title: Ambulatory stapled haemorrhoidectomy: a safe and feasible surgical technique.
abstract: OBJECTIVE
  To compare outcomes following stapled haemorrhoidectomy as an in-patient versus day-surgery procedure.
  
  
  METHODS
  Prospective non-randomised study.
  
  
  METHODS
  University affiliated hospitals, Hong Kong.
  
  
  METHODS
  Forty-eight consecutive patients who underwent stapled haemorrhoidectomy were included in the study. Twenty-four patients had the procedure in an ambulatory setting and the other 24 were treated as in-patients. The symptoms, operative details, postoperative complications, length of hospital stay, pain scores, analgesic requirements, and patient satisfaction scores were collected. Comparison was made between those patients undergoing ambulatory surgery and those treated as in-patients.
  
  
  RESULTS
  There were 25 women and 23 men in the study. The mean age was 46.6 years (standard deviation, 12.1 years). The mean operating time was 29.3 minutes (standard deviation, 9.9 minutes). An incomplete 'doughnut' after stapling was found in one patient. There were no other adverse intra-operative events or complications. Postoperative morbidities occurred in eight patients but none required further surgery. One patient in the day-surgery group could not be discharged because of urinary retention and three required re-admission to hospital because of secondary haemorrhage (n=1) or fever (n=2). There were no differences in the postoperative complications, pain scores, analgesic requirements, and patient satisfaction scores between the two groups. The total mean hospital stay was significantly shorter for those undergoing day-surgery stapled haemorrhoidectomy (0.46 versus 1.9 days, P<0.01). The mean follow-up period was 4.6 months (standard deviation, 4.0 months). All patients reported symptomatic improvement during this time and there was no incidence of faecal incontinence. One patient had a soft stricture, one had a fissure, and two had residual skin tags. All of these problems were conservatively managed, without the need for further surgical procedures.
  
  
  CONCLUSIONS
  Stapled haemorrhoidectomy is a safe and effective operation for haemorrhoids. It is a feasible procedure to perform as day-surgery. The hospital stay can be significantly shortened, thus reducing the costs associated with in-patient care.
authors.affiliation: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
authors.forename: W L
authors.initials: WL
authors.lastname: Law
authors.forename: H M
authors.initials: HM
authors.lastname: Tung
authors.forename: K W
authors.initials: KW
authors.lastname: Chu
authors.forename: F C W
authors.initials: FC
authors.lastname: Lee
mesh_terms: D000556:Ambulatory Surgical Procedures; D003251:Constriction, Pathologic / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D005334:Fever / Q000209:etiology; D005401:Fissure in Ano / Q000209:etiology; D006484:Hemorrhoids / Q000601:surgery*; D006723:Hong Kong; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012871:Skin Diseases / Q000209:etiology; D017792:Surgical Stapling / Q000009:adverse effects; D014552:Urinary Tract Infections / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology