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A prospective evaluation of stapled haemorrhoidopexy/rectal mucosectomy in the management of 3rd and 4th degree haemorrhoids
Author(s) -
Slawik S.,
Kenefick N.,
Greenslade G. L.,
Dixon A. R.
Publication year - 2007
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2006.01163.x
Subject(s) - medicine , degree (music) , prospective cohort study , surgery , general surgery , acoustics , physics
Objective We have audited our 5 years experience of circumferential‐stapled haemorrhoidopexy (PPH). Method A prospectively collected electronic data base of our 5‐year experience to September 2005 has been examined. Results A total of 357 consecutive patients (220 – 62% women, median age 46 years; range 28–92) with symptomatic third‐ and fourth‐degree haemorrhoids (ratio 222:135) have undergone a stapled haemorrhoidopexy/rectal mucosectomy. One hundred and thirty‐two (37%) had failed previous banding; 42 (12%) had undergone a Milligan–Morgan haemorrhoidectomy in the past. All but one was performed under general anaesthetic. Mean duration of surgery was 15 min (range 11–40); 299 (84%) were planned day cases (three patients were admitted overnight for pain relief (2) and retention of urine) and 57 were planned successful overnight stays. Reactive postoperative bleeding requiring a blood transfusion occurred in three patients (0.8%): one returned to theatre (0.2%). Three patients (0.8%) had a secondary haemorrhage requiring a hospital visit, one was admitted overnight. Four patients complaining of severe pain were managed in the community. Transient urgency was reported in 92 patients (26%); 58 (63%) were men, faecal impaction 4 (1.1%), minor staple line stenosis requiring dilatation 5 (1.4%), peri‐anal sepsis from an associated untreated chronic anal fissure 1 (0.2%). Normal work was resumed between 3 and 31 days (median 7). Five patients re‐presented with recurrent symptoms between 14 & 18 months: further treatment comprised a repeat PPH in three (one was very painful), banding 1 and reassurance alone. A further patient re‐presented with minor soiling which responded to physiotherapy. Conclusion Stapled haemorrhoidopexy/rectal mucosectomy is a safe, effective and predictable treatment of third‐ and fourth‐ degree haemorrhoids and in the majority of patients can be carried out on a day case basis.