The Comparison of a C-Shaped Partial Stapled Hemorrhoidopexy (C-PSH) Versus Circular Stapled Hemorrhoidopexy (CSH) in Patients with IV Grade Hemorrhoid: A Retrospective Study

Aims The aims of this study were to present a C-shaped partial stapled hemorrhoidopexy (C-PSH) in the treatment of IV grade hemorrhoid and to assess the clinical outcomes of this technique compared with circular stapled hemorrhoidopexy (CSH). Methods Conventional CSH kit matched with an intestinal spatula was used for performing C-PSH. One hundred and fifty eight patients who suffered IV grade hemorrhoid and underwent C-PSH or CSH at Hangzhou Third hospital between December 2017 and July 2019 were retrospected. Intraoperative and postoperative outcomes in both groups were collected and analyzed. Results Operative time, estimated blood loss and hospital stay were similar in both two groups (p values were 0.238, 0.563 and 0.101 respectively). Pain scores on the first defecation, 1st, 2nd, 3rd and 7th postoperative days in the C-PSH group were respectively lower than those in the CSH group, and the numeric rating scale (NRS) scores were 3.29±1.52 vs. 4.23±1.99 (p=0.001), 3.82±1.49 vs. 4.63±1.17 (p<0.001), 3.12±1.51 vs. 3.71±1.85 (p=0.030), 2.67±1.52 vs. 3.37±1.54 (p=0.005) and 1.34±0.92 vs.1.84±1.14 (p=0.003). Fecal urgency incidences in the C-PSH group were lower than those in the CSH group on the 1st, 2nd, 3rd and 7th postoperative days, and the incidences occurred in the C-PSH group vs. CSH group were 44.7% vs. 61.0% (p=0.041), 30.3% vs. 46.3% (p=0.038), 25.0% vs. 43.9% (p=0.013) and 13.2% vs. 35.4% (p=0.001) respectively. Overall postoperative complications rate occurred in the CSH group was higher than that in the C-PSH group, (16/82 vs. 6/76, p=0.035). Six patients suffered from anal stenosis in the CSH group and no patient suffered from stenosis in the C-PSH group (p=0.047). One year recurrence rate in the C-PSH group and CSH group was 8.0% (6/75) vs. 6.3% (5/79), (p=0.687). Conclusions The C-PSH seems to be an efficacy and safety technique in treating IV grade hemorrhoid. It has advantages in alleviating postoperative pain, fecal urgency and anal stenosis compared with CSH. It could be an alternative technique in the treatment of IV grade hemorrhoid.