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The purpose of this systematic review was to compare the long-term results of stapled hemorrhoidopexy with conventional excisional hemorrhoidectomy in patients with internal hemorrhoids. A systematic review of all randomized, controlled trials comparing stapled hemorrhoidopexy and conventional hemorrhoidectomy with long-term results was performed by using the Cochrane methodology. The minimum follow-up was six months. Primary outcomes were hemorrhoid recurrence, hemorrhoid symptom recurrence, complications, and pain. Twelve trials were included. Follow-up varied from six months to four years. Conventional hemorrhoidectomy was more effective in preventing long-term recurrence of hemorrhoids (odds ratio (OR), 3.85; 95 percent confidence interval (CI), 1.47–10.07; P < 0.006). Conventional hemorrhoidectomy also prevents hemorrhoids in studies with follow-up of one year or more (OR, 3.6; 95 percent CI, 1.24–10.49; P < 0.02). Conventional hemorrhoidectomy is superior in preventing the symptom of prolapse (OR, 2.96; 95 percent CI, 1.33–6.58; P < 0.008). Conventional hemorrhoidectomy also is more effective at preventing prolapse in studies with follow-up of one year or more (OR, 2.68; 95 percent CI, 0.98–7.34; P < 0.05). Nonsignificant trends in favor of conventional hemorrhoidectomy were seen in the proportion of asymptomatic patients, bleeding, soiling/difficultly with hygiene/incontinence, the presence of perianal skin tags, and the need for further surgery. Nonsignificant trends in favor of stapled hemorrhoidopexy were seen in pain, pruritus ani, and symptoms of anal obstruction/stenosis. Conventional hemorrhoidectomy is superior to stapled hemorrhoidopexy for prevention of postoperative recurrence of internal hemorrhoids. Fewer patients who received conventional hemorrhoidectomy complained of hemorrhoidal prolapse in long-term follow-up compared with stapled hemorrhoidopexy. [ABSTRACT FROM AUTHOR]

Stricturoplasty was originally used to treat multiple fibrotic strictures of tuberculosis. As the pendulum of treatment of Crohn's disease swung toward conservatism and bowel preservation, stricturoplasty was performed in Crohn's disease. Stricturoplasty can be used when there is limited, well-localized disease and should be avoided in the presence of grossly inflamed or infected material. We describe a new technique of stricturoplasty.Typically stricturoplasty is performed in a manner similar to a Heineke-Mikulicz pyloroplasty. A stapled stricturoplasty technique has been previously described, but in actuality these are more similar to a bypass procedure. Our technique uses a stapled, open technique similar to the triangulating method of bowel anastomosis. This was performed in one patient to correct six strictures.Our patient did well postoperatively and developed no significant complications. He has no evidence of recurrent strictures.We describe a stapled stricturoplasty technique that is truly a stricturoplasty because the bowel lumen is increased; it is similar to the triangulating method of end-to-end stapled bowel anastomosis. It is safe, efficient, and effective. Additionally, it allows radiographic location of the stricturoplasty site, thus allowing determination of effectiveness of the procedure as well as recurrence. [ABSTRACT FROM AUTHOR]

Extraperitoneal colorectal anastomoses were constructed in dogs by four methods: one layer of sutures (N=10), two layers of sutures (N=10), EEA staples (N=10), and SPTU staples (N=10). Dehiscence occurred in eight sutured and one stapled anastomosis (P<0.05). The four leaks following two layer sutured anastomoses caused three deaths, whereas all four leaks following one-layer sutured anastomoses were only detected radiologically (P<0.02). In the stapled group, the single leak followed EEA anastomosis and was fatal. Anastomotic narrowing was greater in sutured than stapled groups (P<0.05). Two layers of sutures produced gross narrowing compared with one layer (P<0.002). Two rows of staples (EEA) produced more narrowing than one row (SPTU) (P<0.01). Mean hydroxyproline concentrations and bursting pressures on the seventh postoperative day were higher in stapled than sutured anastomoses (P<0.05). Submucosal alignment, mucosal continuity, tissue viability, and stage of healing were all inferior for two-layer sutured anastomoses, reaching statistical significance for tissue viability (P<0.05). Stapled anastomoses were completed significantly faster (32.6±7.3 minutes) than sutured (54.1±8.4 minutes) (P<0.01). This experimental study has demonstrated that stapling is a fast and reliable method of colorectal anastomosis with a low complication rate. The shortcomings of the standard two-layer sutured anastomosis are discussed. [ABSTRACT FROM AUTHOR]