NEW YORK (Reuters Health) – As a treatment for symptomatic hemorrhoids, circular stapled anopexy is associated with less pain and has higher patient acceptability than does excisional hemorrhoidectomy, although the 1-year relapse rate is higher, new research shows.

Despite being a painful procedure and having potentially serious complications, excisional hemorrhoidectomy has long been considered the “gold standard” treatment for symptomatic hemorrhoids, Dr. M. Thaha, from the University of Dundee, UK, and colleagues note in their paper in the May issue of Gut.

Stapled anopexy, which was introduced in 1998, involves reduction of the prolapsed anal cushion with a pulling-up effect and clipping of the arterial pedicle, which might better address the underlying mechanism of hemorrhoids than does simple removal.

The researchers assessed postoperative pain, symptom control, complications, satisfaction, and retreatment rates in 182 patients with grade II to IV hemorrhoids who were randomized to undergo stapled anopexy or hemorrhoidectomy. The subjects were followed at multiple points for 1 year.

Postoperative pain was significantly lower in the stapled anopexy group (p = 0.004). Accumulated patient-perceived pain scores in the first week were 77 in the anopexy group and 114 in the hemorrhoidectomy group, out of a possible total score of 420.

In general, complications rates were comparable in each group. Fecal urgency was more common with stapled anopexy than with hemorrhoidectomy, although the difference was not statistically significant.

Patient satisfaction at 6 and 12 weeks was higher with stapled anopexy and more patients were willing to undergo this treatment again than hemorrhoidectomy.

No significant differences in symptoms or disease severity were noted between the groups at 1 year.

There was a trend toward better prolapse control with hemorrhoidectomy. Moreover, the 1-year retreatment rate for residual relapse was significantly lower with hemorrhoidectomy (p = 0.037), with only one patient in that group requiring retreatment compared to 8 patients in the stapled anopexy group.

The results suggest that “patient preference may be biased towards stapled anopexy due to reduced pain,” the authors state. “However, this has to be balanced against a higher long-term recurrence rate and the specific complications, especially fecal urgency and post-defecation pain, that are associated with stapled anopexy.”

Reference:
Gut 2009;58:668-678.