Treating haemorrhoids – warn of risks before offering ‘staples’

While it is less painful and has a quicker recovery rate than conventional surgery, a systematic Review of the research shows that it is associated with a higher risk that the haemorrhoids will return or prolapsed compared to the ‘gold standard’ “Milligan-Morgan” technique of open haemorrhoidectomy.

Haemorrhoids are a common form of anorectal disorder, affecting around half of the population at some point in their lives. When they are severe, the person may be offered surgery. Conventional surgery is effective, but is associated with complications such as urinary retention, haemorrhage and pain. The newer Circular stapled technique reduces the patient’s pain, and initial reports suggested that it was preferred by patients. It was also found to work well in day-case surgery, which makes it economical to perform.

By gathering together all data from randomised trials, Cochrane Review Authors found that haemorrhoids recurred in 23 out of 269 patients who had staples, compared with 4 out of 268 who had conventional surgery. They also found a greater number of prolapses after one year and after five years in the stapled group.

“Patients should be informed of the risks when being offered stapled technique, particularly if they are worried about the chance of recurrence or prolapse,” says lead researcher Dr Shiva Jayaraman who works in the Department of Surgery at the University of Western Ontario, London, Canada.

The Review does confirm, though, that both methods are safe and serious complications are rare with either technique.