We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Hospital Costs of Conventional and Stapled 1-Day Hemorrhoidectomy—Reply

Pasquale Giordano, MD, FRCSEd, FRCS; Gianpiero Gravante, MD; Lauren Ovens, MBChB, MRCS; Piero Nastro, MD, MRCS
Arch Surg. 2009;144(10):977-980. doi:10.1001/archsurg.2009.178.
Text Size: A A A
Published online


In reply

Dr Cariati's comments on the cost of stapled hemorrhoidpexy are certainly interesting, since in the current era of worldwide recession, the economic implications of any new technology and its impact on the health care system are extremely important. Our study, however, was not intended to be an economic evaluation of the 2 procedures, and therefore costs were not part of the parameters analyzed. However, when calculating the financial cost of any surgical treatment and, even more importantly, its overall societal costs, it is necessary to consider not only the added cost of any device required to carry out the procedure but also many other variables, such as operating room time, length of hospital stay, postoperative wound management, incidence of postoperative complications, time of postoperative recovery, and return to work. For this reason, this kind of calculation can be extremely difficult and complicated. In a recent analysis, Burch et al1 have tried to address this issue using sophisticated economic models and different scenarios. According to their results, conventional hemorrhoidectomy and stapled hemorrhoidpexy had very similar costs and quality-adjusted life-years, the cost of the staple gun being offset by savings in hospital stay. However, the estimates were based on published data and may not necessarily reflect local circumstances. For this reason, we do not think that we have enough evidence at the moment to achieve a definitive conclusion on the financial impact of stapled hemorrhoidpexy on hospitals and society. Whether or not the use of stapled hemorrhoidpexy is a viable option needs to be agreed upon locally based on local needs and circumstances, bearing in mind the available evidence.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also 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.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
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.


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

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

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

Articles Related By Topic
Related Collections