Stapled hemorrhoidectomy vs closed diathermy-excision hemorrhoidectomy without suture-ligation: a case-controlled trial.

Objective: We compared stapled hemorrhoidectomy to closed diathermy-excision hemorrhoidectomy without suture-ligation regarding postoperative pain, complications and long-term efficacy.

Methods: A series of 108 patients had indication for stapled hemorrhoidectomy. Patients who underwent stapled hemorrhoidectomy (76) were compared to patients submitted to closed diathermy-excision hemorrhoidectomy (32) due to non-insurance cover. Primary endpoints were postoperative pain, complications, and clinical results after one year. Patients completed a 10-cm visual analog pain scale postoperatively and fulfilled a questionnaire before and 12 months after surgery.

Results: After seven days, median and maximum daily pain scores were lower in the stapled group (P < 0.001). Resumption of activities occurred after 9 days (mean; range 2 to 17 days) after stapling and 14 days (7 to 24) after diathermy surgery - P < 0.001. There was no difference regarding complications during the follow-up. After one year, 45 (80.4%) patients in the stapled group and 18 (78.3%) in the diathermy group were asymptomatic (P = 1.000). After one year, none of the patients needed a second operation and there was no fecal incontinence.

Conclusions: Stapled hemorrhoidectomy selectively indicated is less painful, not associated to greater morbidity and has the same long-term efficacy when compared to closed diathermy excision without suture-ligation.