Rebekah Kim, MD, Andrea Ferrara, Mark Soliman, Robert Stevens, Samuel Dejesus, Paul Williamson, Joseph Gallagher, Jay Macgregor, Kiyanda Baldwin. Colon and Rectal Clinic of Orlando, Orlando Health
Purpose : Two staplers (Ethicon Proximate Hemorrhoidal Circular Stapler and Covidien EEA Hemorrhoid & Prolapse Stapler Set) are currently available for stapled hemorrhoidectomy in the United States. Our aim was to compare the results of both devices by experienced Colon and Rectal Surgeons.
Methods : Retrospective analysis of the initial forty consecutive patients that underwent Ethicon hemorroidopexy in 2003 were compared to our initial experience using the Covidien device in 2010. In addition, forty patients who underwent hemorrhoidopexy with the Ethicon device in 2010 were studied due to the learning curve when the procedure was first introduced. All operations were performed by 5 board certified Colon and Rectal Surgeons. Complications were characterized into early (<2 weeks), and late (>2 weeks) after the initial surgery. Data regarding readmission, hemorrhoid grade, patient age and sex, as well as ancillary procedures at the time of stapled hemorrhoidopexy were compared.
Results : One hundred and twenty charts were reviewed (74 male [63%], 46 female [37%], mean age 48.7 [21-82]). Eleven (9%) had Grade II, 108 patients (90%) had Grade III, and 1 (0.8%) had Grade IV internal hemorrhoids. Early complications (<2 weeks) and ancillary procedures are listed (Table). Two weeks after surgery, 1 patient (2.5%) in each of the groups complained of anal pain. In the early Ethicon group 1 patient (2.5%) complained of fecal incontinence, and 4 (10%) presented with fissure-in-ano. In the late Ethicon group, 1 patient (2.5%) presented with a fissure-in-ano, and 2 (5%) presented with a thrombosed external hemorrhoid requiring excision. The early Covidien group had 1 patient (2.5%) with complaints of constipation, and 1 (2.5%) with a thrombosed external hemorrhoid requiring excision. The late Ethicon and Early Covidien groups both had ancillary procedures such as excision of anal skin tags in addition to the stapled hemorrhoidopexy at time of surgery.
| Early Ethicon (n=40) | Late Ethicon (n=40) | Early Covidien (n=40) | |
| EARLY (<2 weeks) | |||
| Stapler misfire | 0 | 0 | 0 |
| Bleeding | 1 (2.5%) | 1 (2.5%) | 0 |
| Urinary retention | 3 (7.5%) | 0 | 2 (5%) |
| Excessive pain | 5 (12.5%) | 1 (2.5%) | 3 (7.5%) |
| Thrombosed ext hemorrhoids | 2 (5%) | 0 | 2 (5%) |
| Abscess/fistula | 0 | 1 (2.5%) | 0 |
| Fissure-in-ano | 1 (2.5%) | 0 | 0 |
| TOTAL | 12 (30%) | 3 (15%) | 5 (20%) |
| ANCILLARY PROCEDURES (AP) | 0 | 12 (30%) | 15 (37.5%) |
| Excision of skin tag | – | 8 (20%) | 7 (17.5%) |
| External hemorrhoidectomy | – | 3 (7.5%) | 5 (12.5%) |
| Fissure cauterization | – | 0 | 1 (2.5%) |
| Excision of papilla | – | 1 (2.5%) | 2 (5%) |
| NUMBER OF PATIENTS WITH ANCILLARY PROCEDURES | N/A | 0 | 5 (12.5%) |
Conclusions : In our initial experience with both the Ethicon and Covidien devices, the rates of early and late complications are similar. The rates of complications in the early and late Ethicon groups show a slightly decreased rate of urinary retention and pain requiring readmission among patients, however neither were statistically significant. The increasing excision of skin tags and external hemorrhoids during stapled hemorrhoidopexy may decrease the rate of recurrence.
Session Number: Poster – Poster Presentations
Program Number: P128
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