODS: A prospective randomized comparison of conventional Milligan-Morgan haemorrhoidectomy and stapled mucosectomy was carried out on 35 consecutive patients presenting with acute thrombosed circumferential prolapsed haemorrhoids. Operative data, postoperative stay, pain assessment and persistent symptoms were compared at discharge and at 2 week and 6 week review. Additionally at 6 week review the time to return to work was recorded and an endoanal ultrasound was carried out. RESULTS: Thirty patients were randomized and followed up for six weeks. Although postoperative stay and in-hospital analgesia were the same, patients from the stapled group reported significantly more pain at discharge. However, by 2 weeks the conventional group reported significantly higher pain scores particularly on passing stool. By this stage over half the stapled group patients reported no pain at all. More patients in the conventional group complained of persistent symptoms of pain, bleeding and discharge at 2 week and 6 week review with 20% requiring readmission compared with none in the stapled group. The median return to work was significantly shorter for the stapled group (14 days vs 28 days, P < 0.05). Although all patients claimed to be continent, two patients from each group had ultrasonic evidence of internal sphincter damage. CONCLUSION: Stapled mucosectomy for acute thrombosed circumferential piles is feasible and may result in less pain, a more rapid resolution of symptoms and an earlier return to work compared with a conventional procedure.

Circular stapled anopexy for haemorrhoidal disease: results.

Lehur PA, Gravie JF, Meurette G.

Clinique Chirurgicale II - Hotel-Dieu - Nantes, France. paulantoine.lehur@chu-nantes.fr

Colorectal Dis. 2001 Nov; 3(6): 374-9.

OBJECTIVE: Stapled anopexy is a new approach for haemorrhoids requiring surgical treatment. This study reviews the available information concerning the present results of this procedure. METHODS: Medline and hand search of the literature was conducted to identify available information on the procedure, with a special interest for the on-going or published randomized clinical trials. RESULTS: The advantages of the stapled approach of haemorrhoids were analyzed in the different areas of concern, including postoperative pain reduction, length of hospital stay and sick-leave, postoperative wound care and type and rate of complications. Continence status, symptom cure and patient satisfaction following stapled anopexy are also reported. CONCLUSION: Stapled anopexy is probably less painful than conventional haemorrhoidectomy. Other advantages in the short term result from this new approach. Long term efficacy of the procedure is still unknown.