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22-08-2011 | Surgery | Article

Day-case stapled anopexy effective hemorrhoid management


Free abstract

MedWire News: Results from a Spanish study indicate that stapled anopexy (SA) performed as a day-case is an effective treatment for patients with prolapsing hemorrhoids.

However, recurrence of the condition is higher with this procedure than with conventional hemorrhoidectomy, the authors add in the journal Colorectal Disease.

LA Hildago Grau (Hospital de Mataró, Barcelona) and team recruited 297 patients with prolapsing haemorrhoids to undergo SA. Of these, 230 (78%) were performed as a day case.

The patients had a mean age of 48 years and 63% were male.

Most patients reported minimal postoperative pain. Specifically, on a pain scale ranging from 1 to 10, where 1 was equivalent to no pain and 10 equivalent to maximum pain possible, 80% of day-case patients reported a pain score of 2 or less. By 24 hours post-procedure, most day-case patients reported their situation as excellent (14%) or good (76%). Only 1% described their situation as bad.

When followed-up for a period of 2 to 8 years, a hemorrhoid-recurrence rate of 9% (n=20) was observed among the day-case patients.

This rate, say the authors, is "higher than that obtained by classical techniques."

The main presentation of recurrence was prolapse, followed by bleeding, and thrombosis, which occurred in 12, 7, and one patients, respectively.

Grau et al remark that the low pain levels reported by the day case SA patients are encouraging.

They explain that "excessive pain precludes day-case surgery for surgical treatment of hemorrhoids. In our experience, this is the case with conventional excisional surgery when more than one group of haemorrhoids is treated."

Grau and colleagues suggest that by avoiding contact with the sensitive anoderm region during SA, pain and other complications are minimized.

They conclude: "Progressively increased management as day cases is achievable."

By Lauretta Ihonor

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