Stapled hemorrhoidectomy - Cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months

PURPOSE: Stapled hemorrhoidectomy is performed without leaving painful peri anal wounds. The aim of this study was to assess any benefits, compared wit h a conventional open diathermy technique. METHODS: A total of 119 consecut ive patients with prolapsed irreducible hemorrhoids were randomly assigned (conventional open diathermy technique = 62; stapled hemorrhoidectomy = 57) . Preoperative fecal incontinence scoring, anorectal manometry, and endoana l ultrasound were performed. Postoperatively, these were repeated at up to three months with pain scores, analgesic requirements, quality of life asse ssment, and total related medical costs. RESULTS: Conventional open diather my technique was quicker to perform (mean, 11.4 (standard error of the mean , 0.9) vs. 17.6 (3.1) minutes). Hospitalization was similar, but convention al open diathermy technique patients felt more pain during defecation (5.1 (0.4) vs. 2.6 (0.4); P < 0.005) at two weeks, and analgesic requirements we re more for up to six weeks (P < 0.05). Up to the latter, 85.5 percent conv entional open diathermy technique wounds remained unhealed, with more bleed ing (33 (53.2 percent) vs. 19 (33.3 percent); P < 0.05) and pruritus (27 (4 3.5 percent) vs. 9 (15.8 percent); P < 0.05). Total complication rates were similar (conventional open diathermy technique 16 (25.8 percent) za staple d hemorrhoidectomy 10 (17.5 percent)), including mild strictures and bleedi ng in both groups. Minor incontinence occurred postoperatively in two conve ntional open diathermy technique and two stapled hemorrhoidectomy patients at six weeks. Endoanal ultrasound internal anal sphincter defects were foun d in the incontinent conventional open diathermy technique patients, but we re asymptomatic in another one conventional open diathermy technique and on e stapled hemorrhoidectomy. Only one patient (conventional open diathermy t echnique with internal sphincter defect) remained incontinent at three mont hs. Changes between preoperative and postoperative anorectal manometry were similar in the two groups. Patients' satisfaction scores and quality of li fe assessments were also similar. Conventional open diathermy technique pat ients resumed work later (mean 22.9 (1.8) vs. 17.1 (1.9) days; P < 0.05), b ut the total costs incurred were less ($921.17 (16.85) vs. $1,283.09 (31.59 ); P < 0.005). CONCLUSIONS: Stapled hemorrhoidectomy is a safe and effectiv e option in treating irreducible prolapsed piles. It is more expensive but less painful, with less time needed off work. Nonetheless, long-term result s are still awaited.