Day Surgery procedures have been at the forefront of recent changes within the NHS in the fight to reduce waiting times and better patient care. Patients following SH had reduced, post operative pain, hospital stay, analgesic requirements and earlier return to work (21-23). Several studies have suggested that SH may be safely performed as a Day case procedure. Conversely, a recent review from New Zealand (9) suggested that SH was more expensive, and the results should be looked upon with caution. SH had better postoperative pain scores with lower mean epidural morphine requirement and mean hospital stay. A study by Pavlitidsi et al (8) included 80 patients with second to fourth degree hemorrhoidal disease in which patients were randomly allocated to undergo either the stapled Longo procedure (group 1) or Milligan-Morgan hemorrhoidectomy (group 2) under epidural anesthesia. On the one hand recent reports of SH have been positive especially in regards reduced postoperative pain and recovery and adverse functional sequelae.
#Stapled hemorrhoidectomy cpt code skin
Unfortunately, this has been associated with postoperative pain, the risk of severe haemorrhage, and more concerning the risk of anal stenosis (especially if skin bridges are not maintained) and sphincter injury.Ĭontroversy exists as regards to the overall safety and acceptability of SH. Surgery for symptomatic haemorrhoids was popularised by the open Milligan–Morgan technique in the late 1930’s or one of its variations.
Unfortunately there is no single optimum therapeutic option. Historically symptomatic haemorrhoids have been dealt with by simple dietary modification, injection sclerotherapy, cryotherapy, band ligation and surgery (5-7).
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Several studies have shown it to be a safe, effective and relative complication free procedure with fewer days off work, reduced requirement for analgesia and rapid discharge (2-4). Since Longo first described it in 1998 (1), Stapled Haemorrhoidectomy (SH) has been emerging as the procedure of choice for symptomatic haemorrhoids. The majority of patients could avoid an overnight stay which would make this procedure suitable for day surgery. Our present study shows that stapled haemorrhoidectomy is a safe and very well tolerated procedure with low post-operative analgesic requirements, high patient satisfaction and early return to work. The satisfaction data showed that 90% of patients were completely satisfied with the procedure at initial follow-up, which increased to 98% after 6 months-4 years follow-up. Nearly 50% had complete resolution of symptoms and returned to work within a week. 11% (n=7) of patients were discharged the same day and 88% (n=58) had overnight stay. The mean age was 49.8 years (range 16-78 years). Of the 66 patients that underwent a stapled haemorrhoidectomy 43 (65%) were male and 23 (35%) were female.
Follow-up was performed at 4 weeks with a further telephone follow-up up to 4 years after. Parameters recorded included post-operative complications, analgesic requirements, cost effectiveness, duration of hospital stay and patient satisfaction. Several studies have shown it to be a safe, effective and relative complication free procedure (2). The aim of this study was to determine the suitability of SH as a day case procedure at a District General Hospital.įrom June 2001 to May 2005, 66 patients who underwent stapled haemorrhoidectomy were included in this study. Since Longo first described it in 1998, Stapled Haemorrhoidectomy (SH) has been emerging as the procedure of choice for symptomatic haemorrhoids (1).
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