Douglas K. Rex, MD reviewing Watson AJM et al. Lancet 2016 Oct 7. Bach SP and Fearnhead NS. Lancet 2016 Oct 7.

Use excisional hemorrhoidectomy for disease too advanced for rubber band ligation therapy.

Excisional hemorrhoidectomy for advanced hemorrhoids is considered a painful procedure, which has led to development of alternative approaches. One of these is stapled hemorrhoidopexy, which involves excision of a rim of tissue above the internal hemorrhoids with re-anastomosis of the mucosa using staples. This operation is sometimes endorsed for being less painful than excisional hemorrhoidectomy.

In a randomized, controlled trial in the U.K., researchers compared outcomes with excisional hemorrhoidectomy versus stapled hemorrhoidopexy in 777 patients with grade 2, 3, or 4 hemorrhoids (22%, 63%, and 15%, respectively).

In the first few weeks after hemorrhoidectomy, quality of life was better in patients with the stapling procedure, but after 6 weeks it was better with excisional hemorrhoidectomy. Symptoms returned in 32% in the stapling group versus 14% in the excisional group. Continence scores and tenesmus were both worse in the stapling group. Serious adverse events occurred in 9% in the excisional group versus 7% with the stapled hemorrhoidopexy.

CITATION(S):

Watson AJM et al. Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): A pragmatic, multicentre, randomised controlled trial. Lancet 2016 Oct 7; [e-pub].

Bach SP and Fearnhead NS.eTHoS piles pressure on haemorrhoidopexy. Lancet 2016 Oct 7; [e-pub]. 

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