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Saturday, 26 August, 2000, 00:00 GMT 01:00 UK
Concern over new piles surgery
Surgery
Surgery for haemorrhoids can be painful
An increasingly popular state-of-the-art surgical technique for treating haemorrhoids may lead to long-term pain and side effects, say researchers.

Haemorrhoids, or piles, are painful blood vessels which stretch out from the wall of the rectum.


We recommend a more cautious approach to the introduction of stapled haemorrhoidectomy

Research team at St Mark's Hospital, Harrow

The technique, known as stapled haemorrhoidectomy, involves fixing the tissue back into the wall of the anal canal.

However, a study by Professor Robin Phillips and colleagues from St Mark's Hospital, Harrow, has found it can lead to long-term problems.

Severe haemorrhoids have traditionally been treated by surgically removing them, a procedure known as a haemorrhoidectomy.

However, it can result in some pain, and patients take an average of two weeks off work after surgery.

The staple procedure causes less immediate pain, and requires a shorter recovery time.

High rate of problems

The researchers studied 22 patients who underwent stapled haemorrhoidectomy.

Of these, 16 were followed up for longer than six months.

Of the patients who were followed up, five (31%) developed symptoms of pain and problems with going to the toilet.

The problems persisted for up to 15 months after surgery.

One patient had developed a polyp and an ulcer, but no abnormality was found in the other four patients.

However, four of the five affected patients showed evidence that the staples may have embedded too deeply in the wall of the bowel, compared with only one of 11 of the unaffected patients.

The investigators concluded that persistent severe pain and faecal urgency has been found in a high proportion of patients after stapled haemorrhoidectomy.

Writing in The Lancet medical journal, they recommended a "more cautious approach" to the introduction of stapled haemorrhoidectomy."

Professor Phillips told BBC News Online that he had stopped using the technique completely.

He said: "This technique appears to result in long-standing problems in a third of our patients, some of whom have not been able to return to work."

Different findings

Professor John Monson, from the department of colorectal surgery, University of Hull, said the research was "slightly worrying".


Our experience suggests that the technique of the operation is all important

Professor John Monson, University of Hull

He told BBC News Online: "Our own experience of now more than 100 patients is in marked contrast to the St Mark's study.

"We have followed all of our patients and reviewed them with this in mind and have had no similar problems.

"We have seen patients experience significant pain immediately following surgery and believe that this is likely to be due to placing the staple line too low - closer to the more sensitive painful tissues.

"Of course, we have no way of proving this but our experience suggests that the technique of the operation is all important.

"The worldwide experience is not consistent with this new report and therefore I feel it has to be viewed with some care before what has otherwise been shown to be a successful and markedly less painful operation is thrown into disrepute."

However, Professor Phillips said the work of his team had been checked by two independent experts.

The potential drawbacks of the technique were graphically illustrated by the case of a 24-year-old male patient who was treated at Gartnavel General Hospital, Glasgow.

The patient developed a life-threatening infection known as pelvic sepsis following staple haemorrhoidectomy.

He was re-admitted to hospital a few hours after surgery.

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03 Mar 00 | Health
Staple solution to painful piles
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