Evaluation of stapled hemorrhoidopexy for hemorrhoidal disease: 14-year experience from 800 cases.

AIM: The object of the present study was to assess results and document both the need for reoperations and the long-term outcomes.

METHODS: Eight hundred patients with symptomatic grades II-IV hemorroidal disease (HD), mean age 52.3 years, were surgically managed from January 1999 to March 2013. One hundred and eight displayed comorbidity of other anal pathology. All patients underwent stapled hemorrhoidopexy (SH) or double SH, combined with accessory anal procedures in 90 cases. Distance from dentate line to staple line and width of resected doughnut were recorded. Postoperative pain was measured.

RESULTS: Mean measured distance of staple to dentate line was 2.6 cm. Mean hospital stay was 1.2 days. All patients were clinically examined at 1, 4 and 12 weeks, scheduled to be monitored annually for three years and instructed thereafter to contact us for any anorectal problem. Early procedure-related complications that required reintervention occurred in 20 patients (2.5%). Patient satisfaction at 12 weeks was high (98.5%). Thirty-two patients (4%) developed late procedure-related complications that required surgery, with 24 (3%) displaying the most important recurrence. Quite low stapling caused severe pain or stenosis; inadequate mucosectomy was related to stenosis or recurrence. A learning curve was observed over time leading to significant reduction in late reoperations.

CONCLUSION: Considerable experience of SH in the treatment of grades II-IV HD confirms it as safe and effective procedure with sustained favorable results. Meticulous technique is essential to avoid complications and improve outcomes in terms of low recurrence and reintervention rates.