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Letters

Stapled haemorrhoidectomy offers substantial benefits

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7281.303 (Published 03 February 2001) Cite this as: BMJ 2001;322:303
  1. Garth C Beattie, specialist registrar in general surgery,
  2. Malcolm A Loudon, consultant colorectal surgeon (malcolml{at}cwcom.net)
  1. Daisy Hill Hospital, Newry, County Down BT35 8DR
  2. Victoria Hospital Kirkcaldy, Fife KY2 5AH

    EDITOR—Brisinda's synopsis of the contemporary treatment of haemorrhoids was timely and comprehensive.1 We have recently undertaken a detailed questionnaire survey of all 800 general and colorectal specialist surgeons in the United Kingdom and Ireland; with the exception of a few specific treatments, such as the injection of botulinum toxin for sphincter spasm, all the treatment modalities mentioned are currently used with varying degrees of popularity.2

    We strongly support the comments made regarding the role of stapled “haemorrhoidectomy” in the surgical management of prolapsing haemorrhoids. Our own experience of this operation (currently over 80 performed) confirms that this procedure is effective in reducing postoperative pain (thus facilitating day case surgery) and leads to a rapid return to normal activities compared with the conventional excision-ligation (Milligan-Morgan) procedure.3 As with any innovative surgical technique, however, concerns will inevitably be raised about issues of safety and efficacy.4

    Although stapled haemorrhoidectomy does increase operative costs, total hospital costs may be reduced as a consequence of decreased bed usage. The comment that the stapled procedure does not allow for the treatment of concomitant anal disease was a little unclear. We presume this refers to the external haemorrhoidal component, such as oedematous anal skin tags. In his original description of the technique Longo hypothesises that, by interrupting the feeding haemorrhoidal vessels in the resectionanastomosis, the skin tags will regress in the postoperative period, eventually forming radial cutaneous folds.5 This has been confirmed by our own series, in which more than 50 patients have been followed up for six months postoperatively. We regard excision of any external component as unnecessary, especially if such excision is likely to be a major factor contributing to postoperative pain.

    We would also echo Brisinda's comments that the stapling procedure requires advanced surgical skills and should be carried out only by operators with sufficient technical experience. Surgeons should be familiar with operating high in the anorectum and undergo specific training, factors that may be important in the small numbers of adverse events which have been reported in relation to this procedure.4 In the hands of appropriately trained surgeons stapling offers substantial benefits in the surgical management of haemorrhoids.

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