Recently the surgical treatment of
hemorrhoids using a circular stapler device has gained increasing approval. The Longo's procedure reduces the rectal mucosal and
hemorrhoid prolapse using a circular stapler to resect transversally a mucosal-submucosal rectal ring in order to restore the correct anatomical relationships of the anal canal structures. The recent availability of a dedicated instrument kit (PPH01 Ethicon Endo-Surgery) allowed an easy diffusion of this technique. From March 1999 to September 2001, 198 patients with III-IV degree
hemorrhoids were treated by a single expert surgeon using the dedicated kit instrumentation (PPH01) according to the Longo's technique, adopting some variations from the original procedure: 1) The anal dilator is not fixed to the perianal skin with
forceps or stitches but is kept by the assistant. 2) In performing the purse-string
suture particular care must be given to the apposition of the stitches at the same level also in the posterolateral side where there is a natural trend to apply the stitches at a lower level; furthermore the last stitch of the purse-string
suture must be overlapped to the first one in order to allow a better hemostasis when the knot is tightened. 3) After having performed the purse-string and having resected the mucosa and submucosa, an accurate hemostasis with U-shaped 3/0
vicryl stitches firmly reduces the postoperative
bleeding. We recorded
pain scores, short- and long-term complications (included moderate-severe
pain, persistent
pain), recurrences and postoperative
hospital stay. The data of the last 40 consecutive patients who underwent stapled
hemorrhoidectomy were compared with the data obtained by 40 consecutive patients who underwent Milligan-Morgan diathermic
hemorrhoidectomy for III-IV degree non-circumferential
hemorrhoids by the same surgeon. In the 198 stapled
hemorrhoidectomy cases the rate of postoperative moderate-severe
pain and persistent
pain were 6% and 2.5% respectively, the rate of short-term and long-term
bleeding were 4.5% and 3.5%, the recurrence rate was 2.5%. The mean postoperative stay was 1.6 days. The stapled group had significantly lower postoperative moderate-severe
pain,
bleeding and soiling than the Milligan-Morgan group.