Early and late (ten years) experience with circular stapler hemorrhoidectomy

PURPOSE: We present a retrospective clinical study concerning the prelimina ry experience with the circular stapler in the treatment of hemorrhoids. Ea rly results, complications, and long-term follow-up are revisited. METHODS: Fifty-six consecutive patients with second-, third-, and fourth-degree hem orrhoids were included in the study. Data about operation, early postoperat ive results, and follow-up at one, two, and four weeks were collected. Pati ents were also contacted by phone after a long-term follow-up (mean, 33 (ra nge, 5-120) months). RESULTS: Every operation attempted was successfully te rminated. The length of the operation was less than 15 minutes. No major bl eeding or anastomotic disruption occurred. Six patients (13 percent) who un derwent spinal or epidural anesthesia had urinary retention. One patient (1 .7 percent) had minor bleeding, and four patients (7.1 percent) experienced transient edema of the anastomotic ring after the operation. None needed f urther treatments. The mean analgesic requirement was 1.4 Crange, zero to e ight) ketorolac 30-mg injections; 23 patients (41 percent) received no anal gesics, and seven patients (12 percent) required a single extra dose of opi ates CIO mg morphine cloridrate). Length of hospital stay was between 0 and 11 (mean, 2.7) days, but 20 patients (35 percent) received an additional o peration for coexisting surgical disease. At one week, almost all patients experienced little pain at digital inspection and Little bleeding after def ecations. No anastomotic leakage, wound infection, or healing delay was fou nd. Three patients (5.3 percent) experienced wound edema and pain during de fecation. Two weeks later, one patient (1.7 percent) suffered from painful defecation and ten patients (17 percent) reported minor breeding, but all r eturned to normal activities. No pain during defecation, bleeding, stenosis , soiling, incontinence, or other and symptoms were found at one month afte r the operation, and all patients were well. All patients were contacted by phone 5 to 120 (mean, 33) months later, and all were pleased with the resu lts of this procedure. There were no symptomatic recurrences. DISCUSSION: O ur study confirms the feasibility of circular stapler hemorrhoidectomy in t he treatment of hemorrhoids. Complications and postoperative pain were mini mal. There were no recurrences during long-term follow-up. CONCLUSION: Mech anicaI hemorrhoidectomy is a promising new option in the treatment of all p atients eligible for a surgical approach.