title: Stapled anopexy as a day surgery procedure: our experience over 400 cases.
abstract: BACKGROUND
  In 1988, Longo proposed a new treatment for haemorrhoidal disease. In western countries day surgery procedures are becoming more and more common. We propose a new protocol for outpatient haemorrhoidopexy.
  
  
  METHODS
  From 2003 to 2010, we performed 403 out-patient stapled haemorrhoidopexies under spinal anaesthesia, on patients with symptomatic grade III and IV haemorrhoid disease. We used PPH 01 and PPH 03 staplers (Ethicon Endosurgery, Cincinnati, OH, USA). We assessed early and late postoperative pain with a Visual Analogue Scale (VAS), and clinical postoperative examinations were performed 7 days, 6 months, and 1, 3 and 5 years after surgery.
  
  
  RESULTS
  The mean surgery time was about 20 min (range 13-39 min). Out of 403 patients, 41 were not dischargeable as a result of urine retention, severe pain or mild bleeding. Twenty-two patients reported transient faecal urgency, while no patient complained of anal incontinence.
  
  
  CONCLUSIONS
  Our experience with 403 patients demonstrated that stapled haemorrhoidopexy is feasible and safe as a day surgery procedure. However, careful preoperative planning is necessary in order to evaluate the patients' health status and the consequent perioperative and postoperative risk. Our results are positive in terms of surgical safety and postoperative recovery time.
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea Hospital, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy. onedaysurgery-info@yahoo.it
authors.forename: Umile Michele
authors.initials: UM
authors.lastname: Cosenza
authors.forename: Stefano
authors.initials: S
authors.lastname: Conte
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Andrea
authors.initials: A
authors.lastname: Milillo
authors.forename: Marcello
authors.initials: M
authors.lastname: Gasparrini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pancaldi
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017792:Surgical Stapling; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome