[Stapled anopexy for prolapsed hemorrhoids--a new operation]

Haemorrhoidectomy is associated with pain and open wounds. A new closed technique uses an intraluminal stapler to replace the prolapsed haemorrhoidal tissue to a normal anatomical position (anopexy) and to interrupt the vessels. We report our results, including the learning curve.

Forty patients with grade 4 haemorrhoids underwent operation, 26 women, median age 47 years (33-86), and 14 men, median age 53 years (34-75). Outcome parameters were hospital stay, pain score, surgical anatomy score before and after the operation, and complications, symptom-control and patient satisfaction.

Eleven patients left hospital on the day of operation, 19 the day after. The median pain score was 3 (2-10) for the first four days and 1 on day 7 (0-4). The postoperative surgical anatomy score was 1 (normal anus) in 24 patients, 2 in nine patients, which was not different significantly at follow up (p > 0.05). Postoperative bleeding required haemostasis in two patients. One patient had a stenosis temporarily, and two patients had persistent pain and faecal urgency, which disappeared. No sphincter lesions occurred. Control of symptoms and satisfaction were excellent in 20 patients, good in 11, and satisfactory in five.

Stapled anopexy restored surgical anatomy towards normal, with moderate pain and few complications. Control of symptoms and patient-satisfaction was high. The procedure is a new option in the treatment of severe haemorrhoids rather than an alternative to open haemorrhoidectomy.