Stapled anoplasty for haemorrhoids: a comparison of ambulatory vs. in-patient procedures

Haemorrhoids are commonly seen in colorectal practice. Stapled anoplasty is a novel approach to the treatment of this condition and is usually performed as an in-patient procedure. The aim of this study was to investigate the suitability of this technique for ambulatory surgery.

Fifty consecutive patients undergoing stapled anoplasty under general anaesthesia as day cases (DC) (mean age 41 years; 27 females) by a single consultant surgeon over a 12-month period were compared with 50 consecutive patients undergoing the same procedure as in-patients (mean age 44 years; 25 females) (IP) during the same period.

Eight DC patients (16%) were admitted overnight from the day surgery unit for urinary retention (3), pain (2), bleeding (2) and anaesthetic reasons (1). Three other DC patients were re-admitted after a mean period of 4 days with bleeding (2), one of which required surgical haemostasis, and a septic complication (1). Mean hospital stay for IP cases was 2.6 (range 1-9) days. Two IP cases were re-admitted after 4 and 11 days for bleeding and wound infection, respectively. At review 2-4 weeks after discharge, satisfaction in both groups was high. Minor staple-line strictures were seen in 1 DC and 2 IP cases but all were easily dilated digitally. Mean costs incurred were significantly less for day surgery patients.

Stapled anoplasty is suitable for use in day-case surgery as it is a quick and relatively painless procedure. The advantages, particularly financial, support the technique for use in an ambulatory setting, preferably in the morning, and provided detailed patient advice is given.