Stapled anopexy as a day surgery procedure: our experience over 400 cases

Area of Science:

• Colorectal Surgery
• Surgical Innovation
• Minimally Invasive Procedures

Background:

• Hemorrhoidal disease management has evolved, with increasing adoption of day surgery procedures in Western countries.
• The Longo technique, proposed in 1988, laid groundwork for surgical interventions in hemorrhoidal disease.
• Outpatient procedures offer benefits in terms of patient convenience and healthcare resource utilization.

Purpose of the Study:

• To evaluate the feasibility and safety of a new protocol for outpatient stapled haemorrhoidopexy.
• To assess the outcomes of stapled haemorrhoidopexy for symptomatic grade III and IV hemorrhoidal disease in an ambulatory setting.
• To determine the early and late postoperative complications and recovery times associated with this day surgery approach.

Main Methods:

• A prospective study involving 403 patients undergoing outpatient stapled haemorrhoidopexies between 2003 and 2010.
• Procedures were performed under spinal anaesthesia using PPH 01 and PPH 03 staplers.
• Postoperative pain was assessed using the Visual Analogue Scale (VAS), with clinical follow-up at 7 days, 6 months, and 1, 3, and 5 years.

Main Results:

• The mean surgical time was approximately 20 minutes.
• 41 out of 403 patients (10.2%) required extended observation due to urine retention, severe pain, or mild bleeding.
• Twenty-two patients (5.5%) experienced transient faecal urgency, with no reported cases of anal incontinence.

Conclusions:

• Stapled haemorrhoidopexy is a feasible and safe day surgery procedure for selected patients with symptomatic grade III and IV hemorrhoids.
• Careful preoperative assessment is crucial to identify patients suitable for outpatient surgery and manage perioperative risks.
• The study demonstrates positive outcomes regarding surgical safety and postoperative recovery time in an ambulatory setting.