title: Day case stapled anopexy for the treatment of haemorrhoids and rectal mucosal prolapse.
abstract: OBJECTIVE
  Stapled anopexy (SA) gives better early postoperative results than classical haemorrhoidectomy. The aim of this study is to demonstrate that SA is a safe and effective procedure for the treatment of haemorrhoids and rectal mucose prolapse in a day-case surgery programme.
  
  
  METHODS
  From January 2000 to December 2008, 297 SA procedures were performed; 230 (77.4%) were performed in the Day Surgery Unit (DSU). Third- and fourth-degree haemorrhoids, second-degree haemorrhoids with no response to conservative treatment and several cases of rectal prolapse were included. The mean age of the patients in the series was 48.1 years (range 21-85). Preoperative preparation included phosphate enemas and antibiotic prophylaxis. Patients were operated on mainly under spinal anaesthesia. Day-case rate, postoperative pain (measured by a visual analogic scale, 1-10), admissions, re-admissions, early postoperative situation and recurrence were evaluated in the study.
  
  
  RESULTS
  The overall DSU rate was 78%, with a progressive increase from 46% to 99% in 2008. One hundred and eighty-five patients (80%) had pain scores under 2; no patient had a pain score over 7. Eighteen (8%) patients required admission on the day of surgery. Late admission was needed for 3 (3%) patients. Thirty-three patients reported their situation as excellent, 174 as good, 20 as acceptable and three as bad when they answered a phone questionnaire 24 h after surgery. Overall, 20 (9%) patients had recurrence of symptoms.
  
  
  CONCLUSIONS
  SA is a safe and effective procedure for prolapsing haemorrhoids in the day case setting. The recurrence rate is higher than that observed in classical haemorrhoidectomy. Most patients can be managed as day-cases.
authors.affiliation: Colorectal Surgery Unit, General and Digestive Surgery Department, Hospital de Mataró, Mataró, Barcelona, Spain. lahidalgo@csdm.cat
authors.forename: L A
authors.initials: LA
authors.lastname: Hidalgo Grau
authors.forename: A
authors.initials: A
authors.lastname: Heredia Budó
authors.forename: S
authors.initials: S
authors.lastname: Llorca Cardeñosa
authors.forename: J
authors.initials: J
authors.lastname: Carbonell Roure
authors.forename: O
authors.initials: O
authors.lastname: Estrada Ferrer
authors.forename: E
authors.initials: E
authors.lastname: García Torralbo
authors.forename: X
authors.initials: X
authors.lastname: Suñol Sala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D004733:Enema; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010710:Phosphates / Q000008:administration & dosage; D012005:Rectal Prolapse / Q000601:surgery*; D012008:Recurrence; D017792:Surgical Stapling / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D005839:Gentamicins; D010710:Phosphates; D008795:Metronidazole