Stapled anopexy as a Day Surgery procedure: our experience over 400 cases

Introduction: In 1988, Longo proposed a new treatment for hemorrhoidal disease. In western countries day surgery procedures are becoming more and more common. We propose a new protocol for outpatient hemorrhoidopexy. Patients and methods: From 2003 to 2010, we performed 403 out-patient stapled hemorrhoidopexies under spinal anesthesia, on patients with symptomatic grade III and IV hemorrhoid disease. We used PPH 01 and PPH 03 staplers (Ethicon Endo-surgery, Cincinnati, OH, USA). We assessed early and late postoperative pain with a Visual Analog Scale (VAS), whereas clinical postoperative examinations were performed 7 days, 6 months, and 1, 3 and 5 years after surgery. Results: The mean surgery time was about 20 min (range 13e39 min). Out of 403 patients, 41 were not dischargeable as a result of urine retention, severe pain or mild bleeding. Twentytwo patients reported transient faecal urgency, while no patient complained of anal incontinence. Discussion: Our experience with 403 patients demonstrated that stapled haemorrhoidopexy is feasible and safe as a day surgery procedure. However, careful preoperative planning is necessary in order to evaluate the patients’ health status and the consequent perioperative and postoperative risk. Our results are positive in terms of surgical safety and postoperative recovery time.