Page 12 - World Journal of Laparoscopic Surgery

Stapler vs Open Hemorrhoidectomy
8
hemorrhoidectomy. The bleeding was due to a minute vessel in this manner, stapler hemorrhoidectomy is a procedure of choice
stapler line which is preventable complication by examining the in treatment of second and third grade hemorrhoids as it is safe
staple line for bleeding after removing circular stapler. and reliable. Clinical outcomes of stapler hemorrhoidectomy are
Stapler hemorrhoidectomy has a probable risk of strictures very good in the form as it offers a similar clinical outcome as open
9
after rectal wall resection. There was no complain and clinical sign hemorrhoidectomy, and it takes considerably less operating time,
on examination for rectal strictures or stenosis after 12 months in considerably less postoperative pain, and an earlier gaining of work.
our study. Further clinical trials are required to prove results of our study;
In our study, after fifth postoperative day, no patient presented stapler hemorrhoidectomy might become a gold standard for the
with complain of pain in stapler hemorrhoidectomy. This is because second- to third-degree hemorrhoid treatment.
the stapler line remains 3–5 cm above the dentate line comparable
10
to Longo study and others, 3,11 and it is insensitive part of rectum
and anal canal. Both groups had equal access to minor analgesics clInIcAl sIgnIfIcAnce
and considering that stapler hemorrhoidectomy had considerably Stapler hemorrhoidectomy can be a good option as compared to
less amount of pain than open hemorrhoidectomy as per our VAS open hemorrhoidectomy in the form of less postoperative pain,
score for pain on postoperative days 1–4. hospital stay, and early return to work in second- and third-degree
Another finding was over 1-year follow-up; there was no hemorrhoids without added noticeable complications.
recurrence in either group but a longer follow-up should be
8
observed for study of recurrence. Furthermore, recurrence references
also depends on diet and bowel habits of patients which is very
important postoperative advice to be given to patient. We have 1. Brisinda G. How to treat hemorrhoids: prevention is best;
advised all of our postoperative patients to avoid constipating hemorrhoidectomy needs skilled operators. BMJ 2000;321(7261):
582–583. DOI: 10.1136/bmj.321.7261.582.
diet and straining during defecation. We have advised our patient 2. Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy
to avoid maida and its products, coffee, pomegranate, and such (stapled hemorrhoidectomy) versus conventional hemorrhoidectomy:
constipation-causing dietary habits and were encouraged to randomised controlled trial. Lancet 2000;355(9206):779–781. DOI:
eat high-fiber diet such as green leafy vegetables and adequate 10.1016/s0140-6736(99)06122-x.
amount of water with regular exercise. According to our study, 3. Sutherland LM, Burchard AK, Matsuda K, et al. A systematic review of
all of the above advice given to patient also helps in reducing the stapled hemorrhoidectomy. Arch Surg 2002;137(12):1395–1406. DOI:
constipation and recurrence. 10.1001/archsurg.137.12.1395.
Stapler hemorrhoidectomy is better option as compared to 4. Milles E. Observations upon internal pils. Surg Gynecol Obstet
1919;29:497–506.
open hemorrhoidectomy in the form of pain, early discharge from 5. Khalil KH, O’Bichere A, Sellu D. Randomized clinical trial of sutured
the hospital, early regaining of work and equivocal complication versus stapled closed hemorrhoidectomy. J Br Surg 2000;87(10):
rate. However, specialized training is required for stapler 1352–1355. DOI: 10.1046/j.1365-2168.2000.01624.x.
hemorrhoidectomy and also stapler is of single use disposable 6. Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for
one so it increases the cost of surgery. Also, in patients with both hemorrhoids versus Milligan-Morgan hemorrhoidectomy:
internal with external hemorrhoids, we do not recommend stapler randomised controlled trial. Lancet 2000;355(9206):782–785. DOI:
hemorrhoidectomy procedure because external hemorrhoids are 10.1016/S0140-6736(99)08362-2.
needed to be separately removed which eliminate the advantages 7. Ho YH, Cheong WK, Tsang CE, et al. Stapled hemorrhoidectomy—
cost and effectiveness. Randomized, controlled trial including
of stapler hemorrhoidectomy in the form of pain, hospital stay, and incontinence scoring, anorectal manometry, and endoanal
early return to work. ultrasound assessments at up to three months. Dis Colon Rectum
According to our study, stapler hemorrhoidectomy is better 2000;43(12):1666–1675. DOI: 10.1007/BF02236847.
from the patient point of view, but a surgeon requires longer 8. Ganio E, Altomare DF, Milito G, et al. Long-term outcome of a
learning curve with specialized training. multicentre randomized clinical trial of stapled hemorrhoidopexy
versus Milligan–Morgan hemorrhoidectomy. J Br Surg
2007;94(8):1033–1037. DOI: 10.1002/bjs.5677.
conclusIon 9. Fazio VW. Early promise of stapling technique for hemorrhoidectomy.
Lancet 2000;355(9206):768–769. DOI: 10.1016/S0140-6736(00)00086-6.
We conclude that resection line should be kept at least three cm 10. Longo A. Pain after stapled hemorrhoidectomy. Lancet
above the dentate line and proper hemostasis during surgery is a 2000;356(9248):2189–2190. DOI: 10.1016/s0140-6736(05)67258-3.
must requirement in stapler hemorrhoidectomy. Proper training 11. Garth CB, Malcolm AL. Pain after stapled hemorrhoidectomy [letter].
and expertise are also required in stapler hemorrhoidectomy. In Lancet 2000;356(9248):2189. DOI: 10.1016/s0140-6736(05)67258-3.

10 World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022)