Ambulatory circular stapled haemorrhoidectomy under local anaesthesia versus circular stapled haemorrhoidectomy under regional anaesthesia.

BACKGROUND: The usage of circular stapled haemorrhoidectomy (CSH) has increased dramatically in recent years. Hitherto this has been performed using regional or general anaesthesia. The present study assesses the feasibility of performing CSH under local anaesthesia on an ambulatory basis and its acceptance by patients.

METHODS: Sixty patients with symptomatic third or fourth degree haemorrhoids were randomized into two groups. Group A patients had CSH under regional anaesthesia (i.e spinal anaesthesia) and were discharged the next day and group B patients had CSH under local anaesthesia and were discharged on the same admission day. Both groups were assessed by visual analogue pain score. In addition, group B patients were asked questions regarding their satisfaction with the procedure.

RESULTS: No significant differences in pain score and analgesic requirement were found between the two groups of patients. All patients in group B except for one, reported that they were satisfied to highly satisfied with their procedure.

CONCLUSIONS: Circular stapled haemorrhoidectomy can be performed safely under local anaesthesia in an ambulatory care setting. The potential cost savings that may accrue would offset the cost of the stapler.