Modified Longo's stapled hemorrhoidopexy with additional traction sutures for the treatment of residual prolapsed piles.

PURPOSE: Residual prolapsed piles is a problem after the stapled hemorrhoidopexy, especially in large third- or fourth-degree hemorrhoids. We have developed a method using additional traction sutures along with modified Longo's procedure to manage this problem.

MATERIALS AND METHODS: From January 2005 to October 2005, 30 consecutive patients with symptomatic third- or fourth-degree hemorrhoids who underwent the modified Longo's stapled hemorrhoidopexy with additional traction sutures in a single institution were collected. The demographics, postoperative pain score, surgical features, outcomes, and early and late complications were recorded. All patients were followed for a mean duration of 8.8 (range, 4-15) months.

RESULTS: Thirty patients (17 males) with a mean age of 45 (range, 27-63) years were identified. The mean postoperative pain score on the morning of the first postoperative day was 2.8 (range, 1-4). The mean duration of operation was 30.7 (range, 25-37) min. The mean duration of hospital stay was 2 (range, 1-3) days. The mean days for patients to resume normal work was 6.7 (range, 4-9) days. No other procedure-related complications occurred in all patients. There was no early complication except for fecal urgency found in one patient during the first postoperative days. Regarding the late complications, no residual prolapsed piles, persistent anal pain, incontinence, anal stenosis, or recurrent symptoms were found.

CONCLUSIONS: Our preliminary experiences indicated that this modified procedures truly contributed to reduce the residual internal hemorrhoids and maintained the benefits of stapled hemorrhoidopexy. Randomized trial and long-term follow-up warrant to determine possible surgical and functional outcome.