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Hemorrhoid Stapling Has More Long-Term Risks Than Surgical Removal

Stapling of hemorrhoids — a relatively new and increasingly popular procedure — is associated with a higher risk of recurrence and prolapse than conventional hemorrhoid removal surgery, // investigators report in a comprehensive review of clinical studies.

In contrast to removal (excisional) surgery, circular stapling (hemorrhoidopexy) does not remove hemorrhoids but treats them by inhibiting blood flow to the tissue.

“This study shows that stapled hemorrhoidopexy is associated with a greater risk of hemorrhoid recurrence and the symptom of prolapse in long-term follow-up compared to conventional excisional surgery,” said lead investigator Shiva Jayaraman Colquhoun, M.D.

“If surgeons are to offer this novel technique to their patients, there should be an informed discussion of the risks,” said Colquhoun, a resident in general surgery at the Schulich School of Medicine and Dentistry, University of Western Ontario, in Canada.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Hemorrhoid disease is known to affect more than 15 million people annually in the United States, a number believed to be low since an estimated one-third of patients with symptoms of hemorrhoids do not seek a physician’s care for the condition.

Stapling was introduced in the late 1990s, and in some small studies was shown to be less painful and faster to heal than conventional surgery. A few short-term studies — with less than a year of follow-up — suggested that stapling is equal to excision for controlling further hemorrhoid symptoms. These results helped lead to growing demand for the stapling procedure.

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