By Steve Mitchell
NEW YORK, Mar 03 (Reuters Health) -- A new procedure for removing
hemorrhoids, stapled hemorrhoidectomy, is less painful and allows patients to
return to normal activities sooner than with the conventional procedure,
according to two studies in this week's issue of The Lancet.
"Patients... experience very much less pain, leave the hospital earlier and
get back to work earlier than patients undergoing a conventional
hemorrhoidectomy," principal author of one of the studies Dr. David M. Hemingway
told Reuters Health.
Dr. John R.T. Monson, principal author of the second study, agrees. Monson
said, "The level of pain (patients) experience is significantly less and
therefore they simply are more comfortable, more willing to go home." He also
noted that 6 weeks after the new procedure, patients "complain far less."
In conventional hemorrhoidectomy, the surgeons remove the hemorrhoid and may
or may not close the resultant wound. In the new stapled hemorrhoidectomy
procedure, surgeons take tissue from further along the anal canal and 'staple'
it over the wound with surgical staples.
Theoretically, this should result in less pain after surgery, but no
scientific studies had shown this to be the case until now.
In the first study, Hemingway and colleagues of the Leicester Royal
Infirmary in the UK performed stapled hemorrhoidectomy on 11 patients with
severe hemorrhoids. The stapled patients had a shorter stay in the hospital of
about 1 night than patients who underwent conventional hemorrhoidectomy, who
stayed in the hospital an average of about 3 nights.
The stapled group also experienced less pain and returned to normal
activities 8 days sooner than the group who had conventional surgery. In
addition, symptoms of prolapse (tissue protruding through the anus), discharge,
and bleeding were controlled in all of the stapled patients.
"Stapled hemorrhoidectomy is an effective treatment for (severe) hemorrhoids
with significant advantages for patients compared with conventional
hemorrhoidectomy," Hemingway and co-authors conclude.
"This technique," Hemingway told Reuters Health, "should not be used on
patients who have small hemorrhoids."
In the second study, Monson and colleagues of the University of Hull in
Cottingham, UK, performed stapled hemorrhoidectomy on 20 patients with
prolapsing hemorrhoids. The stapled group required less anesthesia time and
reported less pain. Return to normal activity was shorter in the stapled group
as well.
"The... stapled technique offers a significantly less painful alternative to
(conventional) hemorrhoidectomy and is associated with an earlier return to
normal activity," Monson's group reports.
Although the procedure is less painful, it is not without peril. Drs.
Richard G. Molloy and David Kingsmore of the Gartnavel General Hospital in
Glasgow, Scotland, report a case of sepsis -- spread of bacteria in bloodstream
-- in a healthy, 24-year-old man after he underwent stapled hemorrhoidectomy.
Molloy and Kingsmore say that antibiotics that would prevent the dangerous
consequences of sepsis should be given to patients undergoing this procedure.
Monson commented, "The case report is interesting but not helpful." He
added, "The issue is that surgery, of any form, in the ano-rectal region is
occasionally associated with severe pelvic sepsis. This is what happened here
and is simply a case report -- unfortunate though it may be."
Hemingway told Reuters Health, "I am surprised that The Lancet are
publishing a case report like this. This sort of pelvic sepsis is a recognized
but fortunately very, very rare consequence of any form of pelvic surgery."
In an editorial on the two clinical trials, Dr. Victor W. Fazio of the
Cleveland Clinic Foundation in Ohio notes that the reason that stapled
hemorrhoidectomy results in less pain is probably because it "does not leave an
open... wound."
But Fazio notes that disadvantages of the stapling procedure include high
cost, the risk of injuries to the anal wall or vagina, damage to the sphincter
from insertion of the stapling device, and, of course, sepsis. In the latter
case, Fazio agrees that the administration of antibiotics at the time of surgery
to prevent sepsis "seems reasonable."
