0
Invited Critique |

A Systematic Review of Stapled Hemorrhoidectomy—Invited Critique

Susan Galandiuk, MD
Arch Surg. 2002;137(12):1407. doi:10.1001/archsurg.137.12.1407.
Text Size: A A A
Published online

Extract

Dr Sutherland and colleagues have undertaken a difficult task, that of analyzing results of RCTs, evaluating stapled and conventional hemorrhoidectomies. Stapled hemorrhoidectomy seems to be superior with respect to bleeding at 2 weeks and length of hospital stay. There is also a trend toward less postoperative pain and fewer problems with wound healing.

There are several important points that need to be taken into account when comparing stapled with conventional hemorrhoidectomy. Stapled hemorrhoidectomy is not hemorrhoidectomy in the true sense, but rather an excision of redundant rectal mucosa. Stapled hemorrhoidectomy is suitable for those patients who do not have a significant external hemorrhoidal component and those without a significant amount of hemorrhoidal prolapse. This procedure is probably suitable for most patients with grade 1 and 2 hemorrhoids, who are exactly those patients that respond most frequently to conservative treatment using fiber products, topical medication, rubber band ligation, or infrared therapy. Conventional hemorrhoidectomy is typically reserved for those patients with a significant external hemorrhoidal component and for those with large prolapsing internal hemorrhoids. The types of patients who are ideally treated by each procedure, therefore, tend to be different. Conventional hemorrhoidectomy is a rapid and inexpensive procedure that is typically performed using some type of absorbable suture; in the case of open hemorrhoidectomy, the wounds are left open to granulate and heal by secondary intention. Hospital stays associated with this procedure vary greatly. In Europe and in some areas in North America, this is an inpatient procedure with an inpatient hospital stay; however, in much of the United States, this is an outpatient procedure. Data from RCTs performed in different countries can, therefore, not really be compared for length of stay. Stapled hemorrhoidectomy is an outpatient procedure. It does, however, involve the use of a circular stapler at a cost of several hundred dollars. Because there is no external excision, there is, not surprisingly, less pain than with conventional hemorrhoidectomy, and because there is less pain, the rates of urinary retention will be lower.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();