Stapled Hemorrhoidopexy is non-inferior to excisional hemorrhoidectomy in long-term follow-up: A comparative study

Purpose: Symptomatic hemorrhoids are one of the most common perianal problems with various treatment options. Up to 20% of patients suffering from symptomatic hemorrhoids will require surgery. Excisional Hemorrhoidectomy (EH) and stapled hemorrhoidopexy (SH) are both standard and safe procedures. While SH has a short-term advantage of faster recovery and lower postoperative pain, its long-term efficacy is debatable. The purpose of this study was to compare the long-term outcomes of EH and SH. Methods: This retrospective study compares outcomes of patients who underwent surgical treatment for symptomatic hemorrhoids in our institution during a time period of over 5 years. Eligible patients were contacted by phone and were asked to answer a questionnaire to evaluate recurrent symptoms, fecal incontinence, satisfaction, and quality of life improvement. Results: Three hundred sixty-two patients were included, of whom 215 underwent SH, 99 underwent EH, and 48 underwent a combined procedure. Twenty-three patients (6.3%) suffered postoperative complications or were readmitted. There were no statistically significant differences between the groups regarding rate of complications, symptoms' recurrence, or fecal incontinence. A higher proportion of patients who underwent SH stated they would undergo the surgery again if they had to (p=0.011). There was no difference in quality of life improvement between the groups (p=0.904). Conclusion: Stapled hemorrhoidopexy is non-inferior to hemorrhoidectomy in long-term follow-up regarding patient satisfaction, quality of life improvement, and symptoms' recurrence.