Hemorrhoids treated by stapling likely to return

NEW YORK (Reuters Health) - While a "stapling" operation for severe hemorrhoids may be less painful and easier to recover from than actual surgical removal, which has been considered the "gold standard" treatment, the newer procedure carries a higher long-term risk of hemorrhoid recurrence, a review of recent studies suggests.

Hemorrhoids are a very common problem caused by enlarged veins in the anus. The condition, which typically causes pain, itching, and sometimes bleeding, can usually be treated with topical medications. In severe cases, such as those that bleed and protrude outside of the anus, surgery is required.

Unlike standard hemorrhoid surgery, the circular stapling technique, which was first introduced in 1998, does not attempt to remove the hemorrhoid, but instead cuts blood flow to the affected tissue. By limiting the blood flow, the hemorrhoid shrinks and disappears.

The results of the review highlight a major concern of the stapling procedure, "namely, the long-term outcome," Dr. Joshua Katz said in a statement. Katz is a colorectal surgeon in private practice in Rockville, Maryland, who was not affiliated with the study.

Proponents of the stapling procedure point out that it achieves results similar to those of standard surgery, "but with less pain, less disability and more rapid return to work." However, the price of decreased pain and disability may be an increased risk of recurrence, Katz added.

In the review, reported in The Cochrane Library, Dr. Shiva Jayaraman at the University of Western Ontario in Canada, and colleagues, searched medical databases, such as MEDLINE and EMBASE, to identify all trials that compared the two hemorrhoid procedures.

Data from 12 studies were included in the analysis and the typical follow-up periods ranged from 7 to 14 months, the report indicates.

At all time points studied, patients treated with stapling were nearly four times more likely to experience hemorrhoid recurrence than those treated with removal. Of the 269 patients treated with stapling, 23 experienced a recurrence compared with just 4 of 268 patients treated with the conventional procedure.

While stapling was associated with less pain and itching than surgical removal, the differences may have simply been due to chance.

The authors urge physicians to inform their patients of the pros and cons of each operation.

SOURCE: The Cochrane Library, October 18 online, 2006.