Almost all studies, with a few exceptions, also found an early return to work.
Subsequently called stapled hemorrhoidopexy or procedure for prolapsed hemorrhoids (PPH), the technique gained a wide popularity due to the low postoperative pain. The technique was later proposed by Longo for the treatment of hemorrhoids. Stapled transanal mucosectomy, first experimented at our unit, aims to treating rectal internal mucosal prolapse and obstructed defecation. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. Enterocele and anismus are contraindications to PPH and STARR and both operations should be used with caution in patients with weak sphincters. A higher complication rate and worse results are expected after PPH for fourth-degree piles. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures and fecal incontinence. This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. All other clinical parameters showed trends favoring CH.Procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain, but may be followed by unusual and severe postoperative complications. Non significant trends in favor of SH were seen in pain, pruritis ani, and fecal urgency. When all symptoms were considered, patients undergoing CH surgery were more likely to be asymptomatic (12 trials, 1097 patients, OR 0.59, CI 0.40-0.88). Patients undergoing SH were more likely to require an additional operative procedure compared to those who underwent CH (8 papers, 553 patients, OR 2.75, CI 1.31-5.77, p=0.008). In studies with follow up of greater than one year, the same significant outcome was found (7 studies, 668 patients, OR 3.14, CI 1.20-8.22, p=0.02). Furthermore, a significantly higher proportion of patients with SH complained of the symptom of prolapse at all time points (13 studies, 1191 patients, OR 2.65, CI 1.45-4.85, p=0.002). Similarly, in trials where there was follow up of one year or more, SH was associated with a greater proportion of patients with hemorrhoid recurrence (5 trials, 417 patients, OR 3.60, CI 1.24-10.49, p=0.02). There were 37 recurrences out of 479 patients in the stapled group versus only 9 out of 476 patients in the conventional group. Patients with SH were significantly more likely to have recurrent hemorrhoids in long term follow up at all time points than those with CH (12 trials, 955 patients, OR 3.22, CI 1.59-6.51, p=0.001). Since this initial review, several more randomized controlled trials have been published that may shed more light on the differences between the novel stapled approach and conventional excisional techniques. The reports also suggest a better patient acceptance and a higher compliance with day-case procedures potentially making it more economical. A previous Cochrane Review of stapled hemorrhoidopexy and conventional excisional surgery has shown that the stapled technique is associated with a higher risk of recurrent hemorrhoids and some symptoms in long term follow-up. Early, small randomized-controlled trials comparing stapled hemorrhoidopexy with traditional excisional surgery have shown it to be less painful and that it is associated with quicker recovery. Circular stapled hemorrhoidopexy was first described by Longo in 1998 as alternative to conventional excisional hemorrhoidectomy. The Milligan-Morgan open hemorrhoidectomy is the most widely practiced surgical technique used for the management of hemorrhoids and is considered the current "gold standard". Hemorrhoids are one of the most common anorectal disorders.
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