Intraoperative ligation of residual haemorrhoids after stapled mucosectomy

High recurrence rates are being reported with stapled mucosectomy (SM) in patients with high-grade haemorrhoids. A modification was at--tempted in which SM was followed by ligation and cutting of residual prolapsing haemorrhoids, and the procedure was compared with standard SM.

The study included 45 patients with high-grade haemorrhoids (grades 3 and 4), who underwent SM. The patients were divided into an SM(std) group (SM by the standard procedure) and an SM(mod) group (SM by the modified procedure).

There were 21 patients in the SM(std) group and 19 patients in the SM(mod) group. Five patients were lost to follow-up. The mean age, hospital stay, number of painful days during the postoperative period and the number of days before resumption of normal work were not significantly different between the groups (p>0.05). Recurrence rates were significantly lower in the SM(mod) group (2/19, 10.5%) than in the SM(std) group (14/21, 66.7%; p=0.0004). The percentage of patients highly satisfied (score -1) with the procedure was significantly higher in the SM(mod) group (73.7%, 14/19) than in the SM(std) group (33.3%, 7/21; p=0.014).

Patients with high-grade haemorrhoids in whom a modified stapled mucosectomy (ligating and cutting the residual haemorrhoids on the operating table after the procedure) was performed had a significantly lower recurrence rate and better satisfaction rate than patients in whom standard stapled mucosectomy was performed. Long-term studies in a larger group of patients are needed to substantiate these results.