Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Hemorrhoid stapling has more long-term risks than surgical removal

19.10.2006
Stapling of hemorrhoids -- a relatively new and increasingly popular procedure -- is associated with a higher risk of recurrence and prolapse than conventional hemorrhoid removal surgery, investigators report in a comprehensive review of clinical studies.

In contrast to removal (excisional) surgery, circular stapling (hemorrhoidopexy) does not remove hemorrhoids but treats them by inhibiting blood flow to the tissue.

"This study shows that stapled hemorrhoidopexy is associated with a greater risk of hemorrhoid recurrence and the symptom of prolapse in long-term follow-up compared to conventional excisional surgery," said lead investigator Shiva Jayaraman Colquhoun, M.D.

"If surgeons are to offer this novel technique to their patients, there should be an informed discussion of the risks," said Colquhoun, a resident in general surgery at the Schulich School of Medicine and Dentistry, University of Western Ontario, in Canada.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

Hemorrhoid disease is known to affect more than 15 million people annually in the United States, a number believed to be low since an estimated one-third of patients with symptoms of hemorrhoids do not seek a physician's care for the condition.

Stapling was introduced in the late 1990s, and in some small studies was shown to be less painful and faster to heal than conventional surgery. A few short-term studies -- with less than a year of follow-up -- suggested that stapling is equal to excision for controlling further hemorrhoid symptoms. These results helped lead to growing demand for the stapling procedure.

For this new review, the investigators analyzed seven randomized clinical trials involving 537 participants and found that patients who had undergone circular stapling were significantly more likely to have recurrent hemorrhoids in the long term than those whose hemorrhoids were surgically removed.

Out of 269 stapling patients, 23 suffered recurrences, compared with four recurrences among 268 patients in the surgical-removal group.

The investigators also found that a significantly higher proportion of stapling subjects complained of prolapse (protrusion outside the anus) both within 12 months and longer.

In favor of stapling, results were better in terms of less pain, itching or bowel-movement urgency; however, these were data "trends" that did not reach the level of significance All other clinical outcomes favored excisional surgery.

The authors suggested that rather than simply offering stapling to all patients with hemorrhoids, there may be a subset of patients for whom it is more beneficial, and that identifying this subset will require further research. "If hemorrhoid recurrence and prolapse are the most important clinical outcomes," they said, "then conventional excisional surgery remains the 'gold standard' in the surgical treatment of internal hemorrhoids."

"This paper directly confronts the major concern with stapled hemorrhoidectomy, namely the long-term outcome," said Joshua Katz, M.D., in private practice with Montgomery Colorectal Surgery in Rockville, Md. "Proponents of this procedure argue it provides similar results to the open procedure with less pain, less disability and more rapid return to work. This paper states that the decreased pain and disability may entail increased risk of recurrence. As the authors note, patients must be advised of this increased risk."

"In all fairness," Katz added, "the increased risk, although statistically significant, is still clinically acceptable, 23 of 269 [stapled] patients versus four of 268 patients with conventional hemorrhoidectomy. Physicians and patients will therefore choose between a procedure carrying increased morbidity and disability with a low recurrence rate, and a procedure with decreased morbidity and disability and a higher recurrence rate."

Lisa Esposito | EurekAlert!
Further information:
http://www.cfah.org
http://www.hbns.org

More articles from Health and Medicine:

nachricht Collagen nanofibrils in mammalian tissues get stronger with exercise
14.12.2018 | University of Illinois College of Engineering

nachricht New discoveries predict ability to forecast dementia from single molecule
12.12.2018 | UT Southwestern Medical Center

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Data storage using individual molecules

Researchers from the University of Basel have reported a new method that allows the physical state of just a few atoms or molecules within a network to be controlled. It is based on the spontaneous self-organization of molecules into extensive networks with pores about one nanometer in size. In the journal ‘small’, the physicists reported on their investigations, which could be of particular importance for the development of new storage devices.

Around the world, researchers are attempting to shrink data storage devices to achieve as large a storage capacity in as small a space as possible. In almost...

Im Focus: Data use draining your battery? Tiny device to speed up memory while also saving power

The more objects we make "smart," from watches to entire buildings, the greater the need for these devices to store and retrieve massive amounts of data quickly without consuming too much power.

Millions of new memory cells could be part of a computer chip and provide that speed and energy savings, thanks to the discovery of a previously unobserved...

Im Focus: An energy-efficient way to stay warm: Sew high-tech heating patches to your clothes

Personal patches could reduce energy waste in buildings, Rutgers-led study says

What if, instead of turning up the thermostat, you could warm up with high-tech, flexible patches sewn into your clothes - while significantly reducing your...

Im Focus: Lethal combination: Drug cocktail turns off the juice to cancer cells

A widely used diabetes medication combined with an antihypertensive drug specifically inhibits tumor growth – this was discovered by researchers from the University of Basel’s Biozentrum two years ago. In a follow-up study, recently published in “Cell Reports”, the scientists report that this drug cocktail induces cancer cell death by switching off their energy supply.

The widely used anti-diabetes drug metformin not only reduces blood sugar but also has an anti-cancer effect. However, the metformin dose commonly used in the...

Im Focus: New Foldable Drone Flies through Narrow Holes in Rescue Missions

A research team from the University of Zurich has developed a new drone that can retract its propeller arms in flight and make itself small to fit through narrow gaps and holes. This is particularly useful when searching for victims of natural disasters.

Inspecting a damaged building after an earthquake or during a fire is exactly the kind of job that human rescuers would like drones to do for them. A flying...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

ICTM Conference 2019: Digitization emerges as an engineering trend for turbomachinery construction

12.12.2018 | Event News

New Plastics Economy Investor Forum - Meeting Point for Innovations

10.12.2018 | Event News

EGU 2019 meeting: Media registration now open

06.12.2018 | Event News

 
Latest News

When a fish becomes fluid

17.12.2018 | Studies and Analyses

Progress in Super-Resolution Microscopy

17.12.2018 | Life Sciences

How electric heating could save CO2 emissions

17.12.2018 | Power and Electrical Engineering

VideoLinks
Science & Research
Overview of more VideoLinks >>>