Early experience with stapled hemorrhoidectomy in the United States.
BACKGROUND
We report the early results of patients treated with stapled hemorrhoidectomy, which has recently been introduced into the United States.


METHODS
Sixty-eight patients with symptomatic hemorrhoids were treated at two institutions with the Proximate HCS Hemorrhoidal Circular Stapler supplied by Ethicon Endo-Surgery. Patients were prospectively evaluated for functional recovery and postoperative pain on a 1 to 10 scale.


RESULTS
There were 45 (66 percent) males and 23 (34 percent) females with a mean age of 56 years and median duration of symptoms of 5 years. The mean operative time was 22.2 minutes. The operation was performed with spinal (50 percent), local (40 percent), or general (10 percent) anesthesia and as an outpatient (56 percent) or overnight admission (44 percent). Ninety-three percent of patients remained asymptomatic with a mean follow-up of 34 weeks, whereas the remaining 7 percent required either surgical excision or rubber band ligation for persistent symptoms. There was no mortality, new incontinence, fecal impaction, or persistent pain. The total morbidity was 19 percent, with urinary retention as the most common complication (12 percent). The mean pain score decreased from 3.6 on postoperative Day 1 to 1.4 at postoperative Day 7. Ninety-nine percent of patients made a complete functional recovery by postoperative Day 7.


CONCLUSIONS
Stapled hemorrhoidectomy is safe, effective, and can be performed as an outpatient procedure with local or regional anesthesia. There seems to be minimal postoperative pain and early recovery, although a benefit over traditional hemorrhoidectomy needs to be proven in a randomized trial.
Singer
Marc A
MA
Department of Surgery, University of Illinois, Chicago 60612, USA.
Cintron
José R
JR
Fleshman
James W
JW
Chaudhry
Vivek
V
Birnbaum
Elisa H
EH
Read
Thomas E
TE
Spitz
James S
JS
Abcarian
Herand
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006484:Hemorrhoids / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D013528:Surgical Staplers / Q000009:adverse effects*; D017792:Surgical Stapling / Q000009:adverse effects*; D013997:Time Factors; D014481:United States; D016055:Urinary Retention / Q000209:etiology / Q000503:physiopathology