Featured Research

from universities, journals, and other organizations

Hemorrhoid Stapling Has More Long-term Risks Than Surgical Removal

Date:
October 22, 2006
Source:
Center for the Advancement of Health
Summary:
Stapling of hemorrhoids -- a relatively new and increasingly popular procedure -- is associated with a higher risk of recurrence and prolapse than conventional hemorrhoid removal surgery, investigators report in a comprehensive review of clinical studies.

Stapling of hemorrhoids -- a relatively new and increasingly popular procedure -- is associated with a higher risk of recurrence and prolapse than conventional hemorrhoid removal surgery, investigators report in a comprehensive review of clinical studies.

In contrast to removal (excisional) surgery, circular stapling (hemorrhoidopexy) does not remove hemorrhoids but treats them by inhibiting blood flow to the tissue.

"This study shows that stapled hemorrhoidopexy is associated with a greater risk of hemorrhoid recurrence and the symptom of prolapse in long-term follow-up compared to conventional excisional surgery," said lead investigator Shiva Jayaraman Colquhoun, M.D.

"If surgeons are to offer this novel technique to their patients, there should be an informed discussion of the risks," said Colquhoun, a resident in general surgery at the Schulich School of Medicine and Dentistry, University of Western Ontario, in Canada.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Hemorrhoid disease is known to affect more than 15 million people annually in the United States, a number believed to be low since an estimated one-third of patients with symptoms of hemorrhoids do not seek a physician's care for the condition.

Stapling was introduced in the late 1990s, and in some small studies was shown to be less painful and faster to heal than conventional surgery. A few short-term studies -- with less than a year of follow-up -- suggested that stapling is equal to excision for controlling further hemorrhoid symptoms. These results helped lead to growing demand for the stapling procedure.

For this new review, the investigators analyzed seven randomized clinical trials involving 537 participants and found that patients who had undergone circular stapling were significantly more likely to have recurrent hemorrhoids in the long term than those whose hemorrhoids were surgically removed.

Out of 269 stapling patients, 23 suffered recurrences, compared with four recurrences among 268 patients in the surgical-removal group.

The investigators also found that a significantly higher proportion of stapling subjects complained of prolapse (protrusion outside the anus) both within 12 months and longer.

In favor of stapling, results were better in terms of less pain, itching or bowel-movement urgency; however, these were data "trends" that did not reach the level of significance All other clinical outcomes favored excisional surgery.

The authors suggested that rather than simply offering stapling to all patients with hemorrhoids, there may be a subset of patients for whom it is more beneficial, and that identifying this subset will require further research. "If hemorrhoid recurrence and prolapse are the most important clinical outcomes," they said, "then conventional excisional surgery remains the 'gold standard' in the surgical treatment of internal hemorrhoids."

"This paper directly confronts the major concern with stapled hemorrhoidectomy, namely the long-term outcome," said Joshua Katz, M.D., in private practice with Montgomery Colorectal Surgery in Rockville, Md. "Proponents of this procedure argue it provides similar results to the open procedure with less pain, less disability and more rapid return to work. This paper states that the decreased pain and disability may entail increased risk of recurrence. As the authors note, patients must be advised of this increased risk."

"In all fairness," Katz added, "the increased risk, although statistically significant, is still clinically acceptable, 23 of 269 [stapled] patients versus four of 268 patients with conventional hemorrhoidectomy. Physicians and patients will therefore choose between a procedure carrying increased morbidity and disability with a low recurrence rate, and a procedure with decreased morbidity and disability and a higher recurrence rate."


Story Source:

The above story is based on materials provided by Center for the Advancement of Health. Note: Materials may be edited for content and length.


Cite This Page:

Center for the Advancement of Health. "Hemorrhoid Stapling Has More Long-term Risks Than Surgical Removal." ScienceDaily. ScienceDaily, 22 October 2006. <www.sciencedaily.com/releases/2006/10/061018094723.htm>.
Center for the Advancement of Health. (2006, October 22). Hemorrhoid Stapling Has More Long-term Risks Than Surgical Removal. ScienceDaily. Retrieved August 30, 2014 from www.sciencedaily.com/releases/2006/10/061018094723.htm
Center for the Advancement of Health. "Hemorrhoid Stapling Has More Long-term Risks Than Surgical Removal." ScienceDaily. www.sciencedaily.com/releases/2006/10/061018094723.htm (accessed August 30, 2014).

Share This




More Health & Medicine News

Saturday, August 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

3 Things To Know About The Ebola Outbreak's Progression

3 Things To Know About The Ebola Outbreak's Progression

Newsy (Aug. 29, 2014) Here are three things you need to know about the deadly Ebola outbreak's progression this week. Video provided by Newsy
Powered by NewsLook.com
Killer Amoeba Found in Louisiana Water System

Killer Amoeba Found in Louisiana Water System

AP (Aug. 28, 2014) State health officials say testing has confirmed the presence of a killer amoeba in a water system serving three St. John the Baptist Parish towns. (Aug. 28) Video provided by AP
Powered by NewsLook.com
Who Could Be Burnt by WHO's E-Cigs Move?

Who Could Be Burnt by WHO's E-Cigs Move?

Reuters - Business Video Online (Aug. 28, 2014) The World Health Organisation has called for the regulation of electronic cigarettes as both tobacco and medical products. Ciara Lee looks at the impact of the move on the tobacco industry. Video provided by Reuters
Powered by NewsLook.com
CDC Director On Ebola Outbreak: 'It's Worse Than I Feared'

CDC Director On Ebola Outbreak: 'It's Worse Than I Feared'

Newsy (Aug. 28, 2014) CDC director Tom Frieden says the Ebola outbreak is even worse than he feared. But he also said there's still hope to contain it. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins