Assessment of the Success Rates of Stapled Hemorrhoidopexy Intervention for Grade III and IV Hemorrhoids among Adult Patients of North India: An Observational Hospital-based Study

  • Bhumika Narang ESI Hospital Okhla, New Delhi, India
  • Niraj Kumar ESI Hospital Okhla, New Delhi, India
  • Rabi Shankar Singh ESIC PGIMSR,New Delhi, India
  • Shakti Pratap Singh Deen Dayal Upadhyay Hospital, New Delhi, India
  • Shankar Prasad Singh Sir Ganga Ram Hospital, New Delhi, India
  • Vandana Srivastava MCDDispensary, New Delhi, India
Keywords: Bleeding,, Hemorrhoids,, Pain, Stapled hemorrhoidectomy


Introduction: Hemorrhoid disease therapy is effectively been treated with conventional excisional hemorrhoidectomy. Stapled
hemorrhoidopexy (SH) revolutionized the traditional surgical approach by the introduction of the theory of dealing with the rectal
mucosal prolapse by resecting a mucosal cylinder above the dentate line by means of mechanical stapling. It is a non-excisional
approach for the surgical treatment of hemorrhoid disease.
Materials and Methods: Ethical clearance was obtained from the institution. A total of 100 adult patients with Grade III/IV
hemorrhoids indicated for surgery were recruited for the study purpose. Data collected were post-operative pain in the form of
VAS scale, immediate complications, duration, or length of stay in the hospital along with the time to resume work again. SPSS
17.0 was used to carry out the analysis. All P < 0.05 were considered to be statistically significant.
Results: The mean age of the study group was 45 ± 14.93 years. The mean length of hospital stays, postoperatively for 21%
subjects, was mere 1 day; however, it was 2 days for the rest of population studied. The only complication was with 2% of the
study population having excessive intraoperative bleeding. The mean time to return to work was 8 days. About 77% of the
patients resumed their work within 8 days of surgery.
Conclusion: Within the given limitations of the study, we can conclude that SH is a successful procedure for Grade-III/IV
hemorrhoids in terms of immediate post-operative complications, pain as well as the duration of hospital stay.

