Closed hemorrhoidectomy with linear stapler: a consecutive series of 300 patients.
BACKGROUND
Hemorrhoidectomy is one of the most commonly performed anorectal operations. The aim of this study was to evaluate the safety and the efficacy of a new technique for sutured closed hemorroidectomy with linear stapler in a consecutive series of 300 patients.


METHODS
Between January 2006 and December 2009, 300 patients (117 male, 183 female) (mean age, 52 (range 21-85) years) with grade III and IV hemorrhoids were treated with our modified technique with linear stapler with 6 cm vascular recharge. This technique essentially achieves a sutured closed hemorroidectomy. The primary end-points of the study were blood loss, time to achieve complete wound healing and recurrence; the secondary end-points were postoperative pain, operative time, hospital stay, patient satisfaction, need of analgesics and morbidity.


RESULTS
Post-operative bleeding occurred in 8 patients (2.7%), requiring surgical hemostasis in 2 patients (0.6%). Overall, 132 patients (44%) reported no presence of pain, 43% defined it as light, the remaining 13% reported it as moderate and required the use of painkillers for about 1 month. Eight patients (2.7%) required postoperative temporary bladder catheterization because of acute urinary retention. The mean operative time was 13 minutes and the hospital stay was one day in 282 patients (94%), two days in 12 patients (4%) and three or more days in the remaining patients. None of the patients developed anal stenosis or fecal incontinence; 1 patient reported gas incontinence. The median follow-up was 23.4 months. All patients had complete wound healing within 6 months. Two patients had recurrent disease and were re-operated on with the same technique.


CONCLUSIONS
Our modified sutured closed hemorrhoidectomy with linear stapler is a simple and safe technique and may be successfully applied for radical treatment in patients with third-degree or fourth-degree hemorrhoids.
Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. rondellif@hotmail.com
Fabio
F
Rondelli
Lorenzo
L
Mariani
Andreino
A
Tassi
Paolo
P
Stella
Pietro Giorgio
PG
Mariani
Giovanni
G
Bistoni
Enrico
E
Mariani
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D013537:Sutures