World Journal of Laparoscopic Surgery

Register      Login

VOLUME 15 , ISSUE 3 ( September-December, 2022 ) > List of Articles

Original Article

A Prospective Study of Outcomes of Patients with Hemorrhoids after Minimal Invasive Procedure for Hemorrhoids

Tapan Atulkumar Shah, Jatinkumar Bipinchandra Modi, Jaimin Dipakkumar Shah, Rajesh Shah, Divyata Vasa, Yagnik Katara

Keywords : Hemorrhoid, Minimal invasive procedure for hemorrhoids, Stapled hemorrhoidopexy

Citation Information : Shah TA, Modi JB, Shah JD, Shah R, Vasa D, Katara Y. A Prospective Study of Outcomes of Patients with Hemorrhoids after Minimal Invasive Procedure for Hemorrhoids. World J Lap Surg 2022; 15 (3):220-223.

DOI: 10.5005/jp-journals-10033-1541

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.


Introduction: Hemorrhoids are commonly reported anorectal diseases in which veins in the rectum and anal canal get swollen and inflamed, which causes discomfort and bleeding. Within the normal anal canal, there are specialized, highly vascularized cushion-forming discrete masses of thick submucosa containing blood vessels, smooth muscle, and elastic and connective tissue. They are located in the left-lateral, right-anterior, and right-posterior quadrants of the canal to aid in anal continence. The term hemorrhoids should be restricted to clinical situations in which these cushions are abnormal and cause symptoms. Hemorrhoids are a result of sliding downward of these cushions. Hemorrhoids result from disruption of the anchoring and flatting action of musculus submucosa and (Tretiz's muscle) its richly intermingled elastic fibers. Conventional hemorrhoidectomy is the open surgical procedure in which the hemorrhoid pedicle is ligated by transfixing suture. Stapled hemorrhoidopexy (SH) was introduced by Longo that requires no external incision, instead, hemorrhoidal tissue is lifted into ring of tissue with suture and a stapler removes the hemorrhoids, effectively cutting off blood flow to the tissue. Aims and objectives: The current study defines the efficacy of stapled hemorrhoidopexy and its consequences. Materials and methods: It is an institutional prospective study, including patients on which stapled hemorrhoidopexy was done from 4th January, 2019 to 6th December, 2020, who consented to be a part of the study. These patients were followed up through regular visits to the OPD every week for the first month, every 15 days for the next 2 months, and later via telephonic conversations up to a period of 6 months post surgery. Stapled hemorrhoidopexy was performed as per the procedure. Patients were discharged after successful completion of the operation. All clinical variables were collected from a standardized questionnaire evaluation obtained through office follow-up. Results: Total 166 patients: 142 males and 24 females underwent SH (male:female ratio was 5.92:1). The mean age being 44.75 ± 12.99 years. After operation, patients were discharged on postoperative days 1–4; the mean being 1.67 ± 0.66 days. None of the patients had bleeding in the immediate post or period up to 1 month. Nine patients (5.4%) complained of pain in the immediate postoperative period, 1 had grade III hemorrhoids, 2 had grade II hemorrhoids, 2 had bleeding per rectally with grade II internal hemorrhoids, 1 had interno-external piles, 1 had prolapsed piles, 2 had thrombosed piles. In total, 3 had edema in the early postoperative period, 1 had interno-external piles, 1 had prolapsed piles, and 1 had thrombosed piles. After 1 month, 4 (2.40%) had complained of bleeding per rectally, and none of the patients developed incontinence at the 6-month follow-up. Two patients had a recurrence of reports that had interno-external piles. Two patients who had developed peri-purse-string hematoma developed partial stricture in the long run. The mean blood loss during surgery was 44.39 ± 8.08 mL, the mean duration of surgery was 25.13 ± 3.24 min, and the mean duration of patients returning to work after surgery was 5.08 ± 1.17 days. The overall success rate was 98.2%. Conclusion: Stapled hemorrhoidopexy represents a relatively simple and fast operation with less blood loss during surgery, especially when compared with other traditional procedures. The cost of minimal invasive procedure for hemorrhoids (MIPH) gun was the only major limitation.

  1. Araujo SEA, Horcel L de A, Seid VE, et al. Resultados tardios após hemorroidopexia mecânica isolada e complementada por operação excisional. Arq Bras Cir Dig 2016;29(3):159–163. DOI: 10.1590/0102-6720201600030008.
  2. Au-Yong I, Rowsell M, Hemingway DM. Randomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrhoidectomy; a three and a half year follow-up. Colorectal Dis 2004;6(1):37–38. DOI: 10.1111/j.1463-1318.2004.00496.x.
  3. Bikhchandani J, Agarwal PN, Kant R, et al. Randomized controlled trial to compare the early and mid-term results of stapled versus open hemorrhoidectomy. Am J Surg 2005;189(1):56–60. DOI: 10.1016/j.amjsurg.2004.03.014.
  4. Boccasanta P, Capretti PG, Vebturi M, et al. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg 2001;182(1):64–68. DOI: 10.1016/s0002-9610(01)00654-7.
  5. Burch J, Epstein D, Baba-Akbari A, et al. Stapled haemorrhoidectomy (haemorrhoidopexy) for the treatment of haemorrhoids: A systematic review and economic evaluation. Health Technol Assess 2008;12(8):1–193. DOI: 10.3310/hta12080.
  6. Burch J, Epstein D, Sari AB, et al. Stapled haemorrhoidopexy for the treatment of haemorrhoids: A systematic review. Colorectal Dis 2009;11(3):233–243. DOI: 10.1111/j.1463-1318.2008.01638.x.
  7. Cheetham MJ, Cohen CR, Kamm MA, et al. A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 2003;46(4): 491–497. DOI: 10.1007/s10350-004-6588-z.
  8. Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990;98(2):380–386. DOI: 10.1016/0016-5085(90)90828-o.
  9. Ganz RA. The evaluation and treatment of hemorrhoids: A guide for the gastroenterologist. Clin Gastroenterol Hepatol 2013;11(6):593–603. DOI: 10.1016/j.cgh.2012.12.020.
  10. Ali Algadiem E, Aleisa AA, Alsubaie HI, et al. Blood loss estimation using gauze visual analogue. Trauma Mon 2016;21 (2):e34131. DOI: 10.5812/traumamon-34131.
  11. Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: A new procedure. Proceedings of the 6th World Congress of Endoscopic surgery. Monduzzi Publishing Bologna, Rome, Italy; 1998: pp. 777–784.
  12. Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for hemorrhoids versus Milligane Morgan. Hemorrhoidectomy: Randomized controlled trial. Lancet 2000;355(9206):782–785. DOI: 10.1016/S0140-6736(99)08362-2.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.