Author Biographies

Bhumika Narang, ESI Hospital Okhla, New Delhi, India

Senior Resident, Department of General Surgery

Niraj Kumar, ESI Hospital Okhla, New Delhi, India

Surgical Specialists and Laparoscopic Surgeon, Department of General Surgery, 

Rabi Shankar Singh, ESIC PGIMSR,New Delhi, India

Consultant Surgery, Department of General Surgery

Shakti Pratap Singh, Deen Dayal Upadhyay Hospital, New Delhi, India

Senior Resident, Department of General Surgery,

Shankar Prasad Singh, Sir Ganga Ram Hospital, New Delhi, India

Senior Resident, Department of General Surgery

Vandana Srivastava, MCDDispensary, New Delhi, India

Medical Officer, Department of General Surgery


1. Araujo SE, Horcel LA, Seid VE, Bertoncini AB, Klajner S. Long term
results after stapled hemorrhoidopexy alone and complemented by
excisional hemorrhoidectomy: A retrospective cohort study. Arq Bras Cir
Dig 2016;29:159-63.
2. Longo A. Treatment of hemorrhoidal disease by reduction of mucosa
and hemorrhoidal prolapse with a circular suturing device. In: 6th World
Congress of Endoscopic Surgery. Rome, Italy: Bologna, Monduzzi; 1998.
p. 777-84.
3. Inflantino A, Altomare DF, Bottini C, Bonanno M, Mancini S. THD
group of the SICCR Prospective randomized multicentre study comparing
stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid
dearterialization for third-degree haemorrhoids. Colorectal Dis
4. Bikhchandani J, Agarwal PN, Kant R, Malik VK. Randomized controlled
trial to compare the early and mid-term results of stapled versus open
hemorrhoidectomy. Am J Surg 2005;189:56-60.
5. Boccasanta P, Capretti PG, Vebturi M, Cioffi U, DeSimone M, Salamina G.
Randomised controlled trial between stapled circumferential mucosectomy
and conventional circular hemorrhoidectomy in advanced hemorrhoids
with external mucosal prolapse. Am J Surg 2001;182:64-8.
6. Kairaluoma M, Nuorva K, Kellokumpu I. Day-case stapled (circular) vs
diathermy hemorrhoidectomy: A randomized, controlled trial evaluating
surgical and functional outcome. Dis Colon Rectum 2003;46:93-9.
7. Shalaby R, Desoky A. Randomized clinical trial of stapled versus milliganmorgan
haemorrhoidectomy. Br J Surg 2001;88:1049-53.
8. Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G. Stapled
haemorrhoidopexy compared to milligan-morgan and ferguson
haemorrhoidectomy a systematic review. Int J Colorectal Dis
9. Nisar PJ, Acheson AG, Neal KR, Scholefield JH. Stapled hemorrhoidopexy
compared with conventional hemorrhoidectomy: Systematic review of
randomized, controlled trials. Dis Colon Rectum 2004;47:1837-45.
10. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ. Systematic
review and meta-analysis of randomized controlled trials comparing
stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J
Surg 2008;95:147-60.
11. Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse
and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum
12. Giordano P, Gravante G, Sorge R, Ovens L, Nastro P. Long-term outcomes
of stapled hemorrjoidopexy vs conventional hemorrhoidectomy: A metaanalysis
of randomized controlled trials. Arch Surg 2009;144:266-72.
13. Nahas SC, Borba MR, Brochado MC, Marques CF, Nahas CS, Miott-
Neto B. Stapled hemorrhoidectomy for the treatment of hemorrhoids. Arq
Gastroenterol 2003;40:35-9.
14. Ganio E, Altomare D, Gabrielli F, Millito G, Canuti S. Prospective
randomized multicentre trial comparing stapled with open
haemorrhoidectomy. Br J Surg 2001;88:669-74.
15. Gravie JF, Lehur PA, Huten N, Papillon M, Fantoli M, Descottes B, et al.
Stapled hemorrhoidopexy versus milligan-morgan hemorrhoidectomy: A
prospective, randomized, multicenter trial with 2-year postoperative follow
up. Ann Surg 2005;242:29-35.
16. Gutierrez GV, Ortiz EM. Hemorrhoidopexy with a PPH 03 circular stapler
initial experience. Rev Gastroenterol Mex 2006;71:288-95.
17. Jaiswal SS, Gupta D, Daver S. Stapled hemorrhoidopexy-initial experience
from a general surgery center. Med J Armed Forces India 2013;69:119-23.
18. Guraya SY, Khairy GA. Stapled hemorrhoidectomy; results of a prospective
clinical trial in Saudi Arabia. J Clin Diagn Res 2013;7:1949-52.
19. Bhandari RS, Lakhey PJ, Singh YP, Mishra PR, Singh KP. Stapled
haemorrhoidectomy versus open haemorrhoidectomy: A prospective
comparative stidy. J Chitwan Med Coll 2014;4:7-11.
20. Chalkoo M, Ahangar S, Awan N, Dogra V, Mushtaq U, Makhdoomi H. An
early experience of stapled hemorrhoidectomy in a medical college setting.
Surg Sci 2015;6:214-20.
21. Picchio M, Greco E, Di Fillippo A, Marino G, Stipa F, Spaziani E. Clinical
outcome following hemorrhoid surgery: A narrative review. Indian J Surg
22. Voigtsberger A, Popovicova L, Bauer G, Werner K, Weitschat-Benser T,
Pererson S. Stapled hemorrhoidopexy: Functional results, recurrence rate
and prognostic factors in a single center analysis. Int J Colorectal Dis
23. Kishoe PK, Srithi BM, Obulesu G. Comparative study between stapler and
open hemorrhoidectomy in the management of grade III/IV hemorrhoids.
IAIM 2016;3:218-21.
24. Townsend CM Jr. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA:
Saunders; 2012.
25. Ganio E, Altomare DF, Gabrielli F, et al. Schwartz Text Book Surgery. 7th
ed. New York: MacGraw Hill; 2004.
26. Sachin ID, Muruganathan OP. Stapled hemorrhoidopexy versus open
hemorrhoidectomy: A comparative study of short term results. Int Surg J
27. Watson AJ, Cook J, Hudson J, Kilonjo M, Wood J, Bruhn H, et al. A
pragmatic multicenter randomised controlled trial comparing stapled
haemorrhoidopexy with traditional excisional surgery for haemorrhoidal
disease: The eTHoS study. Health Technol Assess 2017;21:1-224.
28. Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled vs excision
hemorrhoidectomy: Long-term results of a prospective randomized trial.
Arch Surg 2002;137:337-40.
29. Pescatori M, Gagliardi G. Postoperative complications after procedure
for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection
(STARR) procedures. Tech Coloproctol 2008;12:7-19.
30. Senagore AJ. A prospective, randomized, controlled multicenter trial
comparing stapled hemorrhoidectomy: A French multicentric study.
Gastroenterol Clin Biol 2005;29:429-33.