Stapled hemorrhoidectomy for the treatment of hemorrhoids.
BACKGROUND
The use of circular staplers in the treatment of hemorrhoidal disease is known as a simple procedure, with low morbidity, less post-treatment pain and with the same efficacy when compared to the classical hemorrhoidectomy.


OBJECTIVE
Analyze the operative technique, intra-operative and immediate postoperative complications and late results in 100 patients treated for hemorrhoid disease by stapling technique.


METHODS
The group included 53 males and 47 females with mean age of 49.8 years, operated during the period June 2000 to June 2002 in the "Hospital Universitário" (São Paulo University Hospital) and "Hospital Sírio Libanês", in São Paulo, SP, Brazil.


RESULTS
The majority of patients (78%) were discharged on the first post-operative day. Eight patients required supplementary analgesia and were given intramuscular diclofenac sodium and four of them received intramuscular tramadol. One intraoperative complication was bleeding which was difficult to control and required a blood transfusion. One patient was reoperated on the first postoperative day due to intermittent and persistent bleeding, however without hemodynamic changes or a drop in hematocrit. Two patients presented hemorrhoidal thrombosis in the early postoperative stage. The postoperative follow-up displayed: recurrence of prolapse, five cases (5%); anal sub-stenosis, two cases (2%); anal fissure, one case (1%); persistent pain, two cases (2%). Seven reoperations were performed: one due to bleeding, one due to sub-stenosis and five due to recurrence of hemorrhoidal prolapse and persistence of symptoms.


CONCLUSIONS
Stapling is simple to accomplish, has low postoperative pain and rate of complications, however, the incidence of late reoperations is rather high and therefore major follow-up for better analysis is required.
Nahas
Sergio Carlos
SC
Hospital Sírio Libanês, São Paulo, Brazil. sergionahas@uol.com.br
Borba
Marcelo Rodrigues
MR
Brochado
Maria Cecília Teixeira
MC
Marques
Carlos Frederico Sparapan
CF
Nahas
Caio Sérgio Rizkallah
CS
Miotto-Neto
Boulanger
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D017792:Surgical Stapling; D016896:Treatment Outcome