Stapled hemorrhoidectomy vs closed diathermy-excision hemorrhoidectomy without suture-ligation: a case-controlled trial.
OBJECTIVE
We compared stapled hemorrhoidectomy to closed diathermy-excision hemorrhoidectomy without suture-ligation regarding postoperative pain, complications and long-term efficacy.


METHODS
A series of 108 patients had indication for stapled hemorrhoidectomy. Patients who underwent stapled hemorrhoidectomy (76) were compared to patients submitted to closed diathermy-excision hemorrhoidectomy (32) due to non-insurance cover. Primary endpoints were postoperative pain, complications, and clinical results after one year. Patients completed a 10-cm visual analog pain scale postoperatively and fulfilled a questionnaire before and 12 months after surgery.


RESULTS
After seven days, median and maximum daily pain scores were lower in the stapled group (P < 0.001). Resumption of activities occurred after 9 days (mean; range 2 to 17 days) after stapling and 14 days (7 to 24) after diathermy surgery - P < 0.001. There was no difference regarding complications during the follow-up. After one year, 45 (80.4%) patients in the stapled group and 18 (78.3%) in the diathermy group were asymptomatic (P = 1.000). After one year, none of the patients needed a second operation and there was no fecal incontinence.


CONCLUSIONS
Stapled hemorrhoidectomy selectively indicated is less painful, not associated to greater morbidity and has the same long-term efficacy when compared to closed diathermy excision without suture-ligation.
Araujo
Sergio Eduardo Alonso
SE
Colorectal Surgery Division, Hospital Santa Helena, Sao Paulo (SP), Brazil. sergioed@terra.com.br
de Caravatto
Pedro Paulo Paris
PP
Dumarco
Rodrigo Blanco
RB
Sousa
Manoela
M
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003972:Diathermy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology; D017792:Surgical Stapling; D016896:Treatment Outcome