Postoperative Pain as a Decision-Making Tool in Treating Hemorrhoids on an In- or Out-Patient Basis After Stapled Mucosectomy (Longo Procedure)

Objective Stapled mucosectomy (Longo operation) is a frequently used procedure for the treatment of hemorrhoidal disease. It is a simple procedure yet similar to resective techniques for patients who frequently suffer from relevant postoperative pain. The aim of our present study is to examine patient satisfaction based on the operative setting (outpatient versus inpatient treatment) in patients undergoing the Longo operation for Grade III or IV hemorrhoids. Materials and methods Outcomes of all patients undergoing stapled mucosectomy for Grade III and IV hemorrhoids at 3 different Swiss public hospitals was analyzed retrospectively and compared with respect to in- or outpatient treatment. Patient satisfaction was recorded by subsequent telephone interviews. Results From a total of 213 patients with stapled mucosectomies, datasets of 144 patients (67.6%) were available for full analysis. A total of 124 patients (86.1%) were satisfied with the treatment and 110 (76%) would choose to undergo the Longo procedure again (P < 0.01). Recurrence of recurrent hemorrhoidal symptoms is negatively correlated with the willingness of undergoing the Longo procedure again (r = −0.187, P = 0.025). Patient satisfaction was not associated with the operative setting (inpatient vs. out-patient setting). Postoperative pain increased the willingness to be hospitalized overnight (r = 0.227, P < 0.01). Conclusion Patient satisfaction after stapled mucosectomy is mainly related to postoperative pain and recurrence of hemorrhoidal symptoms regardless of inpatient or outpatient treatment.

Ambulatory surgery in proctology

Introduction: In our institution we?ve had a lot of exerience in proctology. Ten years ago, we introduced one day surgery in our practice and had really good results in treating practically all patients who needed proctologic surgery. Materials, methods and results: During this period of time 9.636 out of 73.235 outpatient cases were chosen for surgery. Among them, 2664 were patients with operations of perianal haematomas. We had some experiences with minor anal surgery (excisions of skin tags in 537 patients, excisions of papillas in 545 patients); patients with haemorrhoids, operated classically on Milligan- Morgan procedure (1116) or by the new PPH - Longo procedure (270) and HAL technique (12). We also treated patients with fistulas - either with fistulotomy or excision of fistulae - and 1007patients with minor surgery. We made excisions of anorectal polyps in 265 patients, excisions of pilonidal cysts in 421 patients and treated 211 patients with anal abscesses. We had 282 patients with anal warts, 310 patients with anal fisures. In 35 patients we made some other small proctological interventions. In addition to proctology we made tension free operations of groin hernias in 627 patients, corrections of epigastric and umbillical hernias (26 patients) and corrections of stomas in 11 patients. The rest of our peogramm were small aseptic interventions (operations of fibromas, atheromas, verrucas, ganglions, lipomas etc.). Conclusion: We have experienced ambulatory surgery (i.e. day surgery hospital) as an appropriate choice for treating the patients with proctologic pathology. However, it used to be the practice to treat all these patients in hospitals, where they occupied bed facilities that could be intended for other patients. To conclude, our present results have confirmed the decision for ambulatory surgery to be correct in the field of proctology.