Day-surgery stapled prolassectomy: a “ten minutes job”

Abstract

INTRODUCTION: Accordingly with the new physiopathologic insights of the 70s and 80s, hemorrhoidal disease appears to originate not much from venous hyperplasia but rather from a progressive deterioration of connective and support tissues with subsequent venous and mucosal prolapse. In the late 90s a new surgical technique for a more physiological treatment of hemorrhoids was introduced: stapled prolassectomy.

MATERIALS AND METHODS: Between October 2017 and June 2018 we performed 50 hemorrhoidal stapled prolassectomies under local-regional anesthesia. All patients were classified as ASA I and were aged between 18 and 65 years.Patients were administered  Atropine 1 mg and Flunitrazepam 0,7 mg orally 30 minutes prior to the intervention. A topical anesthetic preparation of Lidocaine and Procaine was also applied. A local anesthesia of the anal and perineal region was performed by the surgeon in the presence of an anesthesiologist.

RESULTS: Intraoperative pain control was found to be complete and optimal for the majority of patients (92%). Six of the patients (8%) reported mild pain during the stapling phase but did not require further intervention. A conversion to general anesthesia was never required. Forty-four of the patients (88%) were discharged on the same day of the operation. In four cases (9%) discharge was postponed and patients were kept overnight because of early postoperative complications.

DISCUSSION AND CONCLUSION: Over 20 years after its introduction, stapled prolassectomy has become the allows to gold standard for treating hemorrhoids. This procedure allows for an effective and appropriate treatment of the condition. It preserve the physiology of the anal channel and to reconstruct the correct topographic relationship between anal derma, anal-rectal mucosa, hemorrhoidal plexus and sphincter apparatus . The absence of surgical wounds in the perineal region allows for a reduced stimulation of pain receptors, leading to a less painful post-operatory course and to a reduced risk of long term complications such as stenotizing scarring and soiling .The use of a mechanic stapler leads to higher costs, but they are in part balanced by the possibility of a faster recovery of patients and of an earlier resumption of work activities. The possibility to perform the operation in day surgery may allow for a global reduction health care expenses leaving more resources available for more complex cases.