Day surgery for mucosal-hemorrhoidal prolapse using a circular stapler and modified regional anesthesia.
OBJECTIVE
In 1993, prolapse reduction using the circular stapler for the treatment of hemorrhoidal disease was proposed. The procedure is characterized by minimal postoperative pain. In this study we evaluated the above technique using regional anesthesia to identify the advantages and feasibility of stapled hemorrhoidectomy, with special focus on the efficacy of same-day discharge.


METHODS
From December 1997 to November 1999, we performed 70 consecutive reduction corrections of mucosal hemorrhoidal prolapse using the circular stapler with regional anesthesia (a technical modification of Marti's posterior perineal block). Our series included 41 males and 29 females with a mean age of 43.4 (range, 25-74) years. Three patients were affected by second-degree hemorrhoids and 67 by third-degree hemorrhoids.


RESULTS
Sixty-two patients were discharged three hours after the operation in good general condition and without pain, whereas eight patients were discharged the day after for early complications, consisting of two cases of early bleeding, three cases of urinary retention, and three cases of persistent severe pain requiring prolonged medical treatment.


CONCLUSIONS
Our study shows that, in selected cases, it is possible to perform day surgery for patients with hemorrhoidal disease using a circular stapler device when combined with regional anesthesia.
Gabrielli
F
F
Department of General and Thoracic Surgery, University of Milan, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore Policlinico, Milan, Italy.
Chiarelli
M
M
Cioffi
U
U
Guttadauro
A
A
De Simone
M
M
Di Mauro
P
P
Arriciati
A
A
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000765:Anesthesia, Conduction; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane; D010146:Pain; D011183:Postoperative Complications; D011391:Prolapse; D013537:Sutures; D016896:Treatment Outcome