Hemorrhoid Stapling Riskier Than Surgical Removal

A new study has found that stapling of hemorrhoids is associated with a higher risk of recurrence and prolapse than conventional hemorrhoid removal surgery.

Researchers from the Schulich School of Medicine and Dentistry, University of Western Ontario (UWO, London, Canada), analyzed seven randomized clinical trials involving 537 participants and found that out of 269 stapling patients, 23 suffered recurrences, compared with four recurrences among 268 patients in the surgical-removal group. The investigators also found that a significantly higher proportion of stapling subjects complained of prolapse (protrusion outside the anus). In favor of stapling, results were better in terms of less pain, itching, and bowel-movement urgency. The review appears in the October 2006 issue of The Cochrane Library, a publication of The Cochrane Collaboration.

"This study shows that stapled hemorrhoidopexy is associated with a greater risk of hemorrhoid recurrence and the symptom of prolapse in long-term follow-up compared to conventional excisional surgery,” said lead investigator Shiva Jayaraman, M.D., a resident in general surgery at Schulich. "If hemorrhoid recurrence and prolapse are the most important clinical outcomes, then conventional excisional surgery remains the ‘gold standard' in the surgical treatment of internal hemorrhoids.”

Hemorrhoidopexy utilizes a circular stapling device that, rather than excising the prolapsed tissue, excises a band of prolapsed anal tissue above the hemorrhoid. The device pulls in the prolapsed mucous membrane, cuts the redundant tissue with a circular knife, and then fires staples to attach the remaining tissue to the anal wall. Because it is performed in the anal canal, hemorrhoid stapling restores hemorrhoidal tissue to its original anatomical position.



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