title: Long-term outcome of stapled hemorrhoidopexy for Grade III and Grade IV hemorrhoids.
abstract: OBJECTIVE
  This study was designed to assess the long-term results of stapled hemorrhoidopexy in 291 patients with Grade III and Grade IV hemorrhoids after a minimum follow-up of five years.
  
  
  METHODS
  Records of patients submitted to stapled hemorrhoidopexy for Grade III and Grade IV hemorrhoids between January 1999 and December 2002 were retrospectively analyzed. Long-term outcome was evaluated with a standardized questionnaire and an office visit, including anorectal examination and rigid proctoscopy.
  
  
  RESULTS
  A total of 291 patients with Grade III (57.4 percent) and Grade IV (42.6 percent) hemorrhoids were evaluated. Intraoperative (20.3 percent) and postoperative (4.8 percent) bleeding was the most frequent complication. The questionnaire was submitted to all patients at a median follow-up of 73 (range 60-93) months. There were no symptoms related to hemorrhoids in 65.3 percent of patients, moderate symptoms in 25.4 percent of patients, and severe symptoms in 9.3 percent of patients. Fifty-three (18.2 percent) patients had recurrence. Reoperation was necessary in 21 (7.2 percent) patients (4 in Grade III hemorrhoids and 17 in Grade IV hemorrhoids; P < 0.001), with no recurrent symptoms and/or prolapse. Patient satisfaction for operation was 89.7 percent.
  
  
  CONCLUSIONS
  Stapled hemorrhoidopexy is a safe and effective treatment for Grade III and Grade IV hemorrhoids. Recurrence requiring reoperation was higher in Grade IV hemorrhoids than in Grade III hemorrhoids.
authors.affiliation: Department of Surgery, Civil Hospital A. Fiorini, Terracina, Latina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceci
authors.forename: Marcello
authors.initials: M
authors.lastname: Picchio
authors.forename: Domenico
authors.initials: D
authors.lastname: Palimento
authors.forename: Benedetto
authors.initials: B
authors.lastname: Calì
authors.forename: Sergio
authors.initials: S
authors.lastname: Corelli
authors.forename: Erasmo
authors.initials: E
authors.lastname: Spaziani
mesh_terms: D013505:Digestive System Surgical Procedures / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017792:Surgical Stapling; D011795:Surveys and Questionnaires; D013997:Time Factors